It must be incontestable that patients want the highest possible quality of health care, given the necessarily limited budgets allowed by governments and social or private insurers. Quality, reputation, and other similar concepts often top the public's lists of desirable features of health services—often in preference to specific criteria such as shorter waiting times and greater choice.1 2 But what quality of care is being provided by health services? And is the considerable extra funding that is flowing into the United Kingdom's NHS improving quality?

According to Sheila Leatherman and Kim Sutherland,3 and to answer a question posed by Richard Smith in the BMJ two years ago when reviewing Leatherman and Sutherland's earlier look at this issue,4 5 the NHS is improving, but patchily. Waiting times in England are now at a historic low, mortality is decreasing, and ratings of patient satisfaction are high. However, the prevalence of methicillin resistant Staphylococcus aureus (MRSA) is up, and waiting times in Northern Ireland and Wales remain very long. No real surprises here.

In their report …