Page last updated at 01:39 GMT, Tuesday, 29 December 2009

Boom to bust: The NHS in the noughties

By Nick Triggle
Health reporter, BBC News

Hospital patient

It seems like the NHS has hardly been out of the news over the last 10 years. Targets, superbugs and swine flu have all grabbed the headlines. But just how significant will the noughties prove to be?

From feast to famine could well sum up the past decade for the NHS.

The noughties kicked off with the NHS Plan, a 10-year vision to reform the health service.

It led to the so-called "market" reform of the health service under which NHS trusts have been set a plethora of targets and forced to compete with the private sector for patients.

The plan paved the way for huge rises in funding - the budget now stands at more than £100bn, triple what it was.

This money paid for thousands more nurses and doctors as well as giving them generous rises in their salaries.

The impact is obvious to see in many places. Waiting lists have tumbled, new hospitals built and patients have been given more and more choice over where they have been treated.

But not all the changes have been popular.

'Divisive policies'

Dr Hamish Meldrum, chairman of the British Medical Association, says doctors believe they have been "divisive" and represent a return to the internal market Labour promised to abolish when it came to power.

He complains that money has flowed out of the health service and "into the hands of shareholders".

But he also notes what he calls a "devolution twist", with the Celtic nations "remaining truer to the NHS" than England has.

The past decade has also seen the drug rationing body, NICE, bed in.

And while it has been criticised in some quarters for denying patients access to cancer and dementia drugs, many experts elsewhere in the world have praised it for its efficient use of limited resources.

Nigel Edwards, director of policy at the NHS Confederation, describes the noughties as a period of "frenetic activity".

July 2000 - NHS Plan published setting out 10-year vision for the health service and paving the way for huge rises in spending
2002 - 2007 - Five-year period of record rises in NHS budget to bring health spending up to the levels seen elsewhere in Europe-
November 2004 - Ministers in England set target to halve MRSA rates by 2008. It is eventually met
March 2006 - Scotland becomes the first UK country to introduce a ban on smoking in public places. Other nations follow suit a year earlier
December 2008 - NHS meets 18-week waiting time target for routine hospital care
June 2009 - The first flu pandemic for 40 years is declared. Thousands infected by the end of the year in the UK, but death toll kept relatively low

"It is still too early to say how significant the decade will be, but compared to the 1970s and 1980s it has been much busier."

But for all the progress the fact remains productivity has still declined - and this promises to be the next big challenge for the NHS.

The bail-out of the banks means public sector spending is facing a squeeze with the prospect of no rises in funding - once inflation is taken into account - a real possibility for the best part of the next decade.

Professor John Appleby, chief economist of the King's Fund health think-tank, believes the pressure to save money could be "unprecedented in the history of the health service".

But for those who have not followed the minutiae of policy changes, what will the noughties be remembered for?

Probably three things - superbugs, swine flu and the smoking ban.

MRSA became the bogeyman of hospitals. Rising rates prompted accusations of dirty wards, leaving politicians promising to get tough.

The government - to the surprise of many - achieved what it said it would. Rates were halved in time for the March 2008 deadline and they are now a quarter of what they were at their peak.

But no sooner had the NHS begun winning the war against MRSA, than another bug reared its head in the national consciousness - Clostridium difficile.

Swine flu

And if all this was not enough to cope with, the NHS has also had to deal with the first flu pandemic for 40 years.

Swine flu swept across the world in late spring 2009, but more than six months on it has claimed only 299 lives in the UK so far.

Chief Medical Officer Sir Liam Donaldson says it was "extremely lucky" that the virus proved to be so mild.

Nonetheless, it has still tested the health service. At one point during the summer, GPs reported they were being swamped with patients, prompting ministers to set up a flu hotline and website to hand out drugs.

Woman sneezing
The last year of the decade has been dominated by swine flu

A mass vaccination programme has also been started and hospitals have been put on alert to cancel routine operations if the virus mutates and becomes more lethal.

But despite everything that has happened in the noughties, the most enduring memory of the decade in regards to health could well be the relatively straight-forward move to ban smoking in public places.

The crackdown, introduced in Scotland in 2006 and the rest of the UK a year later, was hailed as one of the most ambitious moves in public health for many years.

The long-term impact on public health is still to be determined, but there is evidence that tens of thousands of people have given up smoking as a result.

It may also have given policy-makers an appetite for more. A campaign is gathering momentum to end cut-price sales of alcohol by introducing a minimum price for alcohol.

Of course, such a move is unthinkable to many, but then who could have predicted where we would be at the end of 2009?

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