Progress made by the NHS in the past 13 years

This review aims to establish whether the NHS in England is a better health care system in 2010 than it was in 1997. We have chosen to concentrate on England since it is the focus of The King’s Fund’s research programmes – devolution in 1998 gave the Northern Ireland Assembly, the Scottish Parliament and the National Assembly for Wales autonomy over health services and public health policy for their respective regions. We have made comparisons with performance in other countries where these are informative.

We have drawn on a series of international studies comparing different health systems to identify eight common criteria for defining a high-performing health system. Our criteria are that its services should be safe, clinically effective, health promoting and offer patients a positive experience; and that the system as a whole should be efficient, equitable and accountable. For each of these criteria, we have asked:

• What was the situation in 1997?
• What action has the government taken in this area since 1997 and how (if at all) has performance changed?
• What are the outstanding challenges?

To answer these questions, we have used evidence from official data sources (government or NHS reports), reviews by regulators and other official bodies such as the Audit Commission, National Audit Office, and academic literature.

Based on these findings, we have highlighted the most pressing outstanding challenges, and suggested where and how the new government should focus its health policy efforts.