TONY BLAIR has failed to transform the National Health Service despite the biggest government spending spree in the 60-year history of the welfare state, according to an independent audit.
The “unprecedented” injection of more than £30 billion of taxpayers’ money into the service has achieved “significant” benefits, says the study, but has yet to translate into clear gains in the nation’s health. “There has been significant improvement in most areas the government has focused policies on,” concludes an analysis published this weekend by the King’s Fund, an independent health research group. “However, the NHS as a whole has not yet been transformed.”
The report, commissioned by The Sunday Times, states that “important problems” remain and that “there is as yet no firm evidence to show that Labour’s reforms have produced a marked difference in health outcomes”.
The findings come as public spending emerges as a key election battleground between Labour and the Conservatives. Blair has accused the Tories of planning to cut spending by £35 billion; the Tories argue that they will maintain spending increases but at a more prudent rate than Labour.
Since Blair declared that he would “save” the health service, spending on the NHS in England has jumped from £34 billion in 1997-98 to £69 billion this year. It is planned to rise to £90 billion in 2007-08.
The soaring budget has reduced waiting times and increased the number of doctors and nurses, say the authors; most patients now get to see their GP promptly and are treated within four hours if they attend an accident and emergency department.
For the first time since the NHS was founded, the upward trend in the number of people waiting has been reversed.
“Overall the results of the audit undertaken by the King’s Fund are positive,” said Niall Dickson, its chief executive. “Is the NHS service better than it was in 1997? The answer is yes — but so it should be since the budget has more than doubled.”
By 2008 Britain will be devoting 9% of its gross domestic product to health, a level comparable with other European nations. Yet standards of care remain better in other leading European Union countries. The King’s Fund believes that many improvements are still feeding through the NHS but gives warning that flaws remain.
The audit’s findings include:
Only slow progress is being made to reduce smoking and improve diet, which are seen as key factors in cancer and heart disease, two of Britain’s biggest killers. The audit — concentrating on England since reform has not been so marked in Scotland and Wales — was carried out on behalf of The Sunday Times to establish whether Labour’s changes are delivering results. Among the measures it assesses are the scale of funding; waiting times; performance in treating cancer, heart disease and mental health (three areas identified as priorities by Labour); and the level of resources including beds and staff.
Uncertainty over some data means that Labour politicians will claim that investment in the NHS is working, while the Tories will accuse the government of overstating results — and not knowing whether money is being well spent or not.
The audit finds that Labour has almost eliminated waits of more than 12 months for treatment and reduced many other waits. The verdict is that “huge progress” has been made, although more work is required, especially to reduce waiting times for diagnostic tests.
Improvements to health are more difficult to determine. The number of people dying from cancer and heart disease is falling, but the report says that this is in line with trends before the budget increases.
Dickson believes that improvement in health outcomes will eventually filter through: “The government injected large sums of money only in the past few years. It is not surprising that (health outcomes) have not yet been transformed. The NHS is making good progress but there is still a fair way to go.”
The report warns that if obesity continues increasing at its present rate, “it is possible that the improvements in life expectancy seen in the past three decades may level off or even start to decrease”.
On staffing, Britain still trails other western European countries. Although Labour claims to have met targets for 10,000 more doctors and 20,000 more nurses, the “position is not quite as impressive as at first it might seem”, say the authors.
Government figures simply count the number of people employed in the NHS, regardless of whether they are working full or part-time. The report says that “since more people are working part-time, this reduces the impact of extra numbers”.
The government’s claims for increasing the number of GPs are particularly misleading. Labour promised 2,000 more GPs by 2004, but counted in the figures are GP assistants and doctors whose practice is restricted. “The increase in the numbers of traditional GPs has been far more modest and, if measured in this way, the target has not been reached,” says the audit.
These findings were broadly echoed by the research of Lois Rogers, the Sunday Times medical editor, who examined in detail the day-to-day pressures of an average English hospital. While doctors there welcomed better funding, they complained that bureaucratic systems still obstruct care and modernisation of the health service.
The study also exposes doubts about government statistics on its national programme to reduce smoking. The programme was given a target of persuading 800,000 people to quit by 2006.
According to official figures the government is “on course” to achieve that target; however, the study reveals that those figures count anyone who has not smoked for four weeks as having quit. Other studies show that after a year only 15% will have remained non-smokers.
The report also addresses the question of value for money, noting that “efficiency” in the NHS seems to be falling, although it is hard to measure.
Despite the various caveats, the King’s Fund’s overall conclusion is optimistic. Last week the authors informally gave the government “7 out of 10” for “overall performance”.
