As the NHS enters a period of little or no real growth in funding but incessant demand and cost pressures,1 the idea that improving the quality of services, treatment, and care could actually save money is an attractive proposition. But although there is plenty of evidence that poor quality health care and adverse events are costly both for the NHS in financial terms and for patients in terms of health consequences, there is, as a new report reveals, a dearth of evidence of the reverse relation: that improving quality leads to lower costs.2

In a wide ranging literature review for the Health Foundation, John Øvretveit unearths just eight reasonably robust and well researched examples—mainly from the US—where service or clinical change has led to identifiable savings. These include annual …