News flash NHS waiting lists have reached 7 million.

[p79] (..) Conclusions: There is little doubt that the Labour Government’s agenda for the NHS has been hugelyambitious. The past five years have seen an unprecedented investment in NHS services. The
Prime Minister, Tony Blair, pledged to bring NHS spending up to ‘European’ levels and broadly
this target has been achieved.
With the investment came reform. The Government’s ten-year blueprint for the NHS, the NHS
Plan, set out an agenda that touched most parts of the service and demanded new working
practices, new staff and better outcomes. As well as the investment, four main tools were used
to improve performance: national targets and standards; regulation and assessment; the
introduction of market-style incentives; and support through professionally led ‘collaboratives’.
So has all this investment paid off? Did the Government achieve the ‘step-change’ in
performance that it was seeking?
We are, perhaps, lucky that a large amount of information is collected about the NHS. Unlike
many other countries, we are able to measure improvement in services in many areas and to
hold the government of the day accountable. For the main areas of performance, relatively good
data are available and they show that activity and some measures of quality have increased.
However, the answers to some key questions remain elusive. On a number of occasions during
this audit, we have sought information that is simply not collected, or not made public. The
Department of Health requires data to be collected on the targets it has set, but the data tells
us more about how many services are delivered and how fast, than about the improvements
in health by patients.
Even so, we are able to draw some broad judgments about the performance of the two Labour
Governments since 1997. And mostly these are positive; significant improvements have
occurred within a relatively short time.
First and foremost, the NHS appears well on the way to tackling its historic Achilles heel –
waiting times. It is true that immediately after 1997, inpatient and outpatient waiting times
actually went up. However, long waits for treatment have been virtually eradicated. Now, for
example, some 70,000 patients are waiting for inpatient treatment compared to nearly 200,000
people in March 2000. This figure is set to reduce to zero by the end of this year. Average waits
appear to be coming down significantly too. Most surprisingly, the Government has reversed a
previously inexorable upward trend in the numbers of people waiting for treatment – the first
time this has been done since the NHS was founded. Therefore, the Government looks set to
meet all of its targets in this key area of NHS performance.
CONCLUSIONS © King’s Fund 2005 79
Conclusions
Particular bottlenecks and areas of concern have also been addressed. Good work has been
done to reduce the maximum wait for patients in accident and emergency (A&E) to four hours.
In primary care, patients now wait only one day to see a primary care professional and a
maximum of two days to see a GP (although there is some disagreement over the actual
waiting times between the views of patients when surveyed and the official statistics).
Many millions of people now contact NHS Direct – the nurse-led telephone helpline and
website that did not exist when Labour came to power – or visit new walk-in centres every year.
The last five years have also seen an increase in hospital building, through the private
finance initiative. The average age of NHS buildings has fallen dramatically and improvements
to primary care are beginning to follow. Heavy investment has also been made in new
diagnostic machines.
Notwithstanding claims that privately financed hospitals have reduced the number of available
(or affordable) beds, acute and intermediate hospital beds increased since the NHS Plan.
While, the total number of hospital beds has fallen, there have been increases in the number
of acute, critical care and intermediate care beds and the targets set out in the NHS Plan have
been met.
But the NHS is essentially a ‘people organisation’. It relies on highly trained and dedicated
staff. The Government is broadly on course to meet its pledges to increase the number of NHS
staff (although final data for 2004 are awaited). Between 2000 and 2003, an additional 5,430
consultants, 2,750 GPs (including GP assistants), 56,720 nurses and 8,030 therapists have
been employed. Perhaps a less popular measure has been to increase the number of managers
between 1997 and 2003 by 12,376 (managers as a proportion of NHS staff also rose from 2.5%
to 3.5%).
So what are the failures? Long waits for diagnostic tests appear to be stubbornly resistant –
some people are still waiting a long time to get the tests they need to diagnose and treat their
conditions even though more staff have been appointed and more tests are being undertaken.
In addition, waits for radiotherapy treatment also appear to be an area where things are getting
worse, not better. This is a crucial bottleneck affecting clinical quality and the Government has
recently announced that it is to step up investment in this area still further.
The number of cancelled operations has also risen and now total 67,000 a year. In part, this
reflects a persistent lack of critical care beds, demonstrated by the case of Mrs Margaret Dixon,
the patient who endured numerous cancellations of an operation. While Mrs Dixon’s case is
unlikely to be typical, pressure on critical care beds remains, despite a significant increase in
numbers since 1997, because the NHS is now having to treat more patients that are severely ill
or very frail.
MRSA has also emerged as an important concern for the NHS, patients and the wider public.
Increasingly, patients are worried that it simply is not safe to enter hospital for fear of the
‘superbug’.
In reality, the numbers of patients contracting the most serious form of MRSA (a ‘bacteraemia’
or bloodstream infection) is very small. However, numbers of cases have risen and there are
wide variations in infection rates across hospitals. However, the apparent link between hospital
80 AN INDEPENDENT AUDIT OF THE NHS UNDER LABOUR (1997–2005)
cleaning and MRSA rates may be a red herring. According to many experts, the big issue is that
of ‘hand hygiene’ and it seems, at a very basic level, that the NHS simply cannot persuade its
staff to regularly wash their hands.
MRSA also perfectly illustrates the problem that any government faces when seeking
simultaneous improvements across a number of different fronts. MRSA rates might be reduced
if hospital wards were not so full of patients, or the turnover was lower.
However, many of the improvements to waiting times have only been achievable because the
NHS has been working flat out – with little elbow room to manage peaks in demand. It is not
economically efficient to keep beds empty. Ultimately, the Government must juggle competing
priorities within what remains a finite budget – even if it is a much more generous one than
when Labour came to power.
It is for this reason that the Government has been keen to increase efficiency and value for
money in the NHS. In fact, productivity has been falling consistently, although the measure
used is recognised to be flawed because it does not count all types of health service activity
(including services that are now carried out in primary care) or quality of care. We simply do
not know whether the NHS is getting good value for all the extra money spent.
Furthermore, much of the growth money for the NHS is already committed – for example, on
changes to staff contracts and pay increases, clinical negligence claims and reducing junior
doctors’ hours to meet the European Working Time Directive. The effect of this is to reduce the
proportion of the substantial cash increase for the NHS available for new patient services. Once
these ‘cost pressures’ are taken into account, the generous 12.38% rise in funding in 2004/05
reduces to a rather more modest 2.4%.
We appear to be getting healthier in some regards (such as our longevity and rates of infant
mortality); a slight decline in smoking rates, and the increased prescribing of statins for heart
disease will, according to the best research, save deaths and disability some years down the
track. However, an ageing population and some worrying trends, such as the levels of obesity
and diabetes, will soon impact on the demand of health services in a major way. In the face of
these challenges the NHS cannot stand still.
Comparing the performance of the NHS in England to that in Scotland and Wales is instructive.
The quality and pace of reform, and growth in investment in England has been higher than in
Scotland and Wales where devolved governments are responsible for the NHS. In relation to
waiting times at least, the English NHS appears to be performing far better.
However, it is also clear that we still lag behind many other countries in some key health
measures and in terms of health service ‘inputs’ such as numbers of doctors and hospital beds.
There have been some areas where we appear to be catching up (for example, with regard to
rates of heart operations).
Overall, in our view, the results of this audit are very positive. The ambition for the NHS has
been appropriately high. There has been unprecedented investment. There has been significant
improvements in most areas the Government has focused policies on. Has there been a ‘step-
change’ in NHS performance? If step-change means a significant change of gear, with more and
better services, then yes there has. (..)