Financial performance of English NHS Trusts and variation in clinical outcomes: a longitudinal observational study
File(s)
Published version
Author(s)
Nagendran, Myura
Kiew, Grace
Raine, Rosalind
Atun, Rifat
Maruthappu, Mahiben
Type
Journal Article
Abstract
Objectives
To examine the association between financial performance as measured by operating margin
(surplus/deficit as a proportion of turnover) and clinical outcomes in English NHS trusts.
Setting
Longitudinal, observational study in 149 acute NHS trusts in England between the financial years 2011 and
2016.
Participants
Our analysis focused on outcomes at individual NHS Trust-level (composed of one or more acute hospitals).
Primary and secondary outcomes
Outcome measures included readmissions, inpatient satisfaction score and the following process measures:
emergency department (A&E) waiting time targets, cancer referral and treatment targets, and delayed
transfers of care.
Results
There was a progressive increase in the proportion of trusts in financial deficit: 22% in 2011, 27% in 2012,
28% in 2013, 51% in 2014, 68% in 2015 and 91% in 2016. In linear regression analyses, there was no
significant association between operating margin and clinical outcomes (readmission rate or inpatient
satisfaction score). There was, however, a significant association between operating margin and process
measures (delayed transfers of care, A&E breaches and cancer waiting time targets). Between the best and
worst financially performing Trusts, there was an approximately 2-fold increase in A&E breaches and
delayed transfers of care overall although this variation decreased over the six years. Between the best and
worst performing trusts on cancer targets, the magnitude of difference was smaller (1
·
16 and 1
·
15-fold),
although the variation slowly rose during the six years.
Conclusions
Operating margins in English NHS trusts progressively worsened during 2011-16, and this change was
associated with poorer performance on several process measures but not with hospital readmissions or
inpatient satisfaction. Significant variation exists between the best and worst financially performing Trusts.
Further research is needed to examine the causal nature of relationships between financial performance,
process measures and outcomes.
To examine the association between financial performance as measured by operating margin
(surplus/deficit as a proportion of turnover) and clinical outcomes in English NHS trusts.
Setting
Longitudinal, observational study in 149 acute NHS trusts in England between the financial years 2011 and
2016.
Participants
Our analysis focused on outcomes at individual NHS Trust-level (composed of one or more acute hospitals).
Primary and secondary outcomes
Outcome measures included readmissions, inpatient satisfaction score and the following process measures:
emergency department (A&E) waiting time targets, cancer referral and treatment targets, and delayed
transfers of care.
Results
There was a progressive increase in the proportion of trusts in financial deficit: 22% in 2011, 27% in 2012,
28% in 2013, 51% in 2014, 68% in 2015 and 91% in 2016. In linear regression analyses, there was no
significant association between operating margin and clinical outcomes (readmission rate or inpatient
satisfaction score). There was, however, a significant association between operating margin and process
measures (delayed transfers of care, A&E breaches and cancer waiting time targets). Between the best and
worst financially performing Trusts, there was an approximately 2-fold increase in A&E breaches and
delayed transfers of care overall although this variation decreased over the six years. Between the best and
worst performing trusts on cancer targets, the magnitude of difference was smaller (1
·
16 and 1
·
15-fold),
although the variation slowly rose during the six years.
Conclusions
Operating margins in English NHS trusts progressively worsened during 2011-16, and this change was
associated with poorer performance on several process measures but not with hospital readmissions or
inpatient satisfaction. Significant variation exists between the best and worst financially performing Trusts.
Further research is needed to examine the causal nature of relationships between financial performance,
process measures and outcomes.
Date Issued
2019-01-28
Date Acceptance
2018-10-25
Citation
BMJ Open, 2019, 9
ISSN
2044-6055
Publisher
BMJ Journals
Journal / Book Title
BMJ Open
Volume
9
Copyright Statement
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Subjects
finance
hospital
outcomes
process measures
Publication Status
Published
Article Number
e021854
Date Publish Online
2019-01-28