Health policy under the coalition government: a mid-term assessment

A high-performing NHS? A review of progress 1997-2010

Priorities for the incoming government 2010

› Tackling unwarranted variations in access, use of services, and quality of care.

› Ensuring that measures of patient experience have an impact on the quality of care provided locally.

› Ensuring adequate investment in tackling preventable causes of ill health.

› Providing better support and care for those living with chronic conditions.

Health policy under the coalition governmentA mid-term assessment

Features of a high-performing health system

› Accessible

› Safe

› Promotes health

› Supports people with long-term conditions

› Clinically effective

› Delivers a positive patient experience

› Equitable

› Efficient

Questions

› What does the latest available data tell us about performance on each of these dimensions?

› What policies has the coalition government introduced?

› Are these policies likely to be effective? Do they address the key issues?

› What should be done next? Are there emerging performance issues to be addressed, or have issues been overlooked?

Availability and access

› Waiting times remain stable except for in A&E where they have risen.

› Access to NHS dentists has risen, as has public satisfaction with dentistry.

› Access to new medicines provided through Cancer Drugs Fund.

› Evidence of locally imposed restrictions to access.

A high-performing health system ensures that people have access to a comprehensive range of services in a timely and convenient manner.

Availability and access

› Waiting times remain stable except for in A&E where they have risen.

› Access to NHS dentists has risen, as has public satisfaction with dentistry.

› Access to new medicines provided through Cancer Drugs Fund.

› Evidence of locally imposed restrictions to access.

A high-performing health system ensures that people have access to a comprehensive range of services in a timely and convenient manner.

Safety

› Reductions in those HCAIs that have been targeted:› MRSA 25% (2011–12)› C Diff 17% (2011–12).

› Increased incidence of patient safety events, but under-reporting in primary care (0.5% of all reports).

› Claims of clinical negligence are rising – from 8,655 in 2010/11 to 9,143 in 2011/12.

› 14% of NHS hospitals inspected between April 2010 and July 2011 did not meet CQC standards for safe management of medicines.

A high-performing health system minimises the risks of accidental injury or death due to medical care or medical error.

Safety

› Reductions in those HCAIs that have been targeted:› MRSA 25% (2011–12)› C Diff 17% (2011–12).

› Increased incidence of patient safety events, but under-reporting in primary care (0.5% of all reports).

› Claims of clinical negligence are rising – from 8,655 in 2010/11 to 9,143 in 2011/12.

› 14% of NHS hospitals inspected between April 2010 and July 2011 did not meet CQC standards for safe management of medicines.

A high-performing health system minimises the risks of accidental injury or death due to medical care or medical error.

Promoting health

› Life expectancy and healthy life expectancy are increasing.

› Smoking:› Rates are continuing to decline.

› Alcohol: › Alcohol consumption stabilised and starting to decline.› Deaths from liver disease continue to rise.

› Obesity:› Increasing for adults; stabilising for children.

A high-performing health system supports individuals to make positive decisions about their own health and acts to maximise its positive impact on the broader determinants of people’s health.

Promoting health

› Life expectancy and healthy life expectancy are increasing.

› Smoking:› Rates are continuing to decline.

› Obesity:› Increasing for adults; stabilising for children.

› Alcohol: › Alcohol consumption stabilised and starting to decline.› Deaths from liver disease continue to rise.

A high-performing health system supports individuals to make positive decisions about their own health and acts to maximise its positive impact on the broader determinants of people’s health.

Managing long-term conditions

› From 2006/7 to 2010/11 the number of people with diabetes increased by 25 per cent.

› 24,000 people with diabetes die every year from avoidable causes related to their diabetes.

› 35% of patients said they had not received any or had not received enough support to manage their long-term condition.

› There was a fall in the number of emergency bed days by 13% 2003/4–2007/8, but between then and 2009/10 the number rose by 7%.

A high-performing health system supports individuals with long-term conditions to manage them effectively and achieve a high quality of life.

Clinically effective

› Decline in mortality amenable to health care, but the United Kingdom still has highest rate in OECD apart from the United States.

› Cancer mortality has fallen but five-year relative survival rates compare poorly with OECD average.

› Mortality from cardiovascular disease has fallen, but geographic variations in access and treatment persist.

› Compliance with 10 best practice indicators for stroke has continued to rise, from 73% in 2008 to 83% in 2010.

A high-performing health system delivers services to improve health outcomes in terms of successful treatment, the relief of pain and suffering, and restoration of functions.

Clinically effective

› Decline in mortality amenable to health care, but the United Kingdom still has highest rate in OECD apart from the United States.

› Cancer mortality has fallen but five-year relative survival rates compare poorly with OECD average.

› Mortality from cardiovascular disease has fallen, but geographic variations in access and treatment persist.

› Compliance with 10 best practice indicators for stroke has continued to rise, from 73% in 2008 to 83% in 2010.

A high-performing health system delivers services to improve health outcomes in terms of successful treatment, the relief of pain and suffering, and restoration of functions.

Patient experience

› A fifth of NHS acute hospitals did not meet essential CQC standards in nutrition and dignity of care for older people.

› The number of breaches of mixed-sex accommodation guidance has fallen.

› Slight decrease in the proportion of patients saying they were offered choice of hospital from 32% in 2010 to 29% in 2011.

A high-performing health system delivers a positive patient experience. This includes giving patients choices and involving them in decisions about their care, providing the information they need, and treating them with dignity and respect.

Equity

› Gap in life expectancy between Spearhead areas and England as a whole has not narrowed but the infant mortality target has now been surpassed.

› Stark differences in life expectancy gaps within local authorities (16.9 years in Westminster).

› Gap in life expectancy between those with a severe and enduring mental health problem and those without is 10–15 years.

A high-performing health system is equitably funded, allocates resources fairly, ensures that services meet the population’s needs for health care, and contributes to reducing health inequalities.

Equity

› Gap in life expectancy between Spearhead areas and England as a whole has not narrowed but the infant mortality target has now been surpassed.

› Stark differences in life expectancy gaps within local authorities (16.9 years in Westminster).

› Gap in life expectancy between those with a severe and enduring mental health problem and those without is 10–15 years.

A high-performing health system is equitably funded, allocates resources fairly, ensures that services meet the population’s needs for health care, and contributes to reducing health inequalities.

Efficiency

› £4.3 billion of productivity gains in 2010/11 (Audit Commission).

› NHS started 2012/13 with estimated surplus of nearly £1.6 billion.

› 12 acute or ambulance trusts ‘below par’ in respect of finance: 6 ‘serious’.

› 15 (of 144) foundation trusts finished 2011/12 in deficit, at least four judged by Monitor not to be viable.

› Drop in number of managers of 8,000 since March 2010 – a fall of 18 per cent.

A high-performing health system uses the available resources to maximum effect. This requires productivity in the delivery of care, economy in the purchase of the goods and services a health service requires to deliver care.

Looking to the future

› Financial pressures on NHS

› Further cuts in social services budgets

› Loss of managers

› Transition risks

› With the dismantling of the old system nearly complete, and the construction of the new one still under way… the NHS is heading into treacherous waters, and the risks are high. …much will depend on the ability of experienced leaders – wherever they may be – to focus on the quality of patient care and financial control to ensure that performance does not slip back.