Government must take care not to raise expectations beyond what NHS can deliver says The King's Fund

Commenting on the health announcements contained in Building Britain's Future, The King’s Fund Chief Executive Niall Dickson said:

'The idea that patients should have a right to certain standards of treatment is a good one and the government should be congratulated on reducing the number of central targets, some of which were hard to justify.

'However, we do need to be clear that many of the 'rights' set out in the Prime Minister's announcement are currently 'must do's' for the NHS. For example, the four-hour maximum wait in accident and emergency, the 18-week wait for hospital treatment and health checks for 40 year olds are all already in operation.

'The announcement today also suggests the government will have to strengthen the new NHS Constitution, which was only launched a few months ago.

'The other concern must be that the new rights raise expectations among patients that the NHS may find hard to deliver. For example the guarantee of access to NHS dentistry and to enable patients with long-term conditions to die at home are laudable ambitions but if the service cannot achieve that standard immediately, there is a risk of alienating staff and frustrating patients.

'Nor should we forget that NHS targets, although unpopular and sometimes misguided, did play a vital role in driving the dramatic decreases in waiting times over the past 12 years.'

Notes to editors: 

  1. 18-week waits
    The NHS Improvement Plan (2004) established a maximum wait of 18 weeks from the time of GP referral to a hospital consultant, to the start of treatment. The target was effectively met on time, at the end of 2008.
    The latest data shows that the ongoing performance targets continue to be met: at April 2009 93 per cent of admitted patients were seen within 18 weeks (within the target of 90 per cent) and 97 per cent of non-admitted patients were seen within 18 weeks (within the target of 95 per cent). Read the Department of Health press release on the latest data.
  2. A&E four-hour target
    This NHS Plan (2000) target stated that by 2004 all patients attending accident and emergency departments should be treated, discharged or admitted within four hours of arrival. This was later refined in 2003 to a requirement that the target be met for 98 per cent of patients. The target was missed only very narrowly – in the first quarter of 2005, 97 per cent of patients were seen within this time.
    In 2008/09 – 98 per cent of patients spent four hours or less from arrival to admission, transfer or discharge. Access Department of Health statistics.
  3. Check ups for 40+ year olds
    Then Secretary of State for Health Alan Johnson announced plans for everyone aged 40-74 to be offered a single, integrated check to assess risk of vascular disease (heart disease, stroke, diabetes and kidney disease) in April 2008. Details of the programme are outlined in Putting Prevention First (2008). The Department of Health estimates that there will be 3 million tests a year, at an estimated cost of £250m per year. Implementation began in April 2009.
    Online health MOTs – called NHS Lifecheck – were developed in 2006 after a commitment in Our Health Our Care Our Say (2006).
  4. Two week cancer waits
    The NHS Cancer Plan (2000) established a two-week maximum waiting time target from GP referral to outpatient appointment for all patients referred as 'urgent' cases. At the end of 2008/09 this was being met in 95 per cent of cases. This particular target does not currently extend to 'routine' GP referrals to cancer specialists. More on cancer waiting times from the Department of Health.
  5. For further information or interviews, please contact The King’s Fund press and public affairs office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  6. The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes  research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.