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Premature deaths from cancer are down but visits to casualty are up, report says

BMJ 2005; 331 doi: (Published 15 December 2005) Cite this as: BMJ 2005;331:1426
  1. Andrew Cole
  1. London

    The latest progress report on the NHS in England by its chief executive, Nigel Crisp, shows a fall in the numbers of premature deaths from heart disease and cancer and a continuing fall in the average waiting time for hospital operations.

    Ninety eight per cent of patients in emergency departments are now seen within four hours, but the number attending climbed sharply, rising by 8.8% (1.4 million) last year. Emergency admissions went up by 5% (220 000), and visits to walk-in centres rose by more than a third. Numbers of ambulance journeys and outpatient consultations also rose.

    However, the number of emergency bed days–the measure of the length of stay of patients admitted to emergency departments–fell by 2% last year. This is welcome news for the health service, given that the service has a target to cut this figure by 5% by 2008. A health department spokesman said the improvement was due to improved, proactive care of patients, particularly those with chronic conditions.

    Launching the six month report, Sir Nigel said the NHS was at a turning point. “Over the last five years the NHS has been growing fast–with more staff and facilities. Now we must concentrate even more than before on using that capacity well to deliver quality for patients and value for money for the public.”

    He was confident the service would hit its targets by January of cutting waiting times for hospital admissions to six months and for outpatient appointments to 13 weeks. Meanwhile the number of people on the inpatient waiting list has fallen to 792 000–the lowest ever, and 500 000 less than the 1998 peak.

    The introduction of choice for patients had already had a profound effect and had helped to cut waiting lists, he said. He accepted that the reforms were causing “financial turbulence” in some trusts, but only a minority of trusts were affected, and he said that the forecast overspend of £620m was a small proportion of the total NHS budget of £76bn.

    He predicted that the final overspend would be closer to £200m or £250m. “In the big picture that's a tiny amount, but it's important because we have got to deliver on the finances. But we want to move on from that to make sure we're creating surpluses to reinvest in the service.”

    The NHS made savings of £1.7bn in the last 18 months, £200m ahead of its target. The average length of hospital stays fell from 7.4 days to 7.1 days, and the number of delayed discharges has fallen by 60% from the 2001 figure.

    The report shows that the number of premature deaths from heart disease and stroke fell by 31% between 1997 and 2003. Statin prescribing rose by 25% each year, and the number of revascularisations also rose sharply.

    Cancer mortality in people aged under 75 fell by almost 14% between 1997 and 2003, equivalent to 43 000 lives saved. Britain had the world's sharpest fall in premature deaths from lung cancer among men and the largest decrease in premature deaths from breast cancer among women. The Chief Executive's Report to the NHS: December 2005 is at

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