The massive increase in government expenditure on the NHS has not resulted in anything like the level of improvements in the service which might have been expected, according to a study from independent social-policy think-tank Civitas.

Total public spending on the NHS in England has increased from £44.9bn in the first year of the NHS Plan (2000-01) to £76.4bn five years later (2005-06). This represents an increase of just over two thirds in cash terms (70%). In spite of this, according to James Gubb, author of The NHS and the NHS Plan: Is The Extra Money Working?, 'service improvement has in too many areas resembled a country stroll, whereas expenditure has increased at a sprint'.

The government sought to improve the NHS by setting specific targets by which performance would be measured. The Civitas report shows that nearly all of the high-profile targets-staffing, facilities, waiting times, cancer care and coronary heart disease - have been met. As a result the NHS has registered some significant improvements, particularly with regard to waiting times.

However, this has sometimes been at the expense of 'gaming' - behaving in a way that meets the targets but goes against the spirit of the reforms. For example, one study found that, in some NHS Trusts, patients were kept waiting inside ambulances outside A&E until staff were confident they could be treated within the four-hour government target once admitted (p.25).

The real problems occur when we look beyond the targets, where we find little or no evidence of improvement in NHS performance, which ranks amongst the worst in the developed world. There are still serious shortcomings in a number of areas, particularly in mental health and stroke care. The UK is the only country of the more advanced nations in the OECD to register virtually no improvement in mortality rates for stroke care between 1999-2003. Fatalities from strokes are near or above 100% higher in the UK than Australia, Canada, Japan, Sweden, Switzerland and the US.

One of the most astonishing findings of the Civitas report is that, in spite of the extra billions, productivity in the NHS has not risen, and may have fallen, suggesting that the problem lies not so much with the amount of money spent, but how it is spent. According to calculations made by the Office of National Statistics, productivity lies somewhere between an average increase of 0.2% per annum or an average decrease of 0.5% between 1999 and 2004, although there is some evidence of improvement in latter years (p.33).

Even more striking is the fact that OECD data reveals how day surgery actually decreased in the UK from 73.9 cases per 1,000 in 2000 to 72.7 in 2005:

'The Healthcare Commission showed an average of 14% of planned day surgery operating sessions were cancelled and that 24% of operating time was lost to delays or excessive gaps between operations. The former figure was actually as high as a third for one in ten units. Restricting comparison to day surgery units that remained substantially unchanged since 2000, weighted activity per member of staff fell by 24% as of 2005 (primarily due to staff increases without much corresponding increase in day surgery output)… Given these trends it concludes that productivity improvements could result in increases in the total number of patients treated on a day surgery basis of between 44 and 49 %' (p.36).

Latest figures from the OECD's Health Data (2006) expose the hollowness of the government's claims that massive increases in healthcare expenditure through the NHS would raise healthcare in Britain to a standard comparable to that of countries at a similar level of economic development. The OECD finds the NHS as a system remains inferior to other providers and, in many cases, is falling further behind. James Gubb describes these international comparisons as the 'nail in the coffin' of the government's NHS reforms.

• Even accounting for recent increases, in 2005 the UK ranked 24th out of 27 countries in terms of the number of practicing physicians per 1,000 of the population. Perhaps as a result the number of surgical procedures in the UK has fallen since 2000 contrary to almost every other OECD country except Germany.
• On the number of age-adjusted CT scanners per million of the population, the UK actually ranked the lowest in the OECD except Mexico (p.39).
• On the important measure of potential years of life lost (PYLL) for under-70s, only four out of 26 countries have performed worse than the UK; UK performance has been so bad that it has fallen two places from 17th to 19th on absolute PYLL between 1999 and 2003 (p.47).
• The UK fared slightly better on mortality rates, but eleven countries still outperformed it in terms of improvements in mortality rates, and the UK's comparative position remains unchanged at a lowly 20th out of 26 countries (p.48).

According to James Gubb:

'In the vast majority of areas improvements in the NHS have in no way increased in proportion to the vast sums of money ploughed into its coffers. Is the extra money working? To a limited extent one has to say yes, for there have been achievements; most notably the NHS's historic inability to deal with long waits for elective care is apparently being reversed. But is it working anything like one would hope? Definitely not.'

To read the full report go to: NHS Briefing August 2006

For more information ring:

James Gubb 07763 901281

Robert Whelan 020 7799 6677