Progress on NHS reform

Executive summary

The Five Year Forward View is a compelling vision for reform. By changing the way services operate, NHS England aims to deliver better care with less resource. It estimates that the NHS must become 2-3 per cent more productive each year to close the funding gap by the end of the decade. This report collects available evidence on the progress towards those ambitions over this Parliament.

In a number of areas the NHS has made improvements. After a decade of unprecedented increases in funding, the health service has managed under the pressure of flat budgets and rising demand. Patient satisfaction is at an all-time high. The NHS has become more efficient. Patient choice has been extended to primary care, mental health services and community care. The first hospital has been put into special administration and the failure regime extended to primary care. There has been the first new entrant into the provider market (Hinchingbrooke). The Integration Pioneers and the Better Care Fund represent real steps forward in the integration agenda. Transparency on data and outcomes has greatly increased.

However the balance of evidence suggests a less positive picture. Savings have been made through short term efficiencies and not sustainable reform to services. When looking across the NHS, there has been disappointing progress towards a more sustainable workforce, a more integrated health service, greater capacity in out of hospital care, greater use of alternatives to A&E, and greater competition and patient choice.

NHS reform: Progress report

health chartThis lack of progress is affecting NHS performance against key measures. Visits to A&E departments and emergency admissions have grown considerably over the last five years; A&E waiting times have reached a decade high; and hospital bed occupancy is high and rising.

The NHS is also showing increasing signs of financial distress. Hospital deficits are expected to total more than £800 million in 2014-15, with 62 per cent of acute hospitals already in the red. By the time of the Autumn Statement in 2014 the health service was in need of an additional £2 billion in funding compared to the 2010 settlement.

There is now widespread recognition that the NHS must reform further and faster than ever before. As Simon Stevens has argued, “We are at a pivotal moment. Either we move to something different or we begin to see services run into the sand.” The next Government must do better to accelerate NHS reform.


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