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Last Updated: Friday, 7 May, 2004, 13:04 GMT 14:04 UK
Is the NHS really getting better?
By Ray Dunne
BBC News Online health staff

A&E staff
How are we feeling this year?
The head of the NHS Sir Nigel Crisp says there are clear signs that the health service is getting better. BBC News Online examines the claims.

"Something big is happening within the NHS." So says NHS chief executive Sir Nigel Crisp.

His annual report paints a glowing picture of the health service over the course of the past year.

More patients treated more quickly than ever before.

Hospital waiting times falling faster than they have for a long time.

More staff recruited. More new buildings. Extra equipment.

Even premature deaths from killer diseases like cancer and heart disease fell last year.

The report is music to the government's ears.

It is spending record amounts on the NHS and is facing local and European elections in a few weeks time and a possible general election next year.

It spent an extra 5.9bn on the NHS last year - an increase of 7.3%. Billions more are promised in the years ahead.

On the face of it, there have been major improvements in the NHS.

Waiting times

The number of people waiting for a hospital operation has dropped by almost 9% in the past 12 months - down from 992,000 to 906,000.

Waiting times have also fallen. According to the report, just a handful of people have now been waiting longer than nine months for surgery. The average waiting time is just 10 weeks.

The NHS in figures
63.7bn spent on the NHS
13.9mvisited A&E
5.5m admitted for non-emergency surgery
1.9m treated as outpatients
1.5m visited NHS walk-in centres
906,000 on waiting lists
However, there have been claims that the drive to cut waiting lists has meant patients who have been waiting months for surgery are sometimes treated before those most in need.

Other say the figures fail to take so-called hidden waiting lists into account, such as waits to see a consultant or to have tests before being placed on waiting lists.

"The claim that few patients are waiting over nine months will not ring true for those patients languishing on hidden waiting lists," says Paul Burstow, Liberal Democrat health spokesman.

"Those waiting for tests and scans before they even get a diagnosis will greet this news with some scepticism."

More treatments

Sir Nigel's report shows that the NHS is treating more people than ever before.

Almost 13.9m people visited A&E last year - up 6% on the previous year.

Close to 5.5m people were admitted to hospital for non-emergency surgery last year - an increase of 3.2%.

Another 1.9m people were treated as outpatients. That's 10% more than the previous 12 months.

Prime Minister Tony Blair
The NHS will be a key election battleground
In addition, 725,000 procedures were carried out in GP surgeries, up 2% on 2002.

The report also shows that 1.5m people visited a NHS walk-in centre - an increase of 15% - while another 6.4m called the telephone helpline NHS Direct - a rise of 1.5%.

However, again some people say the figures only tell part of the story.

For instance, recent studies have suggested that NHS walk-in centres and NHS Direct are not universally popular.

They were originally set up to encourage more people to access the NHS, particularly those who traditionally do not use the health service such as men and people from ethnic minorities.

According to researchers, they are largely used by those people who use the NHS anyway.

Others say the figures hide variations at a local level, with patients having very different experiences of the NHS depending on where they live.

"It is patients' actual experience that matters," says Simon Williams of the Patients' Association.

"We are still concerned about differences in accessing high quality patient care.

"The overall national picture looks quite good but its quite different at a local level."

Value for money?

Perhaps the biggest question is whether the extra billions being spent on the NHS are providing value for money.

Recent reports have suggested that while spending has increased sharply in recent years, productivity in the health service has actually decreased.

Billions are being spent on the NHS
It is something Sir Nigel roundly dismisses.

"We have measurable improvements in outcomes such as mortality rates and the speed with which we treat patients."

Not everyone agrees, however.

"Some improvements are to be expected," says Nick Herbert, director of the think tank Reform.

"After all, spending on the NHS has increased by 40% in real terms in just five years.

"The concern is that the speed of the rises is resulting in inefficiencies, the scale does not represent value for money, and the NHS at these higher levels of funding is not performing at international standards," he says.

"Britain's health spending has already overtaken the EU average but unlike most of these countries we still have around 1 million people on waiting lists.

"Spending without reform may mean sensitive political targets are eventually hit, but in the long run it won't deliver a world class health service."

Others say the government needs to do more to show it is getting value for money.

"More money is going into the NHS but we don't know if the quality of care is improving," says John Appleby, chief economist at The King's Fund.

"Measuring patients' overall health on a regular basis means we would then have a better idea of determining how productive the NHS is becoming for all the extra money going in to the system."

The government, for its part, insists it is on the right course. It has introduced a raft of reforms aimed at modernising and improving the NHS in recent years.

It is standing by, to put its money where its mouth is.

However, it acknowledges that more needs to be done

In the words of Health Secretary John Reid: "We have still have a long way to go."


SEE ALSO:
NHS 'is seeing big improvements'
07 May 04  |  Health


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