NHS is doing well, but financial squeeze poses serious risks, King’s Fund says

BMJ 2012; 345 doi: (Published 27 November 2012) Cite this as: BMJ 2012;345:e8106
  1. Nigel Hawkes
  1. 1London

Halfway through the term of the coalition government the NHS continues to perform well, a report from the healthcare think tank the King’s Fund has found.1

Substantial productivity gains have been made (£4.3bn (€5.3bn; $6.9bn) in 2010-11 and £5.8bn in 2011-12), without waiting lists growing longer or patients’ experience of care getting worse.

The incidence of healthcare acquired infections has continued to fall, with that of meticillin resistant Staphylococcus aureus falling by 42% and Clostridium difficile by 55% between May 2010, when the government took office, and September 2012.

Good progress has been made on the commitment to eliminate mixed sex wards, with the number of breaches falling by 96% in 16 months. And by the end of February 2012 around 12 500 patients had been given anticancer drugs, which they would not otherwise have had, through the cancer drugs fund set up in 2011.2

In the week in which the prime minister was due to announce a consultation on minimum prices for alcohol, the King’s Fund reminded us that alcohol consumption has stabilised and started to fall. The proportion of men exceeding the recommended number of units fell from 31% in 2006 to 26% in 2010 and of women from 20% to 17% over the same period.

Despite these encouraging findings, the fund strikes a downbeat note, pointing out that waiting times in emergency departments have risen since the end of 2009, that 15 foundation trusts finished 2011-12 in deficit, and that there have been rises in the number of emergency admissions of people with long term conditions and of emergency bed days among over 65s.

Anna Dixon, director of policy at the King’s Fund, said, “The NHS is continuing to perform well, but there are treacherous waters ahead. There are huge risks, especially in ensuring that quality of care does not suffer with the further financial squeeze. The stakes for patients could not be higher, and frontline leaders will have a crucial role to play in meeting the challenges ahead.

“Neither competition nor commissioning reform alone can be relied on to make the improvements needed. Fundamental change will be required to address the challenges of the future as the population ages and health needs change.”

Among other findings in the report are that the number of dentists carrying out NHS work rose by 7.4% between 2008-9 and 2011-12 (from 21 343 to 22 290) and that public satisfaction with the dental service rose by five percentage points in 2011. The number of suicides among men and boys rose by 8% between 2007 and 2008 but then fell by 4% by 2010.

Although patients’ scores of their experience of care have generally risen, so have complaints, but it is not clear whether this reflects more to complain about or an increasing propensity to complain.

The government has achieved real terms reductions in the cost of staff, but the pay bill in the NHS has continued to rise as a result of increments. The number of NHS managers has fallen by about 8000 since March 2010, to 35 555.


Cite this as: BMJ 2012;345:e8106