The Healthcare Commission’s final ‘State Of Healthcare 2008’ report to Parliament has attracted criticism for its figures about the error rate in primary care, although it notes significant improvements by the NHS.

The Commission is due to be abolished at the end of March 2009, when the new care Quality Commission wil take over its functions as well as the regulatoion of social care and mental health, and will for the first time licence all healthcare providers.

The Commission’s report called for further efforts to enhance the quality of care and make services more patient-centred. The Commission said that the NHS has dramatically improved access to services by driving down waiting times, pointing out that ‘what gets
measured gets done’.

Now the NHS must focus on enhancing the quality of care by doing more to measure outcomes for patients, the experience of patients, and the journey people make through the system of care.

Major improvements
The report found:
- 95% compliance with national health standards
- Big reductions in MRSA and C. difficile infection rates
- Dramatic drops in waiting times
- Consistently high levels of patient satisfaction
It also highlights the scale of improvements in the NHS:
- The number of annual consultations in the health service has risen from 219 million to 300 million since 1998
- Attendances at A&E have risen from 14 million to 19 million since 2002/03
- NHS Direct answered 4.9 million calls in 2007/08 and received more than 30 million visits to their website.

Sir Ian Kennedy, the Commission's Chairman, said “It is crystal clear that there have been major improvements in the care provided by the NHS over the past five years.

"We have seen more money going in, more staff providing services and more patients being treated. People are getting care much more quickly than they used to, notably for cancer. NHS trusts have, for the first time, a clear understanding of the core standards of service that they should be providing. We are seeing signs of real progress in driving down rates of healthcare-associated infection. People are living longer and there have been some remarkable reductions in premature deaths from the major killer diseases.

"But there are a small number of trusts trapped at a level of performance that is unacceptably poor. It’s also clear that, while patients overall indicate high levels of satisfaction with care, the NHS is still playing catch-up when it comes to consistently providing the patient-centred care that people rightly demand. This is particularly true for those least able to make themselves heard when it comes to getting the best care, such as older people, children and those with mental health needs or learning disabilities. There have been some real improvements in mental healthcare but significantly more remains to be done to support people, especially young people, in the community

“We have made the safety of care our highest priority. Safe care is the first building block of good quality care. It’s clear that safety is higher on the agenda than ever, but we are also a long way from an NHS that hungrily and systematically examines its own performance, gathers in and learns from mistakes, reinforces good practice, and does things differently for the future”.

Primary care controversy over “misleading” figures>
However, the British Medical Association has questioned statistics in the report which suggest that up to 600 errors occur in primary care a day. BMA chair of council DR Hamish Meldrum said the claim was “misleading”, adding, “This is based on data which was mainly gathered outside the UK, and identified that medical error occurs between five and 80 times per 100,000 consultations.

“Any errors are regrettable but there are millions of contacts between the NHS and patients every day. It is inevitable that, in a very small proportion of these, care falls below the highest standards. Doctors want to get rid of unacceptable variations in quality, but we need to be careful to analyse and learn from the causes of low performance rather than jumping to conclusions or simply adopting a blame culture.

“Clinical leadership and engagement are essential elements of efforts to drive up quality which is why doctors are working with the NHS to develop new quality measures, including how patients feel about the treatment they’ve received.”