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NHS far from ‘fighting fit’

Chief Executive’s report makes a colourful picture of a gloomy outlook

A reality check

Accompanying the Chief Executive’s Annual Report to the NHS, released today, the Department of Health claims that the NHS is ‘fighting fit in its 60th year.

The reality is very different. Set against the main achievements the report highlights:

* The promise of cutting waiting times from referral to treatment to an absolute maximum of 18 weeks and ensuring a 13 week maximum wait for an outpatient appointment

– By the end of March, 85 per cent of patients needing hospital admission should have been treated within 18 weeks of referral. Yet figures from the end of February – as predicted in a report by Civitas at the beginning of the year – show this is very unlikely to be met. Only 75 per cent of patients had been admitted within the targeted time; 10 percentage points shy of the target with only a month to go.

-In fact, in February, three per cent – or near 9,000 – had been waiting more than a year and 62,000 had been waiting more than six months.

-For inpatients, median waits have actually increased from 45 days in 1999/2000 to 49 days last year.

* Improving safety and quality – delivering a very challenging target on Healthcare Acquired Infections – to halve the rates of MRSA

-Improvement in rates of MRSA have stalled recently, with the number of cases rising by 0.6 per cent between October and December 2007 to 1,087. Improvement above the trend rate will be required to meet the government’s target.

-Rates of MRSA are also still extremely high by international standards, lower only than Ireland, Malta and Portugal.

-There were also 13,660 cases of C-difficile infection in under-65s in the first quarter of 2007/08.

*As well as continuing to deliver shorter waits for cancer patients.

-Waits have fallen but standards of care remain mediocre by international standards.

-Despite per capita spend in the NHS being among the highest in Europe, progress in terms of outcomes is slowing. Improvement in avoidable mortality – deaths that could have been averted by good healthcare -fell from 3.6 per cent in 2000/01 to 1.7 per cent in 2004/05.

* The introduction of free choice to every NHS patient so that they can choose their routine elective care from any one of over 350 providers including NHS and the independent sector.

– This is a positive development and offers real potential for patient empowerment and driving standards up across the NHS, but the number of patients recalling being offered a choice of hospital by their GP is lower at 44 per cent in November (the latest count), than in March (48 per cent) 2007.

-Only 4 per cent are using NHS Choices, which has inadequate data and ‘navigatability’.

* Increased the number of Foundation Trusts to 96

– The government’s original target was for all acute and mental health trusts to be in a position to apply for Foundation Trust status by 2008; yet just 19 more are currently in negotiations with Monitor for this status. That leaves over half as NHS trusts, despite the increasingly obvious benefits Foundation Trusts offer.

-In a seminar to Civitas at the end of last year, Sir Robert Naylor, CEO of UCLH, recounted how Foundation Trusts are pulling away from NHS trusts quite dramatically on use of resources and quality of care.

* Started the second wave of Independent Sector Treatment Centres.

– Of the original 27 contracts under the second wave, eleven have been cancelled, with just twelve currently going ahead. This is despite the independent ‘gateway’ process describing the proposed schemes as ‘very good value for money’ and the increasingly strong evidence that they are providing significantly higher standards of care than the average NHS organisation.

Inequity, inefficiency and unhealthy outcomes

Far from being fighting fit, the NHS does not look in a good position to take on the challenges of the 21st century. It suffers from:

  • Rising inequity. Premature death rates from coronary artery disease vary from 2.1 deaths per 1,000 population in Kensington & Chelsea, compared with 8.5 in Hartlepool.

    Despite having greater clinical need, patients in deprived areas are much less likely to receive bypass grafts to help buck this trend.

  • Rising inefficiency. The King’s Fund reported if the NHS had shown efficiency along the lines of the Wanless Report, it could have treated an extra one million patients in 2005/06 alone.

    The Audit Commission concluded that 31 per cent of NHS bodies failed to meet even minimum requirements on use of resources.

  • Unhealthy outcomes. Emergency readmissions within 28 days of discharge rose from 5.4 per cent in 2002/03 to 6.6 per cent in 2005/06.

    The UK remains at the foot of international league tables on cancer, stroke care and deaths from medical conditions considered a priori preventable.

Most significantly the NHS is failing to provide its raison d’etre: a patient-centred, safe and clinically-empowered health service. Just this month:

  • More than half (54 per cent) of NHS staff in a Healthcare Commission survey revealed they didn’t think patient care was the top priority where they worked.
  • A Royal College of Nursing poll revealed 81 per cent of nurses surveyed said they always or sometimes left their workplace feeling distressed or upset because they had not been able to give patients the kind of dignified care that they should.

Total public spending on the NHS in England is now approaching £100 billion, yet huge funding gaps remain. Despite a real-terms increase of 70% in funding since 2000, the NHS still ‘solves’ the problem of a gap between resources available and treatment required by rationing.


‘To be truly successful’, the Chief Executive Report states, ‘leaders within the NHS need to look beyond the boundaries of their own organisations….out to their patients and communities…..change happens not through publications and press releases, but through the active engagement and hard graft of staff, working for the benefit of patients and the public’.

But this is exactly what the government and the structure of the NHS is preventing. The undeniable talents of doctors, nurses and health care professionals working in the NHS are being stymied by perverse incentives created by Whitehall and a centre-knows-best attitude.

James Gubb, Director of the Health Unit at Civitas, said: ‘The roots of the NHS problems can be seen in what David Nicholson writes in this very report as his job: to manage and lead the system on behalf of the Secretary of State.

‘That’s who the system is working for, not the patients. Ahead of the Darzi Review it is time the NHS’ political masters dropped their hats. It is time to put money in the hands of all patients, to scrap the targets and diktat and set doctors and health professionals free to do their jobs: to care for patients.’

Notes to authors:

  • i. Civitas is an independent social policy think-tank. The Civitas Health Unit aims to bring fresh thinking to the debate on NHS reform and to consider whether there are better ways to provide quality healthcare for all at an affordable cost. See here.
  • ii. ‘Why the NHS is the sick man of Europe’ by James Gubb is published in Civitas Review, Vol 5 No 1. It is accessible here.
  • iii. The Chief Executive’s Annual Report 2007/08 can be found here and the DH press release here.
  • iv. Sir Robert Naylor’s presentation to Civitas can be found here; along with useful statistics on NHS performance here.


For more information ring:
James Gubb 020 7799 6677 (w) or 07930 243570 (m)


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