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Last Updated: Wednesday, 24 March, 2004, 22:41 GMT
Audit finds NHS has made progress
Does the NHS require more surgery?
The government has made progress in responding to the public's priorities for health service reform - but still has some way to go, a survey finds.

The independent healthcare think tank The King's Fund was asked to assess how ministers had responded to the five top priorities for the health service voted for by the British public during the BBC's NHS Day two years ago.

The top priority for the public was that long-term care for the elderly should be provided free.

The strength of feeling on this issue was demonstrated by the fact that this target secured nearly three times as many votes as the next most popular item on the list.

The five key targets:
Free long-term care for the elderly - 73,402 votes
More pay for NHS staff -28,434 votes
Reduce waits for heart and cancer treatment -17,292 votes
Improved A&E - 15,639 votes
Cleaner hospitals -11,064 votes

Two years later, for most care is not free. In England, the government rejected the idea that the state should pay for personal care, such as help with feeding, washing and dressing.

It has introduced a system where some nursing home residents get financial help with the cost of their nursing care - but payments depend on circumstances, and do not cover the full cost.

As a result, people who live in a residential or nursing home have to pay an average of 400 a week, which must come out of their pension or savings. The state will only pay once you have run out of money.

The government has made extra money available to fund care services, and the King's Fund audit says it is possible to see improvements - particularly in services that prevent people going into care home unnecessarily.

There is also a wider range of long term care options coming into play, the audit says. But as yet it is hard to see notable increases in either the quantity or quality of care services.

In Scotland it is a different story. The Scottish Executive has decided to make a contribution both to nursing care and personal care.

Health Secretary John Reid, appearing before on BBC One's NHS Day: For Better or For Worse, was asked if a patient in his Scottish constituency was better off than their English counterpart.

He said in Scotland elderly patients would not get 1,000 for domestic equipment they needed at home and stroke victims would not get rehabilitation.

"Scotland has made a choice not only to give everybody free medical nursing care that we do in England but to give everybody irrespective of their wealth or income free personal care.

"For instance with my pension when I retire, earning 125,000 a year, I would get free personal care as well in Scotland.

"We do not believe that 1.7bn - and we are spending more than that on old people here - should be spent on that priority."

Better pay

Broadly, all NHS staff have seen their pay increase by more than the rate of inflation over the last few years, says the audit.

However, it warns that many NHS staff may, despite these increases, feel undervalued.

"A difficulty for any government with this issue is to try and get the balance right between fair remuneration for NHS staff and spending money to more directly improve services for patients.

"Another problem is the sheer size of the NHS pay bill: with over 500,000 nurses employed in the NHS across the UK, for example, even a fractional increase in pay costs millions of pounds."

Shorter waiting times

Key points from the King's Fund audit

The King's Fund reports that considerable, but patchy progress has been made on reducing waiting times.

In 2000, around 5% of the total English waiting list had been waiting over a year for admission, by 2003 12-month waits had been all but eliminated.

It has been a similar story in Scotland, but in Wales and Northern Ireland the proportion of people waiting more than a year has gone up.

"The reduction in long waits in the NHS over the last few years has been a considerable achievement - the result of large sums of extra money, new ways of working and organising care and intense ministerial and managerial pressure," the audit says.

"Reducing waiting times has, however, raised concerns amongst some consultants that they have been pressured by NHS managers to treat less urgent patients in front of more urgent cases in attempts to meet targets."

Improved A&E

The audit is upbeat on this. It says that A&E services have improved in recent years - thanks to extra resources that have be made available to cut waiting times, and to deal more effectively with the upsurge in demand during the winter months.

However, it says some hospitals have struggled to meet the government's own target that nobody should wait more than four hours for care in A&E.

Our research paints a largely positive picture with improvements in most areas
King's Fund
The figures show that 88% of trusts have met the target, but how long you wait depends on where in the country you are

And the audit says - as does the government's emergency services tsar Professor Sir George Alberti - that there is still some way to go to ensure that consultants have enough spare time to train others, as well to manage day-to-day demands.

The government has not hit a crucial goal - to increase the number of consultants working in A&E. Two years ago it pledged to recruit a further 200 by this month

But at the last count nine months ago - it had only managed 59.

Cleaner hospitals

The final target on the wish list is perhaps, according to the King's Fund, the one that the government has addressed most effectively.

Nearly eight out of ten hospitals are now rated by inspectors has having a "good" level of cleanliness - and none is rated as "poor".

And a survey of patients carried out last year found 92% of patients thought A&E department either very or fairly clean. The figure for outpatient departments was even higher at 97%.

However, the audit, does stress that the ratings are based on what is apparent to the naked eye - no scientific analysis of samples has been carried out to prove that hospitals actually are clean.

Despite the apparent improvements, rates of infection by the superbug MRSA have remained unchanged.

In conclusion, the report says: "Our research paints a largely positive picture with improvements in most areas.

"Although, it is still too early to judge whether the extra resources the government has put into the NHS are delivering value for money and whether we will see better health outcomes for more people as a result."



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