The quality of health and social care services in England continues to be subject to intense scrutiny and debate.

In this second annual statement from the QualityWatch programme, we draw on analysis of over 200 quality indicators and a series of in-depth research reports to provide an overview of how patterns of quality in services are changing across a range of care settings.

Stress signals we first identified in 2013 are now becoming even stronger and apparent in a wider range of services.

Despite the recent wave of negative headlines and concerns over significant lapses in quality, if we look over a longer timescale, in many ways the NHS has shown signs of continued improvements in areas such as waiting times, safety and staff numbers.

However, the past year has seen an increasing number of signs that historic improvements in quality are not being sustained in some areas, or have even reversed. Stress signals we first identified in 2013 are now becoming even stronger and apparent in a wider range of services.

This year’s QualityWatch annual statement shows that:

  • Prompt access to services has declined in some settings over the last two years.
  • In mental health services, demand seems to be outstripping capacity for urgent care and for younger people.
  • The wellbeing of frontline staff in both health and social care is critical to good-quality care, but there are indicators that suggest increasing problems in this area.
  • Substantial inequalities in the provision and outcomes of care persist, and in many cases the information needed to analyse equity of care for marginalised groups is not available.
  • While some areas continue to improve, for example child health and cancer outcomes, the NHS still lags behind the best in the world.

Our findings raise key questions in the continuing debate about healthcare quality: 

  • At what point do the lapses in performance and quality become intolerable to patients, politicians or those running health and care services?
  • Which services, service users or patients should be targeted for support?
  • How do we measure success in the quality of care and how do we address the most significant gaps in information in the relevant areas?

As financial pressures continue to mount and the system is works hard to accommodate rising demand, scrutiny of the quality of care delivered to patients and service users is now more vital than ever before.