Intended for healthcare professionals


Living through the NHS’s famine years

BMJ 2014; 349 doi: (Published 31 October 2014) Cite this as: BMJ 2014;349:g6536
  1. Andrew Street, professor of health economics
  1. 1Centre for Health Economics, University of York, York YO10 5DD, UK
  1. andrew.street{at}

Quality reversals and increasing deficits are symptomatic of deeper problems

The NHS is now well into its predicted famine years,1 and the strain is beginning to tell. Although quality is generally higher than it was 10 years ago, both the King’s Fund’s latest quarterly monitoring report and the latest quality watch report from the Health Foundation and Nuffield Health highlight several reversals in the past few years.2 3 Waiting times for hospital admission have lengthened, with more than 3.1 million people on the waiting list as of August 2014.2 Accident and emergency targets are increasingly missed—the last quarter’s figures showed that 5% of patients spent more than four hours in the emergency department—the highest seasonal level for a decade.2 Inpatient mental health services are becoming harder to access and the improving access to psychological services programme is a long way from serving all those deemed to require such services.3 Tighter eligibility requirements have led to substantial rationing of community based social care.4 Despite progress, England still lags behind other countries in terms of child health and cancer outcomes. Stress among staff has increased, and …

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