The 14 years since the Audit Commission began auditing the NHS have seen much improvement. In some areas, such as the increased use of day surgery, progress has been rapid. However, auditors have found one thing to be constant throughout this period - the unexplained variation between hospitals in the efficiency and effectiveness with which they deliver services. This remains equally true of the core services covered by this briefing. The conclusion cannot be avoided that some trusts could improve the services they deliver significantly within their existing resources.
In its recent report on progress in the implementation of the NHS Plan, the Audit Commission described the effect of this variation in performance on meeting national targets. The reviews covered by this briefing extend this by:
- focusing on broader patient experiences and on the roles of NHS staff and use of public money, which are as important as the targets
- identifying many specific ways in which trusts could improve
Some of the variation in performance is due to different levels of investment and resources. However, simply adding more resources will not always achieve the desired improvement in services. The answers also lie in the processes through which care is delivered; in the way people organise their work and the quality of the overall management capacity in the trust. Often this requires a shift in attitudes or behaviour - not just from managers, but from everyone (and especially doctors) whose decisions affect the efficiency and effectiveness of patient services.
This is often complex and difficult, and different approaches are needed at different trusts, but some trusts have shown that they can achieve high levels of performance in the key areas raised in the reviews.