Written halfway through the 2010–2014 parliament, this review considers how the NHS is performing under the coalition government, following on from The King’s Fund’s major review of NHS performance from 1997 to 2010.
It examines the policies introduced by the coalition government, assesses how far these will address current and emerging performance issues, and identifies further action needed.
The report focuses its findings on eight key aspects of health care: access, patient safety, promoting health, managing long-term conditions, clinical effectiveness, patient experience, equity, and efficiency. It addresses these against a backdrop of three significant areas of change: major reforms to the NHS, the drive to achieve £20 billion of productivity savings by 2015 (the Nicholson challenge), and reduced spending on social services.
In general, the performance of the NHS is holding up despite financial pressures and disruption from reforms. However, cracks are emerging, with longer waiting times in accident and emergency, and the financial difficulties of more providers being exposed.
There have been improvements in transactional aspects of care (access and waiting times) but concerns remain about relational aspects of care (emotional support, dignity and empathy), particularly in acute hospitals.
Levels of public satisfaction with the NHS have fallen, although the reasons for this are not clear.
Smoking rates continue to fall and obesity among children is stabilising, but excess alcohol consumption continues to rise, as does adult obesity.
Mortality from cancer and cardiovascular disease has fallen but the United Kingdom still has higher levels of avoidable mortality than other countries, and health inequalities persist.
The latest NHS reforms are underpinned by the government’s approach to driving NHS performance – moving away from targets and performance management towards a focus on outcomes, transparency of data, greater control for local clinicians, and increased choice and competition. How these are applied in practice will determine the future performance of the NHS.
Looking to the future, there are several threats to NHS performance, including the continuation for the foreseeable future of a tight financial situation for the NHS, further cuts in local government budgets, new organisations taking time to get established, and the potential failure to maintain financial control.
To rise to the financial challenges facing the NHS and local government, we need to see innovation in models of care at an unprecedented scale and pace.
Anna Dixon on health policy under the coalition government
Anna Dixon, Director of Policy at The King's Fund, looks at the key health policies introduced by the coalition government, and at whether they are likely to be effective in future.