The Healthcare Commission’s report into the state of health services in England and Wales has found that, while some improvements have been made, more needs to be done to ensure world-class care for all.

Over 50 million people are cared for by the National Health Service in England alone and, during the year 2006/7 there were 300 million visits to GPs and 19 million to hospital A&E departments, illustrating the sheer magnitude of the service.

In terms of the quality of service provision, the Commission’s chairman, Professor Sir Ian Kennedy, was quick to praise the achievements that had been made during the year, such as dramatic cuts in waiting times and faster access to doctors, which are helping people to live longer, healthier lives.

However, presenting the report to parliament on Tuesday, he stressed that there is “still some way to go before everyone gets world class care. People are getting healthier, but there is serious disparity in both general health and in the care available to the haves and have-nots”.

Inequality is still a big problem in the country, with men from more deprived areas living 10 years less than those in wealthier areas. On a similar note, in poorer areas, where people tend to need more care, are significantly under-doctored, with 18% less GPs than in wealthier areas, the report notes.

Different experiences
Sir Ian also highlighted the differences in the overall care experiences of patients depending on which hospital they visit. National analysis of the Commission's survey of 80,000 inpatients at acute hospital trusts shows that 89.2% were ranked "satisfactory" on patient experience, 7.8% were "below average" and 3% were "poor".

Furthermore, almost a third of hospital complaints passed on to the Commission for review dealt with dignity and respect, nutrition and other aspects of basic care, demonstrating that there is much room for improvement on even the most basic level.

It was also revealed that primary care is not only still performing under par, but that things seem to have taken a turn for the worse over the last year, with only 26% of PCTs rated ‘excellent' or ‘good' in 2006/7 versus 33% the prior year. “Many PCTs went through a reorganisation over the period but this does not provide a complete explanation for the underperformance”, the report states. And importantly, it adds that trusts are having difficulty understanding the needs of locals, making it harder to buy services tailored towards patients in the area.

Behind Darzi’s vision
In his address to parliament, Sir Ian said he is fully behind Lord Ara Darzi on his vision of a world-class health service, as detailed his an interim report on the NHS, and that the Commission has identified “the gaps that will need to be closed to make that vision a reality”.

To this end, the Commission has called on the government and healthcare providers to: improve service planning/commissioning; provide better access outside the waiting time targets; promote a culture of safety more effectively, with greater leadership from trust boards; improve healthcare for children and young people; be more sensitive towards individual needs; and a make better use of information. This, it hopes, should help boost overall quality and performance, raising the standard of the Service.