The Quest for Quality in the NHS

A Chartbook on Quality of Care in the UK

Sheila Leatherman, Kim Sutherland

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315344959
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

PUBLISHED IN ASSOCIATION WITH THE NUFFIELD TRUST Quality is an issue of central importance in the NHS and yet, despite a considerable number of initiatives, programmes and organisation that have focussed on improving quality in the NHS over recent years, there's no comprehensive, reliable balance and rigorous account of the strengths and weaknesses in healthcare delivery. This book provides an authoritative and accessible account of the state of quality in the NHS. Unless information on quality is properly gathered, organised, analysed and used, the health service will continue to lack a foundation on which sustained and systemic improvement can be based. The Quest for Quality in the NHS: a chartbook on quality of care in the UK is a comprehensive, rigorous and robust account of healthcare quality and will inform the public, managers, researchers and policymakers about gaps between what is possible, and what is delivered by the healthcare system.

1 Effectiveness

Effectiveness refers to the extent to which an intervention produces its intended result. Effectiveness in the context of the quality of healthcare also encompasses the concept of appropriateness, the extent to which interventions or services, based on scientific knowledge, are provided to all those who could benefit and withheld from those who would not (Hurtado et al., 2001). Effectiveness indicators can focus on outcomes such as mortality or survival rates that reflect the success of preventive measures, diagnosis and treatment; or on processes that have been proven to affect those outcomes and can be used as more immediate measures of quality, for example the use of thrombolysis in the treatment of heart attacks.

We have organised the effectiveness charts into six sections, primarily on the basis of five disease groups and one type of service. They are:

1cancer

2circulatory disease

3diabetes

4infectious disease

5mental health

6surgery.

Preceding those sections is a chart that focuses on avoidable mortality which reflects quality across the entire healthcare sector.

Chart 1.1 Mortality from causes considered amenable to healthcare

Measures of avoidable mortality are used to gauge the extent to which healthcare services save lives and contribute to population health. Avoidable mortality is the number of deaths that should not occur in the presence of effective and timely healthcare (Nolte and McKee, 2004). It tallies deaths from conditions that are amenable to treatment and medical care (i.e. with appropriate treatment there should be no deaths, e.g. appendicitis) and those that are preventable (i.e. there are effective means to prevent the condition occurring, often through behavioural and lifestyle changes, e.g. smoking-related lung cancer). Chart 1.1a shows international comparisons on amenable death rates for those aged 0–74 (both including and excluding figures for ischaemic heart disease (IHD)). The UK had the highest rates of the five countries shown. Chart 1.1b shows a time series of mortality rates in England and in Wales (data include IHD). Wales has had a consistently higher mortality rate, but both countries have seen a steady decline in rates, reflecting improvements in healthcare over time.

1.1aMortality from causes considered amenable to healthcare (ages 0–74), international comparison 1998

Source: Nolte and McKee, 2004; Korda and Butler, 2004.

1.1bMortality from causes considered amenable to healthcare (ages 0–74), England and Wales 1993–2003

Source: ONS; NCHOD (analysis by Lakhani, Eayres and Coles).

Cancer overview

Cancer arises from abnormal and uncontrolled cell division. The proliferating cells subsequently invade and destroy the surrounding tissues. Spread of cancer (metastasis) may occur via the bloodstream or the lymphatic system or across body cavities such as the pleural and peritoneal spaces, resulting in secondary tumours.

In 1999–2001, the average annual number of new cancer cases registered in the UK was 269 631 (133 697 for males; 135 934 for females). Incidence rates varied within the countries of the UK with the highest incidence for males occurring in Wales and for females occurring in Scotland (see Table 1.1).

One in three people develop cancer at some time in their lives (Summerfield and Babb, 2004). Cancer is responsible for around one-quarter of all deaths in the United Kingdom. In England and Wales, there were 136 777 cancer deaths in 2002 (ONS, 2004a: pp128–9); and in Scotland 15 063 cancer deaths in 2003 (ISD Scotland, 2004).

Cancer is predominantly a disease of the elderly. Only 0.5% of cases registered in 2001 were in children (aged under 15) and 25% were in people aged under 60 (ONS, 2004c).

The charts in this section display data on mortality, survival and screening rates for the most common types of cancer.

Table 1.1 Incidence per 100 000 population (age-standardised, average rates 1999–2001)

	Males	Females
UK	403.4	343.0
England	398.6	339.1
Wales	437.8	357.6
Scotland	431.2	370.1
Northern Ireland	392.1	345.0

Source: ONS, 2004b.

Chart 1.2 Cancer mortality rates

Comparisons of mortality rates can give some indication of quality of healthcare, but should be interpreted carefully because many other factors, such as lifestyle, genetics and behaviour, also contribute to mortality rates. Comparative data can however give insight into the extent to which deaths may be amenable to healthcare or preventable. The chart shows that since 1990 mortality rates from cancer have fallen more sharply in the UK than in many other countries, a 12% drop compared to 9% in Australia, 7% in the US and Germany, and 5% in Sweden and France. However, the most recently available OECD data shows that the UK mortality rate was still high relative to comparator countries. In 1999 184.7 deaths per 100 000 were attributed to cancer in the UK, compared to 151.3 deaths per 100 000 in Sweden.

1.2Mortality rates from cancer, international comparison 1990–2001

Source: OECD, 2004.

Chart 1.3 Mortality rates from common cancers, UK time series

The four most common cancers – colorectal, lung, breast and prostate – account for more than half of all cancers registered each year (ONS, 2004c). These charts show that mortality rates for these cancers have declined since 1990. Particularly noteworthy is the data on lung cancer; with a marked decrease in the death rate among males (from 87.9 deaths per 100 000 in 1990 to 58.3 deaths per 100 000 in 2002) and little change among females (from 30.6 deaths per 100 000 in 1990 to 29.9 deaths per 100 000 in 2002). The decrease in lung cancer mortality overall echoes a similar decrease in smoking rates, attesting to the major influence that lifestyle changes have on mortality (Summerfield and Babb, 2004).

1.3aMortality rates from selected cancers, UK males 1990–2002

Source: ONS.

1.3aMortality rates from selected cancers, UK females 1990–2002

Source: ONS.

Chart 1.4 Premature deaths from cancer: progress against a target

The Government set a target in 1999 to reduce by 20% the death rate from cancer in people under age 75 by 2010, using 1995–97 data as a baseline (DH, 1999a). As of 2002, a 10% reduction in the rate of deaths had been achieved. A decline in...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• The Nuffield Trust
• Foreword
• Acknowledgements
• Authors’ biographies
• Summary of charts
• Introduction
• Guide to the charts
• 1 Effectiveness
• 2 Access
• 3 Capacity
• 4 Safety
• 5 Patient-centredness
• 6 Disparities
• Technical appendix
• Search strategy
• Statistical glossary
• Acronyms
• Index