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PDF version http://image.guardian.co.uk/sys-files/Guardian/documents/2008/10/15/NHS.pdf
The quality of NHS care in England has improved by leaps and bounds over the past two years, the independent health watchdog says today.
However, 60% of hospitals are still not dealing with superbug infections effectively, and 69% of GPs do not provide patients with the easy access to appointments that ministers want to see.
The mixed picture emerged in the Healthcare Commission's annual performance ratings for 391 NHS organisations. It said 62% of trusts were providing a good or excellent quality of service, compared with 41% two years ago. Financial performance improved even more sharply, with 69% getting high grades, compared with 16% two years ago.
Sir Ian Kennedy, the commission's chairman, said patients should celebrate the success of 42 trusts that received a "double excellent" rating, scoring top marks for both quality and finance. Last year there were 19, and just two in 2006.
Foundation hospitals did particularly well on the scoring system, which measures performance against dozens of criteria including patient satisfaction and achievement of government targets.
But serious weaknesses remain across much of the NHS. In the year to April a quarter of trusts failed to put in place adequate systems of infection control. Just over half did not achieve the government's target for reducing MRSA rates by 20% each year. Only 40% of trusts managed to introduce the right systems and hit the target.
Kennedy said trusts risked losing the licence to treat patients if they did not achieve an adequate standard of hygiene before the end of March, when his inspectorate is due to be replaced by the Care Quality Commission.
Spot checks over the past year found serious breaches of hygiene regulations at four hospitals and minor lapses at almost every trust visited. Inspectors will now begin a programme of spot checks of primary care, ambulance services and mental health trusts.
Anna Walker, the commission's chief executive, said tackling MRSA and C difficile was not enough. Trusts should monitor other infections including norovirus, a vomiting disease that strikes in winter.
She noted "a dramatic decline" in the number of primary care trusts meeting the target that every patient should be able to see a GP within two working days. This year 31% of practices met the target, compared with 80% last year.
The change was due to a new sampling method that asked thousands of patients about their experiences of trying to get an appointment, instead of relying on information from GP practices.
Dr Hamish Meldrum, chairman of the British Medical Association, said the report was misleading about GP waiting times. He said "A recent survey showed almost nine out of 10 patients were satisfied that they were able to get an appointment within 48 hours."
Gary Needle, the commission's head of assessment, said it could not be ruled out that GPs had been lying about how well they conformed to the target.
The commission congratulated hospitals for cuts in waiting times for cancer patients and for making good progress towards treating all patients within 18 weeks of referral by a GP.
Ambulances reached 77% of life threatening emergencies within eight minutes, exceeding the government's target of 75%. And mental health trusts helped thousands of patients by providing more crisis resolution teams in the community.
Trusts in northern England got the highest grades across all services, while standards in London fell well below average.
Alan Johnson, the health secretary, wrote to congratulate 57 high-performing trusts and told six "double weak" trusts to meet his officials to explain themselves.
This week, the prime minister will promise to make public services more accountable and responsive to those who use them
Scandals and Speakers come and go, clamours and controversies build, explode and fade. The enduring Big Question of British politics is about public services. How do we make our schools, our hospitals and our police forces responsive and accountable to those who use them? How do we reward those who perform well and penalise those who fail the public? How do we encourage innovation among the professionals while at the same maintaining minimum national standards? How do we maximise the bang we get for all those taxpayers' bucks? Whoever can find the complete answer will have reached the Holy Grail.
Labour has been on this quest for more than a decade. Tomorrow, the government will present its latest answer when Gordon Brown unveils "Building Britain's Future", an attempt to relaunch his premiership which he will not call a relaunch. Here are some of the phrases I predict you will hear from the lips of Mr Brown and his ministers. We will be promised a "radical gear change". They will talk about "unlocking innovation" among those who deliver services and an "information revolution" to empower those who rely on them. It will be presented as a plan which is "radical about power while being realistic about money".
Ah yes, money. This government has poured unprecedented sums into public services. Total spending on the NHS has more than doubled in real terms since it came to power. Spending on education has grown by nearly two-thirds. The laziest accusation against Labour is that all those resources have been wasted. That isn't true. In 1997, more than 300,000 people waited more than six months for NHS treatment. Ten years later, the number had fallen to fewer than 1,000. There are a record number of police officers. The school building stock, neglected for a quarter of a century before New Labour came to power, has been completely renovated.
What is worth arguing about is whether all that money has been and is being spent effectively. Some hospitals are still so incompetent that they kill patients they should be curing. More than 30,000 16-year-olds are still leaving school each year without a single GCSE to their names. There are wild variations in the performance of different constabularies because the police remain the great untouchable when it comes to public service reform.
New Labour's journey can be divided into five stages. In Phase One (1997-2000), they tried to drive public services through centrally imposed diktat. There were more Five Year Plans than the Soviet Union under Stalin. There were more "tsars" than all the Russias. Thousands of targets were set, sending out performance directives on everything from teenage pregnancies to the annual gross weight of dog turd local councils were expected to collect. There is something to be said for setting goals and establishing benchmarks against which to measure progress. But the proliferation of crude targeting demoralised professionals, encouraged a tick-box mentality and often had perverse and counterproductive effects. They helped to raise standards from poor to adequate. They couldn't get you from adequate to good or excellent.
Tony Blair began to grasp that the dirigiste approach was not delivering the results he hoped for as he approached the end of the first term. He then moved into New Labour Phase Two (2001-5) in which his lodestars were diversity, choice and competition. This resulted in a tentative shift towards giving schools and hospitals more autonomy to manage their budgets, experiment and innovate. The result was foundation hospitals and city academies. This did not prove to be a complete answer either. One handicap was that many in the Labour party were allergic to the concept of using choice to pursue excellence. They remained attached to uniformity even if it meant mediocrity. They did not want to move in the same direction as Mr Blair.
Another problem was that his idea of devolution was limited to handing down power to head teachers or hospital managers. Choice remains an empty word for many parents, pupils and patients. Then there was the huge obstacle of his chancellor. Gordon Brown constantly and often very effectively used his power at the Treasury to sabotage the reforms pursued by his next-door neighbour. It never struck me that the Mr Brown of those years really had a theory of his own about how to reform public services. He simply knew what he didn't like. What he didn't like was anything proposed by his rival. As a senior member of the current cabinet says: "Gordon wasn't necessarily against reform, he was just against any reform proposed by Tony. It was about authorship as much as anything." As a result, reform happened in a compromised and cramped way.
The latter part of Tony Blair's reign saw New Labour Phase Three (2005-07). By now, he had fully bought into the idea that the best way to achieve change was to make it self-fuelling. Ministers and civil servants sitting in Whitehall could not hope to succeed in driving up performance in thousands of individual schools and hospitals. The way to lift standards was to empower their customers. The snag was that Mr Blair finally reached a clear view of what to do just as he was running out of political road. He could only get his final round of schools reform through the Commons in diluted form and with the support of the Tories.
In Phase Four (2007-09), reform petered out. Gordon Brown got to the premiership winking and nodding to his party that he would smother that Blairite stuff about choice, competition and diversity that many in Labour found so difficult to get their heads round. Some quiet progress continued here and there. At health, Alan Johnson persuaded GPs that it may be an idea to open their surgeries at times when it would be more convenient for those who paid their salaries. But many GPs still firmly shut the doors at evenings and weekends. The foot came off the accelerator of reform and inertia set in.
This week, we enter Phase Five (2009-?). Suddenly, the consumer is again supposed to be king. Tomorrow, the prime minister will tell us that his new concept is to make a big shift away from the Whitehall command and control which he personified as chancellor and towards the power of the customer. He has been influenced by Liam Byrne, chief secretary to the Treasury, who has been focused on this for some months. Among the many things wrong with the target regime, Mr Byrne realised that there weren't really any meaningful penalties for those who didn't hit the targets. Their latest answer is to give "entitlements" to parents, pupils, patients and everyone else who uses public services. We will be told what we should be able to expect from the NHS, schools, local councils and police forces. The idea is that this creates pressure to perform from the bottom up rather than vainly trying to drive everything from the top down.
Mr Brown recently wrote: "Government must transfer more power to parents, pupils and patients." His belated conversion to consumer power shows the intellectual and political odyssey he has been on. When he was chancellor and fighting his bloody battles with Mr Blair, Mr Brown delivered an 11,000-word lecture in which the core argument was that the consumer "cannot be sovereign" in the NHS because patients did not have enough information to make sensible choices about their healthcare. He has now committed a volte face, though I doubt anyone will get him to admit it tomorrow. He will extol the benefits of being able to use the internet to compare the performances of hospitals and schools. There will be a website on which patients can give online reviews of GPs - TripAdvisor for doctors. His ally, Ed Balls, the children's secretary, plans to introduce "report cards" about school performance for parents. "The longer a prime minister is in the job, the more he understands how much needs to change," comments one member of the cabinet.
That still leaves the Big Question, the £600bn question, the question with which Labour has wrestled for more than a decade. How do you put the public in charge? "Entitlements" sound dandy, but they will be meaningless unless people are equipped with a means of enforcing them. Am I entitled to a good state school at a reasonable distance from my home for my child? If the local authority fails to deliver, what is the mechanism of redress? Mr Balls is launching a related white paper on Tuesday which will promise an entitlement to personal tuition. That's great if the teacher is good. It's hopeless if the teacher is rubbish. What will a parent be entitled to do about useless teachers?
Am I entitled to expect the police to respond promptly if I am the victim of a crime? If they don't, how do I make my voice heard? Am I entitled to be treated within a set period of time at accident and emergency? If I'm not, what lever can I pull to penalise those who have failed to deliver the service that my taxes have paid for?
These are the questions that Gordon Brown and his ministers ought to be asked tomorrow. They will need to have some persuasive answers. If they don't come up with any, we will be entitled to conclude that they still haven't cracked it.
http://www.guardian.co.uk/commentisfree/2009/jun/28/gordon-brown-buildin...
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