NHS performing well... but future is risky

28 November 2012

The NHS is entering a period of significant risk which could jeopardise progress made over the past decade, according to an assessment of the coalition government's health policies by The King's Fund.

The NHS Confederation has called the analysis "fair and reasonable".

The think tank said that NHS performance was continuing to hold up well but as unprecedented financial pressures start to bite, cracks are beginning to appear, with accident and emergency waits rising and more hospitals in financial difficulty. Because of major organisational changes and the loss of experienced managers, the service is in a precarious position.

The King's Fund said that many of the problems had been in existence since 1997, ie when the last Labour government came to power, so were not of the coalition's making. These include tackling health inequalities and improving patient experience. However, it is too early to judge the impact of the coalition's policies in these areas.

The think tank listed many improvements since the 2010 general election, including MRSA rates falling by 42 per cent and C difficile rates by 55 per cent, breaches relating to mixed sex wards falling by over 96 per cent, and more than £10bn of efficiency savings made through the QIPP (quality, innovation, productivity and prevention) scheme.

However, progress needs to be made on stopping the rise in A&E waiting times, 12 acute or ambulance trusts have been performing below par financially, and 15 foundation trusts finished 2011/12 in deficit. Also, there has been a rise in emergency admissions for people with long-term conditions and in emergency bed days among the over-65s.

Anna Dixon, director of policy at The King's Fund, said: "The NHS is continuing to perform well but there are treacherous waters ahead. There are huge risks, particularly in ensuring that quality of care does not suffer with the further financial squeeze. The stakes for patients could not be higher, and frontline leaders will have a crucial role to play in meeting the challenges ahead."

She added: "Neither competition nor commissioning reform alone can be relied on to make the improvements needed. Fundamental change will be required to address the challenges of the future as the population ages and health needs change."

Mike Farrar, the NHS Confederation's chief executive, said the think tank had delivered a fair and reasonable report card on the NHS's performance. The health service was undergoing significant reorganisation during a period of immense financial pressure and it was important to acknowledge its successes with patients and staff.

However, he added: "It is clear that there are a number of areas where we have to do much better. In particular, we need to do much more to make sure that every patient receives dignified care every time, and maintain a strong focus on reducing emergency admissions and avoidable mortality. We cannot afford to let standards slip in these important areas."

Labour didn't issue a formal response to the report but the shadow health secretary Andy Burnham reckoned some services were starting to be rationed by the NHS.