Building a better UK health system

Sir Ian Carruthers, Acting NHS Chief Executive, gives an update on the Department of Health’s ten-year plan

 In 2000 the Department of Health published a ten-year plan for the NHS, a medium-term strategy with long-term aims for the benefit of patients.

Whilst there are still challenges ahead, even at this stage just over halfway through, the NHS is already delivering better health services and much better quality of care for patients.

If you ask people what their own personal experience has been of the National Health Service, it is usually very positive. Yet if you ask people about the overall state of the Health Service, they are less positive.

This may largely be due to publicity around NHS finances or job losses, but looking at the wider picture, we must remember that people come first and that is why there is an absolute determination to get the best possible care and treatment for patients.

The achievements of the last five years are significant. Putting this in context of the last decade’s spending and real increases in money, there has been a rise from £33 billion to £84 billion, heading to in excess of £92 billion next year.

While increases of this scale are not sustainable in the long-term, these resources are making big positive differences everywhere, now.

Waiting times are now at a record low with the average in-patient wait around nine weeks; noboby waits longer than 13 weeks for a first out-patient appointment; and most are seen a lot quicker than that.

Since 1 January 2006, NHS patients have been led to expect a maximum waiting time from GP surgery to treatment of six months with some specialities, such as cataracts and coronary and artery by-pass grafts, having a maximum wait even lower than that, with most receiving treatment within three months.

Improved outcomes have also been achieved. Lives have been saved through reductions in death from cancer, circulatory disease, coronary heart disease and suicides. Investment has helped some of this, and we are ahead of most national targets.

Investment has also made a big difference to a wider range of areas, such as stroke services, diabetes, mental health, care of the elderly - and it is important to recognise that the reform and progress being made in the NHS is across a wide spectrum of care, not concentrated in individual areas.

It is essential that a sustainable NHS is developed which can continue to improve locally and nationally, with ambitions to improve on national targets, providing services where local communities would like them to be - the time to address these issues is now and we can’t avoid that any longer.

While there is a deficit, it is worth putting it in perspective. It represents one per cent of the annual budget, with half of it accounted for by seven per cent of NHS organisations.

With a 9.7 per cent growth this year and a further 9.3 per cent next, investment and reform is making a positive difference to people’s lives but this doesn’t excuse the overspend.

That’s why this is being addressed with reform, with the aim of eliminating overspend in individual hospitals, making services better for patients.

This year our focus will be on three things. First, by the end of 2006/7 the aim is to have the NHS in net balance, and to achieve this there is hard work going on throughout the country.

Second, while we are helping many organisations to overcome their financial challenges themselves, we have also sent in teams of turnaround experts to help those facing the biggest challenges.

Third, through improving patient care and outcomes, this ambitious agenda will continue to deliver high quality services.

To make a success of this approach there will be greater continuing concentration on improving workforce efficiency,
productivity, improving clinical effectiveness, procurement and introducing best practice, in tandem with the White Paper implementation;introducing a shift to primary care so that services are closer to home in a safe and well resourced environment, which is what the public tell us they want.

We need to press ahead with reform, and push forward with the Independent Sector Treatment Centre (ISTC) programme which plays an important part in local reforms, getting more people care more quickly.

We should see ISTCs as a complementary helpful programme rather than something to be resisted, because we will need this capacity as health services develop and change. 

The NHS is in the middle of the biggest hospital building programme in its history to make the infrastructure of the NHS fit for the 21st Century.

Renewing the fabric of the NHS will continue using new and innovative ways of partnering and benefiting from the private sector.

Programmes such as LIFT, PFI, and ProCure21 have delivered 196 new NHS buildings worth around £9.2 billion since their launch, with 189 on the way. For example, ProCure21 is relatively new but a review of the 80 completed schemes shows that the procurement method has helped to deliver quality schemes with time and cost savings.

Two of the openings include the on time and on budget delivery of the £5 million urgent care centre for the Sunderland Primary Care Trust and the £18 million gateway surgical centre at Newham University Hospital.

In the NHS workforce, reductions are happening and no one is pretending they are not. Uncertainty is difficult for any member of staff who might be affected by workforce changes and, of course, I sympathise with anyone in this situation.

However many of the widely reported national figures are not based on the facts from trusts, but are derived from extrapolations of anecdotal evidence, and in some cases, from inaccurate media reports.

One example is in the North Cumbria Acute Hospitals NHS Trust, where the media reported that nursing jobs were being cut, but where the trust had actually taken on 39 nurses.

It does not make sense to look at the different issues in different trusts and add them up to get a crude overall figure.

Situations are different in every trust and hospitals are responding themselves too their own individual circumstances.

A recent snapshot survey of HR directors by NHS Employers showed that while it’s true that some trusts are planning redundancies, many other NHS trusts will use alternative methods to reduce their spending on workforce.

This includes freezing posts, redeploying staff to other roles or organisations, redesigning roles, and reducing or banning the use of expensive agency and temporary staff. The bottom line is compulsory redundancies are being kept to an absolute minimum.

Where trusts are adopting best practice,such as using less agency staff and increasing productivity, it’s a fact that more patients can be treated with the same or less staff.

Efficient trusts are already doing this by using their staff to the full and in the right places at the right times.

There is so much good practice currently being carried out worthy of praise in the NHS (ie, new hospitals, health centres,and success stories) that it would be very easy to do nothing but listen to those with good news.

But I am aware how absolutely essential it is that the Department of Health listens and hear those facing hard times too.Everyone - the public, managers, clinicians, politicians - want to continue to witness improving health services, which can only be achieved with reform.

From my experiences I believe that the environment is there for that to happen.