Frontiers of Performance in the NHS

As the government announces the next steps in the reform and modernisation of the NHS, this report highlights in some detail the key factors that determine overall patient perceptions. This research is particularly relevant and timely - one of the challenges facing the new Healthcare Commission is how much weight to give to patient perceptions, as opposed to financial or clinical measures of success, in whatever system replaces CHI's star ratings.

In this report we show that there are some very clear key drivers of patient perceptions that individual managers and clinicians can affect. There are others, however, that neither they nor the Department of Health can influence very much at all.

Our analysis provides an alternative picture of relative performance that suggests that some apparently under-performing trusts may actually be doing very well given local conditions, whilst some top-rated trusts are benefiting from operating under relatively `easy' circumstances.

While there is always room for improvement, and individual trusts should not be complacent in striving to meet patient expectations, the results presented here do highlight the need for any new system of assessing overall performance to properly reflect local conditions, rather than assuming a level playing field. We show that, by looking beneath headline figures and being sensitive to local factors, it is possible to put patient perceptions in context and recognise that excellence looks different in different parts of the country.