Editorials

Is the NHS getting better or worse?

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7426.1239 (Published 27 November 2003) Cite this as: BMJ 2003;327:1239
  1. Richard Smith, editor (rsmith@bmj.com)
  1. BMJ

    We need better data to answer the question

    The NHS is a shambles, and you are too much of a coward to say so. This was the gist of an email I received from an NHS consultant a few weeks ago. I answered–weakly in his eyes–that I couldn't be sure that the NHS was collapsing. I met many people who agreed with him but also many who thought otherwise. I didn't see clear evidence. Yet whether the NHS is improving may be the most important political question in Britain. The government, which has increased NHS expenditure by billions and launched into a 10 year modernisation plan, insists that it is improving. The opposition alleges that the money is being wasted. The people want a better health service, and a billion pound investment that came to nothing would be a national tragedy. So what is the answer? The main conclusion of an extensive, independent review funded by the Nuffield Trust and published this week is that we don't have the data to answer the question reliably.1 This in itself is an indictment–particularly when the NHS is awash with bodies auditing and inspecting it.

    The review–which is of quality in the NHS in England not the other three home countries–has been conducted by Sheila Leatherman, an American professor with appointments in both the United States and the United Kingdom, and Kim Sutherland from the Judge Institute in Cambridge. They describe the review as a mid-term evaluation of the Labour government's 10 year agenda described in The New NHS–Modern, Dependable: a National Framework for Assessing Performance, published in 1997.2 That document introduced the National Institute for Clinical Excellence (NICE), the Commission for Health Improvement (CHI), national service frameworks, primary care groups, and the concept of clinical governance. In January 2000–under …

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