London School of Hygiene & Tropical Medicine

Survival among patients in intensive care units in England has improved significantly since the implementation of the NHS Plan in 2000, says a new study published in the BMJ. The chances of leaving hospital alive following intensive care did not change in the years leading up to 2000 but during the following six years mortality declined by 2.4% a year so that by 2006 it was 13.4% lower. If such improvements are ignored, assessment of changes in the productivity of the NHS will be misleading.

Changes under the NHS Plan included increased funding for additional beds, the introduction of critical care outreach services throughout the hospital, the adoption of clinical guidelines and the establishment of regional networks of hospitals to enhance cooperation. While it is unclear how much each innovation contributed to the dramatic improvements in outcomes, the researchers from the London School of Hygiene & Tropical Medicine and the Intensive Care National Audit & Research Centre have demonstrated that these changes were a highly cost-effective use of NHS resources.

Andrew Hutchings, lead researcher from the London School of Hygiene & Tropical Medicine, said: “In addition to the fall in mortality, we observed other improvements such as 11% fewer patients each year needing to be transferred between intensive care units and a significant reduction in the number of patients having to be discharged from units at night to make way for other patients.”

“It appears that the government’s provision of additional resources since 2000, in combination with the modernisation of NHS services led by clinicians and managers, has greatly improved the survival chances of patients” Nick Black, Professor of Health Services Research and one of the study’s researchers said.

“This study also demonstrates the need for taking improvements in patients’ outcomes into account when judging the impact of additional NHS funds. If assessment of efficiency or productivity relies entirely on the number of patients treated and fails to take into account improvements in outcome, then the true gains in productivity will be seriously underestimated.”