King’s Fund praises work on smoking and cancer but says NHS is still “not world class”

BMJ 2010; 340 doi: (Published 13 April 2010) Cite this as: BMJ 2010;340:c2018
  1. Helen Mooney
  1. 1London

    The NHS is not yet world class and needs to change rapidly to meet its future challenges, says a new report by the healthcare think tank the King’s Fund.

    The review of the NHS in England since 1997 describes the rise in health inequalities between different groups in society as the “most significant failure” in health care.

    It warns that the health service is unprepared for the future and now faces “the worst of times,” with a £21bn (€24bn; $32bn) gap in funding by 2014 as it struggles with tighter budgets and ever increasing demand, including meeting the needs of an ageing population.

    But it also highlights the achievements made since 1997, including reductions in waiting lists and in numbers of deaths from cancer and of strokes and heart attacks. It also praises the smoking ban and a fall in the number of people smoking.

    Chris Ham, the King’s Fund’s chief executive, warned in a press release accompanying the report that doing more of the same in the NHS was not an option.

    He said, “The next government faces a huge challenge in nursing the NHS to full health at a time when funding will grow very slowly, if at all . . . The NHS will have to do things differently by embracing innovation and becoming much more efficient in how it uses the £100bn it spends each year.

    “The NHS must now transform itself from a service that not only diagnoses and treats sickness but also predicts and prevents it. If the same energy and innovation that went into reducing waiting times and hospital infections could be put into prevention and chronic care, the NHS could become truly world class. This will not be easy, and it is vital that politicians engage in an honest dialogue with the public about the changes needed.”

    The report is particularly critical of the government’s attempts to stop the rise in alcohol consumption, saying that no sign has been shown that its aims have been achieved. The number of admissions to hospital related to alcohol consumption rose by 69% from 2002-3 to 2007-8, to reach 863 000.

    Moreover, on obesity the report says “there is no sign of the tide turning.” In 2007, 24% of men and women were classed as obese, but experts predict that by 2020 the figure will rise to 41% of men in 2020 and 36% of women.

    And despite good intentions to reduce health inequalities, “in sharp contrast to the previous administration” progress in this area has been “elusive.”

    The review identifies three key challenges now facing the NHS. The financial challenge must be the NHS’s top priority in the short term, with a “relentless drive” to improve productivity. The public health challenge means that the NHS must reverse rises in levels of obesity and alcohol related illness and replicate the progress it made in reducing smoking. Lastly, the NHS faces a demographic challenge of an ageing population, and it still has a long way to go to transform the delivery of care to support rising numbers of people with chronic conditions such as diabetes, heart disease, and dementia.


    Cite this as: BMJ 2010;340:c2018


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