While waiting times have shortened and funding has increased since this Government came into office, a closer look at the state of the NHS reveals a different picture. Sam Barrett reports.
In 2000, the Government set out its plans to reform the NHS. As well as organisational changes, it promised additional funding, rising from £65.4bn in 2002/03 to £110bn in 2010/11, to enable it to deliver a 21st century service designed around the patient.
Seven years and many billions of pounds later and there have undoubtedly been some improvements in the service delivered. Waiting lists have certainly come down. In the latest figures released by the Department of Health, only 7,900 patients had been waiting more than 20 weeks for treatment at the end of September last year, a decrease of 1,000 on the previous month and 40,800 less people than a year before.
There has also been marked improvement on waiting times when today's figures are compared with those from 2004. Then, 64.6% of patients were seen within 13 weeks, 26.4% between 13 and 26 weeks and the remaining 8.9% had to wait more than 26 weeks. Today, 88.4% are seen in less than 13 weeks with the remaining 11.6% seen before the end of the 26 week period.
under the surface
But beneath the headline figures, there are some significant differences in the standard of service delivered, as a recent report by independent think tank Civitas revealed. "There's massive variation between the regions," says James Gubb, director of the health unit at Civitas. "At University College London NHS Foundation Trust, the waiting time for a CT scan is only a matter of days, but in Norfolk and Norwich University Hospital NHS Trust you would have to wait 141 days."
Other examples of the disparity of service include waiting times for MRI scans. The average wait in Wales is 47 days, while those in the North East can expect to wait twice as long. Looking at individual trusts, the waiting time ranged from less than 10 days to more than 170 days.
Additionally, a study by York University found that people living in deprived areas are more likely to need hip replacements but less likely to get them.
Gubb says that the way performance is measured is hindering reform and creating these disparities. "There's such a focus on year-on-year and month-on-month financial performance that organisations are prevented from focusing on long-term objectives," he explains. "Some are taking a more long-term view, for instance University College London Hospital recently made an investment in its services that saw it go £500m in debt. But this is unusual."
This short-term planning is also evident in the trusts' budget statements. After serious deficits in the last few financial years, NHS trusts appear to be heading for end of year results that will show them seriously in the black. Dr David Costain, medical director at Axa PPP healthcare, explains: "A £1.8bn underspend is forecast for this year. The NHS should really aim for a situation much closer to parity as this is £1.8bn that could have been used on people's healthcare."
Another problem for the NHS's return to glory is that additional funding has been spent on some areas of healthcare but not all as Mike Izzard, managing director of Premier Choice Healthcare and chair elect of the Association of Medical Insurance Intermediaries, explains: "Money has been heavily targeted and we're only seeing real advances in areas such as cancer and heart. Here you can expect fast treatment and very high standards of clinical care."
exclusive treatment
Because of this shift he says he is now more likely to recommend a budget medical insurance plan that excludes heart and cancer. "If a customer needs treatment for anything other than heart or cancer they have the reassurance that they will be seen quickly and if they do have cancer or a heart condition they can use the NHS benefit to pay for a private room," Izzard adds. "Accommodation is dire in NHS hospitals. You could find yourself on a mixed ward that's not only dirty but puts you at risk of contracting a superbug like MRSA or Clostridium difficile."
Certainly, the desire for a private room has increased in recent years as fears regarding superbugs have grown. Hospital-acquired infections account for around 5,000 deaths a year according to the National Audit Office. Further, it estimates that these infections cost the NHS around £1bn a year.
To address this, back in July, Alan Johnson, secretary of state for health, announced £50m extra funding to tackle healthcare-associated infections. This will see infection improvement teams doubling in size to ensure that 2008 MRSA targets will be met.
Dr Costain believes this will prove effective. "There's been a massive education programme and changes have been implemented that should be successful in reducing the incidence of infection. However, it is evidence of the failure of management; they took their eyes off the ball and these high infection rates were the result," he says.
While the NHS may be on course to wipe out infection, another challenge comes from public health problems. In particular, obesity and drink-related issues are set to become a bigger drain on funds.
ups and downs
As much as 20% of the NHS's budget is spent on treating obesity-related diabetes and this figure will rise further if the problem is left unchecked. Likewise, alcohol-related admissions figures are rising as the public's taste for it increases. In the five years to 2005/06 there was a 27.3% increase in the number of men admitted to hospital with drink-related problems and a 28.9% increase in the number of women admitted.
But educating the public should not be a responsibility for the NHS alone. "When it comes to childhood obesity, schools are probably in the best position to tackle the problem. It can't be the NHS's responsibility and it doesn't have a mechanism to make any changes to how the public is educated on health matters," says Dr Costain.
Additionally, while these may be emerging risks for the NHS, other areas of public health have been successfully addressed, which could help to keep costs down. Dr Costain explains: "The biggest public health threat was smoking and, while there is still more to do on reducing this, there have already been advances."
But, whichever health problem is draining NHS resources, it also faces other pressures that cannot be addressed by education. "The population is increasing as a result of immigration and there is also an increase in the age of the population. On top of this, the public expects more and more advanced treatment for a wider range of health conditions. It is a case of an infinite demand chasing a finite resource," says Izzard.
He believes there will be a point when the Government publicly acknowledges that the NHS cannot provide a free universal service. "The public is being conditioned to accept this. Look at the dental market. Most people pay for their dental treatment now but 15 years ago it was mainly delivered on the NHS," he adds.
Gubb agrees: "There has to be an honest and open debate about what the NHS can afford to pay for," he says. "The Government has created an illusion that it will pay for everything and it's not possible." n
Sam Barret is a freelance journalist
