Reduction In Waiting Times
Drop in waits, but NHS reforms need 'refinement'
Government-led reforms have "undoubtedly improved the NHS", resulting in "dramatic" falls in waiting list levels, according to a report commissioned by an influential independent research organisation.
However, the report for the Nuffield Trust - which is not related to the independent sector hospital chain of a similar name - said that reforms introduced by Labour since it came into power in 1997 lack cohesion, while there are wide variations in quality and coverage in some areas of NHS provision.
The report, led by Shelia Leatherman, a research professor at the University of North Carolina School of Public Health and a visiting professor at the London School of Economics, studies the impact of the government's reforms which it began to introduce in 1998.
It finds that it is "apparent that quality within the NHS has improved". Waiting times have fallen "dramatically", it suggests, with almost all (99.9%) of patients with suspected cancer seen by a specialist within two weeks of a referral from their GP. Around 22,000 lives are saved every year by a reduction in the death rates from heart disease alone, the report adds.
However, while many reforms - including centrally]set targets - have led to improvements, "taken as a whole they have lacked cohesion". Further, it is not yet clear if the government's additional spending on health over the past decade has delivered value for money.
"It is less clear whether gains are commensurate with the investment and effort," the report states.
The report also suggests that while death rates from cancer and heart disease have fallen, the rates are still higher than many other countries such as France, Germany, the US and Australia. There are also "significant variations" in quality of care across England, the report says, pointing to eye screening for people with diabetes as a good example of patchy coverage.
The report also notes that plurality of provision - whereby private, public and voluntary sector providers compete to deliver care on behalf of the NHS - has slowed during Prime Minister Gordon Brown's tenure. Market forces, though, continue to play a significant role in the NHS.
Overall, Professor Leatherman said that what is needed now is a "refinement, not rejection" of the reforms, suggesting, it appears, that she believes the government is on the right track.
A "coherent national strategy which builds on the improvements of the past ten years" is needed, the report suggests. It outlines a blueprint for a "National Quality Programme", which would set national goals and deliver an annual independent report on progress.
The authors have drawn up a three]year action plan, which includes the creation of a steering group that would bring together and strengthen the multiple organisations and individuals currently engaged in improving quality in the NHS.
Efforts should be concentrated on where there is most potential for the NHS to save lives, lessen suffering and improve quality of life, the report says.
Responding to the report's findings, Dr Jennifer Dixon, director of the Nuffield Trust, said that although the news "on the whole is good", it is "sobering" that there is still so much variation across England and that for some services quality still lags behind that seen in other countries.
"Also, apart from the use of central targets and investment to pay for more staff and equipment, it is not possible to tell which reforms have had most impact," Dr Dixon said.
The Health Insurance Magazine: 21 May 2008