NHS performance holding up, but treacherous waters are ahead

The NHS is entering a period of significant risk which could jeopardise progress made over the past decade, according to an assessment of coalition health policy published today by The King’s Fund.

Halfway through the coalition government’s term of office, the report finds that NHS performance is continuing to hold up well. However, as unprecedented financial pressures start to bite, cracks are beginning to appear, with accident and emergency waits rising and more hospitals in financial difficulty. Major organisational changes and the loss of experienced managers leave the service in a precarious position.

The report identifies several longstanding challenges which were highlighted in The King's Fund's previous review of NHS performance between 1997 and 2010. These include tackling health inequalities and improving patient experience. The report finds that it is too early to judge the impact of the coalition's policies in these areas, as much of the underlying data is in line with previous trends or is not yet available for the current year.

Areas where the data shows consistent improvements since 2010 include:

  • health care-acquired infection rates continue to fall, with MRSA rates falling by 42 per cent and C difficile rates by 55 per cent from May 2010 to September 2012
  • good progress has been made on the government’s commitment to eliminate mixed sex wards, with the number of breaches falling by over 96 per cent in 16 months
  • more than £10 billion of planned efficiency savings have been delivered through the QIPP scheme.

But important areas where progress is needed include:

  • while waiting times have remained low overall, A&E waiting times have risen since the end of 2009
  • 12 acute or ambulance trusts are performing below par in respect of finance, and 15 foundation trusts finished 2011/12 in deficit
  • there has been a rise in emergency admissions for people with long-term conditions and in emergency bed days among the over-65s.

The report also examines the coalition’s recent reforms and their greater emphasis on outcomes, transparency, competition, and commissioning. It finds that, despite ministerial rhetoric, the shift from targets and performance management under the last government has been gradual, with much of the previous system still in place. Overall, the report concludes that more time will be needed to judge the impact of the reforms on NHS performance.

Anna Dixon, Director of Policy at The King’s Fund, said: ‘The NHS is continuing to perform well but there are treacherous waters ahead. There are huge risks, particularly in ensuring that quality of care does not suffer with the further financial squeeze. The stakes for patients could not be higher, and frontline leaders will have a crucial role to play in meeting the challenges ahead.

‘Neither competition nor commissioning reform alone can be relied on to make the improvements needed. Fundamental change will be required to address the challenges of the future as the population ages and health needs change.’

Notes to editors: 

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In 2010, The King’s Fund published a comprehensive analysis of the progress made by the NHS between 1997 and 2010. This review, A high-performing NHS? A review of progress 1997-2010, assessed the service’s performance during this time against eight key areas: access; safety; health promotion and management of long-term conditions; clinical effectiveness; patient experience; equity; efficiency and accountability.

This report provides an update on NHS performance two and a half years into the current parliament; halfway into the agreed term of the coalition government. The report is structured around similar dimensions, although promoting health and managing long-term conditions have now been examined in two separate sections. The section on accountability has not been updated because the structures governing the NHS are still undergoing significant change.

The King’s Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.