Health policy under the coalition government: A mid-term assessment

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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.

Key findings

  • 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.

Policy implications

  • 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.


Simon Hunt

Cumbria Partnership NHS FT
Comment date
07 December 2012
In your summary of key messages, you state "At national level, the government has achieved substantial real-terms reductions
in the cost of staff, but the NHS pay bill has continued to rise through the impact of increments". In the detailed text, section 8 (p.49), you cite Clover 2012 as the source of this info. Have traced back to the source, and Clover 2012 does not mention the impact of increments. I hear this cited often as an underlying cause of rising pay bills, always anecdotally. Has anyone actually done any quantitative work to actually prove it? With the combined impact of staff turnover and a fairly high proportion of staff at the top of their pay band, sometimes I think the impact of "incremental drift" is exaggerated. Can you or anyone point me to any conclusive work on the subject?
Many thanks in anticipation...

Maggie Whitlock

Local LINk
Comment date
30 November 2012
My concern is that as secondary care contracts due to changes to health care provision and monetary constraints. The pressures on health and social care delivered in the home will increase, people with chronic illness will be cared for in their home where will the increase in demand for trained "community " nurses come from? Domiciliary Care in general consists of health care workers that are under trained under supervised and underpaid. People who are cared for in their homes want to be in control, to be unrushed and receive continuity of staff they trust. I think this issue needs to be looked at now rather than later. Who is funded to train nurses that are made redundant in secondary care and are making the transition
to the community?

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