The NHS in England faces well-known challenges in meeting rising demand for health care within available resources. Previous work by The King’s Fund has brought together evidence on the opportunities for improving productivity and has emphasised that many of these opportunities are to be found in changes to clinical practice (Alderwick et al 2015). Recent work by the Organisation for Economic Co‑operation and Development (2017) has confirmed our analysis and has documented the extent of wasteful spending on health in many countries.
The evidence that we and others have brought together is not new, but it assumes greater salience at a time when health care budgets across the world are under increasing pressure. The challenge in England and elsewhere is knowing how to act on this evidence to reduce wasteful spending and deliver better value for patients and taxpayers. A particularly promising area of focus is unwarranted variations in clinical practice, building on the seminal work of Jack Wennberg (2010) and researchers who have followed in his wake.
With this in mind, The King’s Fund asked Nick Timmins to study and report on work being led by Professor Tim Briggs to document and tackle variations in clinical practice in England. We became aware of this work in 2015 as part of our programme of research and analysis into funding and productivity in the NHS. Our intelligence indicated that Briggs’s analysis of variations in orthopaedic surgery was beginning to gather momentum and was being extended to other specialties such as vascular surgery. It was also attracting interest and support at senior levels in government.
In commissioning this work, we wanted to understand how data on clinical variations was being used within the NHS and how this data was being acted on, or not. Anecdotal evidence suggested that managers and clinicians were paying more attention to the work of Briggs and his team than to previous efforts of this kind, and we were curious to know if this was the case and, if so, why. We also wanted to bring this work to the notice of a wider audience at a time when knowledge of what was being done was limited mainly to NHS insiders.
In the time-honoured phrase, the paper that follows should be read as ‘the first draft of history’ rather than as a definitive analysis. We hope that it provides insights into a programme that has the potential to make a major difference to patients as well as to the use of resources within an increasingly cash-strapped NHS. Much more work is needed to evaluate the longer-term impact of the programme, but for now this review shows why a focus on unwarranted variations really matters and is beginning to show results.