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Can we save money by improving quality?
  1. Martin Marshall1,
  2. John Øvretveit2
  1. 1The Health Foundation, London, UK
  2. 2Medical Management Centre, The Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Professor Martin Marshall, The Health Foundation, 90 Long Acre, London WC2E 9RA, UK; martin.marshall{at}

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After years of unprecedented growth, the National Health Service (NHS) in the UK faces a major financial challenge. The cuts which providers will have to make to achieve savings will be dramatic.1 The UK is not alone: most health systems are challenged to ‘do more with less’ to meet the immediate funding crisis, but also the longer-term financial pressures resulting from changing demographics, new technologies and increased demand.2 This will require both immediate and sustained efforts.

The challenge for the NHS is to act in such a way that does not damage the significant gains in quality that have been achieved in the last decade3 and, ideally, is able to build on them. This will require the Department of Health and the NHS to respond to this financial crisis in ways that are different from those of the past. Too often, indiscriminate cuts were made without considering the longer-term costs, and often in ways which save little but irritate staff greatly.4 Those who work in and comment on the health service are aware of the risks to patient care of such ‘slash and burn’ policies, and of the need for a more considered approach to the current financial crisis. A number of recent reports by leading institutions have proposed an alternative approach by suggesting that improving quality and safety can help to address both the short- and long-term financial challenges.8

This paper uses research evidence to assess the contribution that quality-improvement can make as a central component of cost reduction. It draws on this evidence to suggest realistic strategies and changes that might help to improve both the quality and the efficiency of healthcare provision.

Proposed financial benefits of quality and safety improvement

Savings of £15–20 billion are said to be required of the NHS in England over the next 4 years.1 It …

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  • JO conceived and designed the work on which this paper is based. Both authors contributed to the development of the ideas in this paper and to its writing. MM is the guarantor.

  • Funding The Health Foundation.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.