Anna Dixon, Director of Policy at The King's Fund, looks at where the NHS is positioned currently.

1. Where is the NHS now?
Anna Dixon, Director of Policy

2. A high-
performing
NHS?
A review of
progress
1997 –2010
Editors: Ruth Thorlby and Jo Maybin
http://www.kingsfund.org.uk/publications/a_highperforming_nh.html

3. Features of a high performing
health system
- Available and accessible
- Safe
- Promoting health
- Clinically effective
- Delivering a positive patient experience
- Equitable
- Efficient (offering value for money)
- Accountable

4. Key questions
What was the situation in 1997?
What policies did the Labour government
introduce?
What progress has been made?
Where should the new government focus its
efforts?

5. Availability & Access
A high-performing health system makes a comprehensive range of services available,
and ensures that people can access them in a timely and convenient manner.
Successes:
– Waiting times for hospital care
18 months to 18 weeks
- Establishment of NSFs and NICE
Weaknesses:
- Access problems persist in some areas –
community mental health, physiotherapy & out
of hours
- Shifting care out of hospital

6. Median waiting times (weeks), inpatients
and outpatients, England, 1994–2009

7. Percentage increase in GP practices offering
extended opening hours, 2008/9

8. Safety
A high-performing health system protects patients from injury or death arising from the
delivery of care – particularly medical error, or from the conditions in which it is provided,
such as hospital-acquired infections.
Reductions in those HCAIs that have been targeted:
– MRSA 54% (2006/7 – 2008/9)
– C. Diff 35% (2007/8 – 2008/9)
Increased incidence of patient safety events but likely to
reflect increase in reporting
Under-reporting, especially in primary care (0.5% of all
reports)
‘Blame culture’ still persists

9. Number of MRSA bloodstream infection reports,
England, by quarter, June 2006 to September 2009

10. Care setting of incident reports,
England, 2008/9

11. Health Promoting
A high-performing health system supports individuals to make positive decisions about
their own health and how to manage the impact of long-term conditions.
Smoking:
– rates are declining, but in line with trend
– Socio-economic inequalities persist
Obesity:
– Increasing for adults; some levelling off for children
Alcohol:
– no significant change in alcohol abuse
– liver cirrhosis on increase against trends in other
countries
Long term conditions:
– support for management of LTCs not yet sufficient

12. Prevalence of cigarette smoking among men
and women (weighted), 1998–2007

13. Prevalence of obese (including morbidly
obese) adults in England, 1993–2007

14. Clinically Effective
A high-performing health system delivers services to improve health outcomes in terms of
successful treatment, the relief of pain and suffering, restoration of functions and, where
these are not feasible, adequate care and support.
Improved outcomes in line with international
trends
Under-75s mortality for major killers has declined…
Cancer mortality 19% since 1995-7
CHD mortality 44% since 1995-7
Greater compliance with NICE guidance and
clinical standards, though often from low base
But: geographic variations persist and challenge
of increases in co-morbidities
PROMS data provides opportunity

15. Deaths per 100,000 population from diseases of the
circulatory system 1990–2007, selected OECD
countries

16. Performance against quality indicators from the
Myocardial Ischaemia National Audit Project,
England

17. Patient Experience
A high-performing health system delivers a positive patient experience. This includes
giving patients choices and involvement in decisions about their care, providing the
information they need, and treating them with dignity and respect.
Proportion of patients saying they had a good
NHS experience high but stable - c.75%
Poor experience for inpatient mental health
patients and systematic differences by age,
health status, ethnicity and region
Public satisfaction highest ever
Choice of location introduced – but patients want
to be more involved in decisions about treatment
and for family and carers to be involved

18. Public satisfaction with the way the
NHS is run, 1993–2007

19. Proportion of patients reporting their doctor always
involves them in treatment options and decisions

20. Equity
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.
Ambitious outcome targets set on reducing gaps
between deprived & average on infant mortality
and life expectancy = gap is widening
Lack of knowledge about whether those in need
are accessing services & getting treatment –
‘inverse care law’ in GP services
Equality Bill going through Parliament – will
require equitable access (deprivation, age,
gender, disability, religion, sexual orientation)
= major data collection & analysis task

21. Distribution of GPs per 100,000 population,
by deprived area, England 2005

22. Value for Money
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 that care, and effectiveness in the design and
selection of its services.
Activity has increased more slowly than the
increase in resources = slight decline in
productivity
Higher pay costs have absorbed more than half of
extra money
Pay EU average for drugs, and made savings on
procurement
Still room for further savings on reducing length
of stay, increasing day surgery & using lower cost
drugs

23. Accountability
A high-performing health system can demonstrate that it is achieving high standards of
care, taking into account the views of those who it serves and that it has in place effective
systems to remedy poor performance.
‘Targets and terror’ : have they worked? What has been the
cost?
Decentralisation to commissioners but performance still
judged to be ‘weak’
Public involvement and accountability to local
communities
– Repeated changes to local structures PPI, LINks
– Variable levels of engagement by FT members
Introduced quasi-independent regulators of organisations
– Burden of multiple agencies & data requests

24. Looking forward . . .
Still unwarranted variations in access to & quality of
care
Need to ensure patients’ experiences have an impact
on quality of care locally
Need to deliver improvements & investment in
prevention and management of chronic disease
Trade-offs inevitable, especially in light of tighter
budgets