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Report

The NHS under the coalition government: Part two

NHS performance

This report, the second part of 'The NHS under the coalition government', looks at how well the NHS has performed under the coalition government. The report acknowledges that assessing the performance of any health service is an inexact science for many reasons, but using routinely available data, the report creates a conventional ‘production path’ – describing the financial inputs to the NHS before detailing its outputs, such as hospital admissions, or A&E attendances.

It draws on surveys of patient and staff experience; access to care as measured by waiting times; and data on outcomes, safety and quality of care. The report concludes with an analysis of NHS productivity and financial performance between 2010 and 2015, and an assessment of its prospects in the next parliament and beyond.

Key findings

  • NHS performance held up well for the first three years of the 2010–2015 parliament but has since come under increasing strain.

  • Patient experience of the NHS generally remains positive, and public confidence is close to an all-time high and the very limited data on outcomes, safety and quality of care indicates some improvement.

  • There are growing concerns about the quality of mental health services and challenges in achieving parity of esteem between mental and physical health.

  • A substantial NHS deficit in the final year of this parliament seems certain, despite extra funds during 2014/15 and with funding boosted more in real terms since 2010 than planned.

  • Most of the NHS is working close to its limits, and staff morale is a growing concern – making prospects for NHS performance in the next parliament extremely challenging.

Policy implications

  • The next government must commit to additional resources while avoiding grand reforming gestures. Without more funding, there is a real prospect of accelerating decline in NHS performance.

  • The NHS must renew its commitment to productivity improvements. This will involve finding time and ways to equip staff at all levels with skills in quality improvement.

  • A transformation fund is needed to pump-prime investment in new models of care on a scale commensurate with the challenges facing the health and social care system.

  • A greater priority must be given to reforming the NHS ‘from within’ – including developing leadership (especially clinical leadership) and nurturing cultures focused on safe and high-quality care.