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A high-performing NHS? A review of progress 1997-2010

Since 1997 funding for the NHS has doubled, but has this produced a high-performing NHS?

Using official data, government reports and academic research, A high-performing NHS? is the first comprehensive evaluation of the NHS in England from 1997 to 2010. The report assesses how much progress the NHS has made in the following eight areas:

  • access

  • safety

  • health promotion and management of long-term conditions

  • clinical effectiveness

  • patient experience

  • equity

  • efficiency

  • accountability.

There is no doubt that there has been considerable progress in the last 13 years. The NHS is now high performing in several respects and is delivering more care to more people more quickly.

A number of important achievements are highlighted, including major reductions in waiting times and rates of health care associated infections and progress in reducing smoking rates. There has been a concerted effort to implement national standards of care for major diseases across the NHS which has contributed to the continued falls in deaths from cancer and cardiovascular disease.

There are less obvious changes too, including improvements in data collection and reporting, at a national and local level. There is now far more information about performance in the public domain, accessible to patients, carers and members of the public, than ever before.

However, further progress is needed in a number of areas. There are unwarranted variations in access, utilisation and quality of care even where national guidelines exist; and health inequalities have widened since 1997. The NHS may not be fully prepared for the key challenges that lie ahead, including:

  • The financial challenge – a decline in productivity is a significant concern given the difficult financial circumstances currently facing the NHS.

  • Demographic change – although small-scale initiatives are having an impact, the NHS has a long way to go in transforming the delivery of care to support increasing numbers of people with long-term conditions as the population ages.

  • The public health challenge – obesity and alcohol-related illness have increased since 1997. Unless the progress made in reducing smoking can be matched, these issues will place the NHS under significant pressure in the decades ahead.

Despite the challenges the future holds, the next government must build on the progress made and aspire to create an NHS that can deliver quality to all patients, in all areas, all of the time.