Targets out and standards in for next NHS three-year plan
pharmafile | July 22, 2004 | News story | |Â Â Â
The government has unveiled its masterplan for the NHS in the three years from 2005/6, slashing the number of national targets from 62 to 20, and shifting away from statistical measures towards health outcomes and patient experience.
The multitude of targets introduced since the NHS Plan in 2000 have been consistently criticised by people working in the NHS, who say their emphasis on cutting waiting times and other easily measurable indicators has distorted priorities within the service, but the government says the system has now done its job and is ready to be superseded.
"After inheriting an NHS that had suffered from decades of under-investment, we set tough targets to raise performance," said Health Secretary John Reid, hailing the achievement of NHS staff in cutting waiting times drastically and producing significant reductions in mortality rates of heart disease and cancer.
"Seven years ago, almost 120,000 people were waiting over nine months for treatment. Now just a handful wait that long. Targets have led to 19,000 more doctors and 6,500 more nurses since 1997, as well as the biggest hospital building programme in the history of the NHS.
"Patients now expect and are receiving faster, better treatment. The next stage is to build on these achievements by further raising the quality of care."
At the heart of the new standards framework, which will allow for local NHS bodies to tailor their services to local need, will be seven 'domains' designed to cover the whole range of healthcare, including prevention:
- Safety
- Clinical and Cost-Effectiveness
- Governance
- Patient Focus
- Accessible and Responsive Care
- Care Environment and Amenities
- Public Health
Standards within these areas are then divided into 'core' and 'developmental', the former representing the service levels the NHS has already achieved.
Dr Gill Morgan, chief executive of the NHS Confederation welcomed the shift in emphasis to local targets, saying: "Those areas that are already close to hitting national targets and standards will be able to concentrate on local targets. And, demand for local targets will put more pressure on the system in those areas of the country where they still need to concentrate on meeting the national targets and standards."
She added that setting local targets successfully would require a cultural shift to working with the public and clinicians rather than Whitehall in agreeing aims.
Dr Morgan said: "We will need to go beyond engagement to genuine mutual negotiation."
While there are fewer clinical targets, a major headache for NHS managers will be the Payments by Results system of financial incentives, aimed at stimulating the redesign of services around the patient but also expected to generate overall savings.
The system, to be in place from April 2005 will allow GP practices to take on the commissioning of services (although control of the budget will remain with PCTs) with the aim of providing practices with incentives to manage referrals efficiently and to reinvest any savings back into services.
Despite being in agreement with these aims, Dr Morgan warned that the 9% overall savings expected from the NHS would stretch trusts, especially those already struggling to control finances.
"The NHS is required to make a total 9% efficiency saving in its budget over the coming three years, which will be extremely challenging in itself and will make the other new targets more difficult to achieve."
The new guidance, entitled National Standards, Local Action says National Service Frameworks and NICE guidance are 'integral' to the standards-based system, and should be considered as part of the developmental standards of all NHS organisations. Three new NSFs for children, renal services and long-term conditions are currently in development.
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