Is Labour's 10 year NHS plan working?
Five years ago the government launched its latest NHS Plan. The 10 year programme of reform set out a series of measures to overhaul the health service. Has the prescription worked?
Pledges were made to reduce waiting times, increase the number of doctors and nurses and spend more on fighting cancer and heart disease.
Prime Minister Tony Blair said the plan would make the NHS the envy of the world. But has it lived up to the radical promises, and what is left to do?
THE PATIENTS
While most NHS patients are satisfied with the care they receive, there are pockets where treatment is not good enough, a leading patient group says.
Simon Williams, director of policy at the Patients Association, said the NHS Plan had driven forward many improvements. "Patients are being seen more quickly and the majority do receive a good quality of care. We have seen a lot of change, but patients needs still need to be more of a priority."
NHS blueprint unveiled
"But there are still significant pockets were there are problems. If you are old or poor you are unlikely to get the level of service you deserve. The fact remains those who shout the loudest get the best care."
Mr Williams also pointed out that a recent report by the Healthcare Commission said patients were still not being put first.
The NHS watchdog's annual health report said the service often seemed to be designed around the needs of staff rather than patients. "It was a good barometer of where we are at. We have seen a lot of change but patients' needs still need to be more of a priority." Please see:
http://www.healthdirect.co.uk/2005/08/new-nhs-star-ratings-by-healthcare.html
THE DOCTORS
James Johnson, BMA chairman has concerns about the way policy is going
Despite some improvements in the health service, doctors are concerned about the direction policy is heading.
James Johnson, chairman of the British Medical Association, which represents 130,000 doctors, said there had been "successes and failures".
"Patients are seeing some improvements to services as a result of increased funding, and by increasing medical school places, the government has begun to address chronic shortages of doctors.
"However, many of the government's aims remain unfulfilled. The modest target of an extra 2,000 family GPs between 1999 and 2004 was missed (when expressed in full-time terms), and there are still problems with many of the waiting time targets."
And he warned since the plan was published there has been a "very significant shift" in the way the reforms have started to be implemented.
The government envisages about 15% of NHS operations will be done by the private sector within a couple of years.
Mr Johnson, a consultant surgeon, said: "It is increasingly determined that the only way to increase NHS capacity and drive up standards is by opening up the service to private companies."
He added: "We remain concerned that the move could destabilise services and result in hospitals closing - both at the expense of patients and the founding ethos of the NHS."
THE MANAGERS
Health service managers remain positive about the effect of the NHS Plan on patients.
Dr Gill Morgan, chief executive of the NHS Confederation, which represents more than 90% of trusts, said: "The plan has delivered some major successes thanks to the hard work of all NHS staff - improved accident and emergency care and shorter waiting lists to name just two of the high impact improvement areas.
"Every patient wants a health service that provides fast, efficient and high quality emergency treatment when they need it and so it is a tribute to the hard work of NHS staff that public confidence in our A&E departments is now so high that more and more people are using them."
Dr Morgan added: "It wasn't so long ago that horror stories about trolley waits were a weekly occurrence, but now nearly all A&E patients are seen, treated and either discharged or admitted to hospital within four hours."
She also said thanks to other targets, patients waiting for hospital treatment were being seen quicker.
"Just before the NHS Plan was launched, 50,000 patients had spent more than 12 months on an NHS waiting list for an operation but by December 2004, only 24 had been waiting that long."
But she said there was still work to do. "The NHS Plan was always meant to be a 10-year roadmap and so it is hardly surprising that there is still plenty of room for improvement when we are only halfway through the journey.
"We want to work with the government so that all the different pieces of the jigsaw that are intended to transform the NHS - patient choice and increased use of the private sector - make sense and deliver improved care for patients."
THE NURSES
Beverly Malone said another 20-30,000 nurses are needed- especially when 50,000 nurses left the NHS in 2004 alone. Please see:
http://www.healthdirect.co.uk/2005/04/50000-nurses-left-nhs-in-2004.html
Nurses leader Beverly Malone said one of the main benefits of the NHS Plan was that it led on to a record programme of investment which had transformed the health service.
Two years after the reforms were published Chancellor Gordon Brown announced the health budget would increase by more than 7% a year until 2008.
"The record level of investment has just been incredible," said the general secretary of the Royal College of Nursing. "It has shown a positive commitment to the health of the country. We were in such a basement situation that to get to a level floor you needed such a big investment."
"I think what we have shown is that through investment and focusing on areas [such as waiting lists and cancer treatment] we can make a difference.
"The areas where we don't have that focus, as in mental and sexual health, there are difficulties." But she said she felt "foreboding" about the number of trusts posting end-of-year deficits.
One in four NHS organisations failed to balance the books in the last financial year.
"The NHS Plan has been pretty radical. But I think there are tricky times ahead."
She also said that despite the rise in the number of nurses since the plan was published, another 20-30,000 more nurses were required over the next four or five years as there was an ageing workforce.
THE THINKERS
Only time will tell if the NHS Plan lives up to its billing as a transformational programme, according to leading health think-tank King's Fund.
Fellow Richard Lewis said: "Our view is that it has been pretty effective.
"The NHS has improved substantially in a number of areas - hospital facilities, amount of treatment and lower waiting lists - and broadly speaking the targets have been met.
"But I would not say it has transformed and it would be unreasonable to expect that to have happened within five years. Only in the future will we be able to tell."
However, Mr Lewis also said some of the reforms that have happened have had had a negative impact.
"The public has quite rightly been concerned about MRSA. I think the rise in MRSA is inextricably linked to success in other areas - the more patients which are pushed through, the greater risk of infection."
And Mr Lewis also said there was a possibility the NHS may not be able to adapt to future changes. "The NHS is operating at full pelt. There is no spare capacity so there have to be questions about whether this is sustainable."
Pledges were made to reduce waiting times, increase the number of doctors and nurses and spend more on fighting cancer and heart disease.
Prime Minister Tony Blair said the plan would make the NHS the envy of the world. But has it lived up to the radical promises, and what is left to do?
THE PATIENTS
While most NHS patients are satisfied with the care they receive, there are pockets where treatment is not good enough, a leading patient group says.
Simon Williams, director of policy at the Patients Association, said the NHS Plan had driven forward many improvements. "Patients are being seen more quickly and the majority do receive a good quality of care. We have seen a lot of change, but patients needs still need to be more of a priority."
NHS blueprint unveiled
"But there are still significant pockets were there are problems. If you are old or poor you are unlikely to get the level of service you deserve. The fact remains those who shout the loudest get the best care."
Mr Williams also pointed out that a recent report by the Healthcare Commission said patients were still not being put first.
The NHS watchdog's annual health report said the service often seemed to be designed around the needs of staff rather than patients. "It was a good barometer of where we are at. We have seen a lot of change but patients' needs still need to be more of a priority." Please see:
http://www.healthdirect.co.uk/2005/08/new-nhs-star-ratings-by-healthcare.html
THE DOCTORS
James Johnson, BMA chairman has concerns about the way policy is going
Despite some improvements in the health service, doctors are concerned about the direction policy is heading.
James Johnson, chairman of the British Medical Association, which represents 130,000 doctors, said there had been "successes and failures".
"Patients are seeing some improvements to services as a result of increased funding, and by increasing medical school places, the government has begun to address chronic shortages of doctors.
"However, many of the government's aims remain unfulfilled. The modest target of an extra 2,000 family GPs between 1999 and 2004 was missed (when expressed in full-time terms), and there are still problems with many of the waiting time targets."
And he warned since the plan was published there has been a "very significant shift" in the way the reforms have started to be implemented.
The government envisages about 15% of NHS operations will be done by the private sector within a couple of years.
Mr Johnson, a consultant surgeon, said: "It is increasingly determined that the only way to increase NHS capacity and drive up standards is by opening up the service to private companies."
He added: "We remain concerned that the move could destabilise services and result in hospitals closing - both at the expense of patients and the founding ethos of the NHS."
THE MANAGERS
Health service managers remain positive about the effect of the NHS Plan on patients.
Dr Gill Morgan, chief executive of the NHS Confederation, which represents more than 90% of trusts, said: "The plan has delivered some major successes thanks to the hard work of all NHS staff - improved accident and emergency care and shorter waiting lists to name just two of the high impact improvement areas.
"Every patient wants a health service that provides fast, efficient and high quality emergency treatment when they need it and so it is a tribute to the hard work of NHS staff that public confidence in our A&E departments is now so high that more and more people are using them."
Dr Morgan added: "It wasn't so long ago that horror stories about trolley waits were a weekly occurrence, but now nearly all A&E patients are seen, treated and either discharged or admitted to hospital within four hours."
She also said thanks to other targets, patients waiting for hospital treatment were being seen quicker.
"Just before the NHS Plan was launched, 50,000 patients had spent more than 12 months on an NHS waiting list for an operation but by December 2004, only 24 had been waiting that long."
But she said there was still work to do. "The NHS Plan was always meant to be a 10-year roadmap and so it is hardly surprising that there is still plenty of room for improvement when we are only halfway through the journey.
"We want to work with the government so that all the different pieces of the jigsaw that are intended to transform the NHS - patient choice and increased use of the private sector - make sense and deliver improved care for patients."
THE NURSES
Beverly Malone said another 20-30,000 nurses are needed- especially when 50,000 nurses left the NHS in 2004 alone. Please see:
http://www.healthdirect.co.uk/2005/04/50000-nurses-left-nhs-in-2004.html
Nurses leader Beverly Malone said one of the main benefits of the NHS Plan was that it led on to a record programme of investment which had transformed the health service.
Two years after the reforms were published Chancellor Gordon Brown announced the health budget would increase by more than 7% a year until 2008.
"The record level of investment has just been incredible," said the general secretary of the Royal College of Nursing. "It has shown a positive commitment to the health of the country. We were in such a basement situation that to get to a level floor you needed such a big investment."
"I think what we have shown is that through investment and focusing on areas [such as waiting lists and cancer treatment] we can make a difference.
"The areas where we don't have that focus, as in mental and sexual health, there are difficulties." But she said she felt "foreboding" about the number of trusts posting end-of-year deficits.
One in four NHS organisations failed to balance the books in the last financial year.
"The NHS Plan has been pretty radical. But I think there are tricky times ahead."
She also said that despite the rise in the number of nurses since the plan was published, another 20-30,000 more nurses were required over the next four or five years as there was an ageing workforce.
THE THINKERS
Only time will tell if the NHS Plan lives up to its billing as a transformational programme, according to leading health think-tank King's Fund.
Fellow Richard Lewis said: "Our view is that it has been pretty effective.
"The NHS has improved substantially in a number of areas - hospital facilities, amount of treatment and lower waiting lists - and broadly speaking the targets have been met.
"But I would not say it has transformed and it would be unreasonable to expect that to have happened within five years. Only in the future will we be able to tell."
However, Mr Lewis also said some of the reforms that have happened have had had a negative impact.
"The public has quite rightly been concerned about MRSA. I think the rise in MRSA is inextricably linked to success in other areas - the more patients which are pushed through, the greater risk of infection."
And Mr Lewis also said there was a possibility the NHS may not be able to adapt to future changes. "The NHS is operating at full pelt. There is no spare capacity so there have to be questions about whether this is sustainable."
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