Effect of diverging policy across the NHS
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7522.946 (Published 20 October 2005) Cite this as: BMJ 2005;331:946
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Alvarez-Rosete et al are astonished at the difficulty in obtaining
some basic NHS statistics. I am astonished at their statement that “Since
1948 the NHS has provided universal coverage that is free at the point of
use…”.
In 1951 Nye Bevan and Harold Wilson resigned from the Labour
government because their colleagues forced through a proposal to introduce
prescription charges, and fees for dental and optical care (1). Labour
introduced the fees for dentures and spectacles before losing the 1951
election. The victorious Conservatives activated the prescription charge.
(1) Foot M. Aneurin Bevan. Vol. 2. 1945--1960. London: Davis-Poynter,
1973.
Competing interests:
None declared
Competing interests: No competing interests
I was surprised that the article didn't discuss what is thought to be
the best piece of evidence that the NHS in England has improved: A&E
performance. Then I double checked my sources.
What is clear is that English A&E departments are dramatically better
than they were 5 years ago when more than 1 in 4 people waited more than 4
hours for admission or treatment. Over the last 6 months fewer than 2 in
100 have waited more than 4 hours in England. The situation in Scotland,
which boasted about being the best in the UK in 2001
(http://www.scotland.gov.uk/News/Releases/2001/11/694), has certainly got
worse and is probably much worse than England. The current Scottish
figures (should be
http://www.isdscotland.org/isd/info3.jsp?pContentID=3589&p_applic=CCC&p_...
but website appears to be down as so I can't confirm )are hard to compare
and may not be reliable as the sampling technique (a 3 day sample once a
year) may be both unrepresentative and gameable. English departments have
to submit statistics on all-patient performance weekly.
I could find no site reporting useful statistics about Wales, but
anecdotal evidence suggests A&E performance is as poor as English
performance in 2000 in some of the larger hospitals.
It appears that the experience of reform in this part of health in
England is a success.
There is an ongoing debate in these pages about the evidence for and
against reform and it would be ironic indeed if the evidence for elements
of reform were undermined by the lack of information about what happens if
you don't do it.
Competing interests:
Has worked for Department of Health on A&E performance
Competing interests: No competing interests
Re: Omitted evidence?
We are indeed aware of improvements in reported performance in
Accident and Emergency (A&E) services in England. This is considered in a
paper one of us has submitted to the BMJ, which is on the impact of
targets on the NHS in England. But, the purposes of the paper that has
just been published were to update a previous analysis of performance
across the four UK countries, to look at both changes over time and make
cross-country comparisons; and the earlier study had not included A&E. Mr
Blacks’ observations, however, powerfully emphasises one of our main
messages, namely, the difficulty of obtaining comparable data across the
four countries: it is indeed extraordinary that comparable data are not
available in other countries for the key target of waiting times in A&E,
that was used to drive improvements in the NHS in England.
Competing interests:
GB was director of the Office for Information on Healthcare Performance at Commission for Health Improvement from 2001 to 2003 and had lead responsibility for the commission’s contribution to, and development of, star ratings for NHS organisations in England. JD is a board member of the Healthcare Commission and the Audit Commission.
Competing interests: No competing interests