Anna Dixon, Director of Policy at The King's Fund, looks at the key health policies introduced by the coalition government and at whether they are likely to be effective in future.

1. Health policy under the
coalition government:
a mid-term assessment

2. A high-performing NHS?
A review of progress
1997-2010

3. Priorities for the incoming
government 2010
› Tackling unwarranted variations in access, use of services,
and quality of care.
› Ensuring that measures of patient experience have an
impact on the quality of care provided locally.
› Ensuring adequate investment in tackling preventable
causes of ill health.
› Providing better support and care for those living with
chronic conditions.

4. Health policy under the coalition
government
A mid-term assessment

5. Features of a high-performing
health system
› Accessible
› Safe
› Promotes health
› Supports people with long-term conditions
› Clinically effective
› Delivers a positive patient experience
› Equitable
› Efficient

6. Questions
› What does the latest available data tell us about
performance on each of these dimensions?
› What policies has the coalition government introduced?
› Are these policies likely to be effective? Do they address
the key issues?
› What should be done next? Are there emerging
performance issues to be addressed, or have issues been
overlooked?

7. Availability and access
A high-performing health system ensures that people have access to
a comprehensive range of services in a timely and convenient
manner.
› Waiting times remain stable except for in A&E where they
have risen.
› Access to NHS dentists has risen, as has public satisfaction
with dentistry.
› Access to new medicines provided through Cancer Drugs
Fund.
› Evidence of locally imposed restrictions to access.

9. Availability and access
A high-performing health system ensures that people have access to
a comprehensive range of services in a timely and convenient
manner.
› Waiting times remain stable except for in A&E where they have
risen.
› Access to NHS dentists has risen, as has public satisfaction with
dentistry.
› Access to new medicines provided through Cancer Drugs Fund.
› Evidence of locally imposed restrictions to access.

10. Safety
A high-performing health system minimises the risks of accidental
injury or death due to medical care or medical error.
› Reductions in those HCAIs that have been targeted:
› MRSA 25% (2011–12)
› C Diff 17% (2011–12).
› Increased incidence of patient safety events, but under-
reporting in primary care (0.5% of all reports).
› Claims of clinical negligence are rising – from 8,655 in
2010/11 to 9,143 in 2011/12.
› 14% of NHS hospitals inspected between April 2010 and
July 2011 did not meet CQC standards for safe
management of medicines.

12. Safety
A high-performing health system minimises the risks of accidental
injury or death due to medical care or medical error.
› Reductions in those HCAIs that have been targeted:
› MRSA 25% (2011–12)
› C Diff 17% (2011–12).
› Increased incidence of patient safety events, but under-
reporting in primary care (0.5% of all reports).
› Claims of clinical negligence are rising – from 8,655 in
2010/11 to 9,143 in 2011/12.
› 14% of NHS hospitals inspected between April 2010 and
July 2011 did not meet CQC standards for safe
management of medicines.

13. Promoting health
A high-performing health system supports individuals to make
positive decisions about their own health and acts to maximise its
positive impact on the broader determinants of people’s health.
› Life expectancy and healthy life expectancy are increasing.
› Smoking:
› Rates are continuing to decline.
› Alcohol:
› Alcohol consumption stabilised and starting to decline.
› Deaths from liver disease continue to rise.
› Obesity:
› Increasing for adults; stabilising for children.

15. Promoting health
A high-performing health system supports individuals to make
positive decisions about their own health and acts to maximise its
positive impact on the broader determinants of people’s health.
› Life expectancy and healthy life expectancy are increasing.
› Smoking:
› Rates are continuing to decline.
› Obesity:
› Increasing for adults; stabilising for children.
› Alcohol:
› Alcohol consumption stabilised and starting to decline.
› Deaths from liver disease continue to rise.

16. Managing long-term conditions
A high-performing health system supports individuals with long-term
conditions to manage them effectively and achieve a high quality of
life.
› From 2006/7 to 2010/11 the number of people with
diabetes increased by 25 per cent.
› 24,000 people with diabetes die every year from avoidable
causes related to their diabetes.
› 35% of patients said they had not received any or had not
received enough support to manage their long-term
condition.
› There was a fall in the number of emergency bed days by
13% 2003/4–2007/8, but between then and 2009/10 the
number rose by 7%.

17. Clinically effective
A high-performing health system delivers services to improve health
outcomes in terms of successful treatment, the relief of pain and
suffering, and restoration of functions.
› Decline in mortality amenable to health care, but the
United Kingdom still has highest rate in OECD apart from
the United States.
› Cancer mortality has fallen but five-year relative survival
rates compare poorly with OECD average.
› Mortality from cardiovascular disease has fallen, but
geographic variations in access and treatment persist.
› Compliance with 10 best practice indicators for stroke has
continued to rise, from 73% in 2008 to 83% in 2010.

19. Clinically effective
A high-performing health system delivers services to improve health
outcomes in terms of successful treatment, the relief of pain and
suffering, and restoration of functions.
› Decline in mortality amenable to health care, but the
United Kingdom still has highest rate in OECD apart from
the United States.
› Cancer mortality has fallen but five-year relative survival
rates compare poorly with OECD average.
› Mortality from cardiovascular disease has fallen, but
geographic variations in access and treatment persist.
› Compliance with 10 best practice indicators for stroke has
continued to rise, from 73% in 2008 to 83% in 2010.

20. Patient experience
A high-performing health system delivers a positive patient
experience. This includes giving patients choices and involving them
in decisions about their care, providing the information they need,
and treating them with dignity and respect.
› A fifth of NHS acute hospitals did not meet essential CQC
standards in nutrition and dignity of care for older people.
› The number of breaches of mixed-sex accommodation
guidance has fallen.
› Slight decrease in the proportion of patients saying they
were offered choice of hospital from 32% in 2010 to 29%
in 2011.

21. Equity
A high-performing health system is equitably funded, allocates
resources fairly, ensures that services meet the population’s needs
for health care, and contributes to reducing health inequalities.
› Gap in life expectancy between Spearhead areas and
England as a whole has not narrowed but the infant
mortality target has now been surpassed.
› Stark differences in life expectancy gaps within local
authorities (16.9 years in Westminster).
› Gap in life expectancy between those with a severe and
enduring mental health problem and those without is 10–
15 years.

23. Equity
A high-performing health system is equitably funded, allocates
resources fairly, ensures that services meet the population’s needs
for health care, and contributes to reducing health inequalities.
› Gap in life expectancy between Spearhead areas and
England as a whole has not narrowed but the infant
mortality target has now been surpassed.
› Stark differences in life expectancy gaps within local
authorities (16.9 years in Westminster).
› Gap in life expectancy between those with a severe and
enduring mental health problem and those without is 10–
15 years.

24. Efficiency
A high-performing health system uses the available resources to
maximum effect. This requires productivity in the delivery of care,
economy in the purchase of the goods and services a health service
requires to deliver care.
› £4.3 billion of productivity gains in 2010/11 (Audit Commission).
› NHS started 2012/13 with estimated surplus of nearly £1.6 billion.
› 12 acute or ambulance trusts ‘below par’ in respect of finance: 6
‘serious’.
› 15 (of 144) foundation trusts finished 2011/12 in deficit, at least
four judged by Monitor not to be viable.
› Drop in number of managers of 8,000 since March 2010 – a fall of
18 per cent.

25. Looking to the future
› Financial pressures on NHS
› Further cuts in social services budgets
› Loss of managers
› Transition risks
› With the dismantling of the old system nearly complete,
and the construction of the new one still under way… the
NHS is heading into treacherous waters, and the risks are
high. …much will depend on the ability of experienced
leaders – wherever they may be – to focus on the quality of
patient care and financial control to ensure that
performance does not slip back.