Opposition parties are painting a picture of an NHS with major deficiencies. The Labour government, however, believes that the NHS is ‘good’ but needs further transformation to become ‘great’.

The King’s Fund released a review this week, called A High Performing NHS, which assesses how far the investment and accompanying reforms since 1997 have transformed the NHS in England. The following is a summary of its findings:

1. Access

Since 1997, there have been major and sustained reductions in waiting times for most hospital treatments. Now most patients are seen, given tests and treated within 18 weeks of referral by their GP. More progress is needed in some specialties and services which are not included in the targets. Sustaining short waiting times might prove challenging as funds tighten in the future.

There have also been improvements in the number and variety of primary care services, and most people can access GP services within the target of 48 hours. Progress is needed in access to out-of-hours care. The government has identified public demand for some kinds of hospital care to be delivered closer to home, but progress in shifting care out of hospital settings has been slow.

2. Patient safety

Ongoing increases in the number of reported safety incidents reflect improved reporting and coding, but under-reporting continues to be a major obstacle, particularly in primary care, and will have to be addressed in the future.

There have also been considerable efforts made to learn from adverse events and disseminate that learning to the NHS front line. But it is clear that there is some way to go on creating a fully open culture of reporting within NHS organisations.

3. Health promotion

There has been significant progress in tackling smoking. It is too soon to see the benefits of the most radical legislative action - the 2007 ban on smoking in public places - but the effects are likely to accelerate falls in smoking rates and associated ill health.

This review has found that progress has been more elusive in reducing harm from alcohol and rates of obesity. Consumption of alcohol has increased since 1998, accompanied by a rise in alcohol-related hospital admissions and rates of liver disease, suggesting more aggressive, cross-departmental action will be needed in the future. The prevalence of obesity is rising in adults and children, despite government targets to halt the increase.

4. Clinically effective

This review considered the progress made in relation to the three major health conditions which account for the most NHS spending: cancer, cardiovascular disease and mental ill health. Mortality from cancer and cardiovascular disease has fallen substantially since 1997 and suicides have also reduced.

Even though mortality and survival rates for several cancers have been improving they still lag behind those of other European countries and effort will need to be sustained in the areas already identified as needing further work, for example, early diagnosis and access to radiotherapy.

There have been notable improvements in access to cardiac surgery and recommended standards of stroke care, and these have contributed to falling mortality for cardiovascular disease. However, variations in quality persist.

In mental health services, access to specialist early intervention and crisis resolution teams for acute illness has improved and is judged to be one of the best systems in Europe. This has led to reductions in acute admissions, but long-term reductions in symptoms and improvements in the quality of life of service users have been more difficult to achieve.

5. Patient experience

Overall public satisfaction with the way the NHS is run has been increasing steadily for the past few years.

Understanding how patients experience the NHS has been transformed through the creation of one of Europe’s largest patient experience surveys. Most patients report being treated with dignity and respect but progress still needs to be made in relation to choice, involving patients with their care and some aspects of the hospital environment.

6. Equity

From 1997 there was a clear shift in government policy towards reducing inequalities in health outcomes, and goals were put in place to reflect this ambition. Infant mortality has reduced and life expectancy has improved for all social groups in England; however, progress has been faster among less deprived groups. Targets to reduce gaps in infant mortality and life expectancy between the most deprived areas and the national average have not been met.

Questions remain about the extent to which reducing inequalities has received adequate investment and commitment from the NHS.

New legal requirements on the NHS to ensure equitable access for all patients regardless of age, gender, disability, ethnicity, religion and sexual orientation, as well as deprivation, represent a big challenge in the future.

7. Efficiency

NHS productivity overall has declined over the last decade despite the introduction of stronger incentives through new hospital payment systems and quasi-market reforms in part designed to bear down on production costs.

Higher pay costs have absorbed more than half of the increase in the financial resources that became available to the NHS since 2002. On the other hand, substantial savings have been made in the cost of medicines and other goods and services used.

There is substantial scope for further savings through more efficient delivery of hospital and other services, such as reducing lengths of stay in hospitals, increasing the rate of day case surgery, and using lower-cost drugs.

8. Accountability

Since 1997, accountability of NHS trusts to the government has been strengthened, particularly through the use of targets and strong direct performance management.

NHS trusts are also accountable to local commissioners, but it is clear that PCTs are still at a fairly early stage of development in their capacity to use commissioning as a lever, in part due to several years of reorganisation.

There have been significant developments in creating more locally accountable services, for example, through the creation of foundation trusts with members and elected governors. The impact of these changes has so far been limited.

One of the government’s most striking contributions in this area has been to set up independent regulators of health care organisations to inspect and assure the quality of services.

Professional regulation has also been overhauled, with the aim of making the professions more responsive to public rather than professional interests, but many of the changes are still very recent.

There has also been effort to make the system more accountable to individuals, notably through the NHS constitution.

Summary

In summary, the King’s Fund says the NHS is closer to being a high-performing health system now than it was in 1997. It is capable of delivering high-quality care to some patients, in some areas, some of the time.

But, it claims work remains to be done to fill in the gaps: unwarranted variations in access, utilisation and quality of care even where national guidelines exist; ensuring that patients’ experiences have a real impact on the quality of care locally; and, above all, ensuring there is adequate investment and energy in tackling the preventable causes of ill health and better support and care for those living with chronic conditions.

Read the full report.