Three new reports cast contrasting light on the current state of the NHS as it approaches its 60th anniversary.
NHS chief executive David Nicholson has issued The Year - his second annual report on the state of the NHS - describing the service as "fighting fit". Covering 2007-8, Nicholson reports that the NHS “is on course to deliver its key pledges to the public”. He also writes that important reforms coupled with financial stability mean the service is well placed to continue to improve services for patients, but there is more to do.
The report highlights the good progress towards the 18-week referral-to-treatment waiting time target by the end of 2008; good (if currently stalled) progress towards halving the rates of MRSA; and continuing to deliver shorter waits for cancer patients.

It also emphasises the last year’s achievements of introducing free choice to every NHS patient from any of over 350 providers including NHS and the independent sector; the increased number of semi-independent NHS foundation trusts (to 96); and Wave 2 of the Independent Sector Treatment Centre programme. The report does not, however, emphasise that ISTC Wave 2 has been considerably scaled back from initial plans in light of under-use of the Wave One contracts.

David Nicholson said" “The NHS is in good shape. We are on track to deliver hugely ambitious promises on waiting times and healthcare acquired infections. However, there is more to do if we're to continue to make the progress that patients and the public expect. The NHS Next Stage Review has provided us with a fantastic opportunity to bring about real and lasting improvements for patients all over the country. My job - and that of every leader and member of staff in the NHS - is to seize this and make it happen."

Dissenting voice
However, Civitas quickly issued a response release which indicated that the picture is less rosy.

According to the independent policy think-tank about the DH waiting time targets, “figures from the end of February show this is very unlikely to be met. Only 75% of patients had been admitted within the targeted time; 10 percentage points shy of the target with only a month to go. In fact, in February, three per cent (nearly 9,000) had been waiting more than a year and 62,000 had been waiting more than six months. For inpatients, median waits actually increased from 45 days in 1999/2000 to 49 days last year”.

Civitas also points out the the UK’s MRSA rates remain extremely high by international standards, lower only than Ireland, Malta and Portugal. And although they acknowledge the fall in waiting times for cancer care, they contend that ”standards of care remain mediocre by international standards. Despite per capita spend in the NHS being among the highest in Europe, progress in terms of outcomes is slowing. Improvement in avoidable mortality – deaths that could have been averted by good healthcare – fell from 3.6% in 2000/01 to 1.7% in 2004/05”.

Hard to tell what’s working
Meanwhile, a new report from the Nuffield Trust think-tank points out that the NHS has undergone so many radical changes and reforms in re cent years, it is very difficult to tell which ones have made the difference.

The Quest For Quality report points out the need for a refocusing of attention onto quality of care. Broad measures such as reducing mortality amenable to healthcare and cancer survival rates remain on a downwards trajectory as was the pattern prior to the big increase in NHS spending since 2002. The report notes that much of the new money “has gone on cost increases rather than an expansion or improvement in services".

It notes that the creation of the National Institute for Health and Clinical Excellence, clinical governance and the introduction of national service frameworks have helped raise quality. The report calls for “a national quality policy, using data collected independently of the Department of Health to measure success and failure”, and points out that quality must become integral to every NHS organisation. It cannot be imposed, say authors Sheila Leatherman and Kim Sutherland, by the Care Quality Commission, which comes into existence next April.