Lack of targets leads to underperformance in NHS services

BMJ 2005; 331 doi: (Published 21 July 2005) Cite this as: BMJ 2005;331:175
  1. Susan Mayor
  1. London

    Many services provided by the NHS in England and Wales have improved over the past year, but others, including mental health, sexual health, maternity, and dental services, have “been left behind,” according to an annual report on the state of health care. The report, presented to parliament this week, said that a lack of targets or requirement to collect information in these areas may underlie the poorer performance.

    It says that the NHS still has a long way to go to achieve a “patient-led” service. The annual report from the Healthcare Commission, an independent body that inspects and reviews various aspects of health services, focused for the first time on the experience of patients. It reviewed existing evidence on the experience of patients, including the commission's own surveys of patients.

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    Anna Walker, chief executive of the Healthcare Commission (pictured with chairman Professor Ian Kennedy) said there had been less progress in areas not covered by targets


    The results showed that patients were highly satisfied with many NHS services, with more than 90% of patients who took part in the surveys rating their overall care as good, very good, or excellent. However, there were some exceptions. Only 76% of patients in mental health services were satisfied with their care.

    Anna Walker, chief executive of the Healthcare Commission, said, “Clear improvements in prevention and treatment have occurred, whether there is some form of target or national service framework. There has been less progress in areas not so thoroughly covered by targets.”

    The report warned that less than half the people with mental health problems surveyed in 2004 said they had access to crisis care, such as an out-of-hours phone number of a mental health professional, when they needed it.

    Also, only two thirds of community based crisis resolution teams operated around the clock, the report found, even though the purpose of these services is to prevent the need to hospitalise adults with acute psychiatric crises by providing 24 hour community based treatment.

    The report found long waiting times for sexual health services, with 28% of people who needed to be seen urgently having to wait more than 48 hours and 29% of people who had symptoms of sexual infection waiting more than two weeks.

    The report highlighted major problems in some maternity services. It warned that three independent investigations into maternity services over the past two years had shown a range of problems, including inadequate support for women who do not speak English, overcrowding, and poor standards of cleanliness


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