Four Department of Health Czars published reports covering cardiac care, cancer treatment, emergency services and mental health to examine the progress made in the NHS over the last decade.
National Service Framework for Coronary Disease in England
Prof Roger Boyle, National Director for Heart Disease and Stroke
Key points of report:
- 1997: “coronary heart disease capital of the world”, with high mortality rates, poor access, long waits
- NSF published in 2000, setting out high-level standards and reinforced by NHS Plan
- Key achievements: rapid decline in CVD mortality: 40 per cent target will be met early
- Waits for coronary bypass surgery down from up to two years in 1999 to 3 months
- Tobacco control programme
- 3.4m people now taking statins, 9,700 deaths avoided each year
- over 80 per cent of people now treated within 30 minutes of arrival at hospital
- 3000 public access defibrillators now installed: over 100 people resuscitated
- 90 new catheter laboratories across England costing £125 million
“[in 1997]…public health measures struggled to impact on public attitudes or behaviour. Patients with heart attacks were not getting treatment within the crucial early hours and patients were waiting up to two years for heart surgery.”
“A number of factors have contributed to the falling waiting times: more staff - surgeons, cardiologists and nurses; new facilities - we have invested £600 million in new or expanded facilities; greater efficiency - better management of staff and resources to make efficient use of the capacity; and, patient choice - allowing patients to travel to wherever they can be treated soonest.”
“Cardiac services have improved enormously in England since 1997 driven largely through the impetus of the National Service Framework and the NHS Plan.”
“The NSF in particular succeeded in uniting Government and clinical agendas to provide a formidable force that has delivered dramatic improvements across the entire patient pathway supported by major public health initiatives and better public understanding of the determinants of disease. Importantly, we are beginning to see improvements in the inequalities that exist within cardiovascular disease.”
Improvements in Emergency care in the past 10 years
George Alberti
Key points of report:
- 1997: huge waits in A&E, junior doctors doing most of the work
- NHS plan included 4 hour target for A&E.
- Key achievements:
- Senior decision-maker now makes initial diagnosis
- 2003: over 25 per cent of patients spent more than 4 hours in A&E, now 98 per cent seen within that time
- Walk-in centres and minor injury units have improved access
“[in the 1990s] Junior doctors were doing much of the work in A&E departments, supervised by registrars. Patients and the public were becoming increasingly concerned about the length of time they had to wait, even for very simple problems, and it was recognised that improvements were essential.”
“Thanks to the hard work and professionalism of the full range of NHS staff, and their willingness to work in new ways, A&E services have been transformed over the past few years.”
“An urgent and emergency care strategy, due for publication shortly, is currently being developed. This will continue the direction of encouraging health communities to deliver appropriate care closer to home, helping to ensure that patients receive appropriate, timely emergency and urgent care wherever, and whenever, they need to access the system.”
Cancer Ten Years On: Improvements across the whole care pathway
Prof Mike Richards, National Cancer Director
Key points of report:
- 1997: survival rates lagged behind Europe, no co-ordination
- Key achievements:
- 1997-9 targeted investment for breast, colorectal and lung cancer
- 2000 NHS plan covered whole care pathway
- Smoking prevalence down from 28 per cent in 1998 to 24 per cent per cent in 2005; 1m people have quit since 1999 through NHS stop smoking services.
- 62% increase in breast cancer diagnoses, following extension of age range to 50-70 years (from 50-64) and upgrading in mammography
- Improved cervical screening technology
- 150,000 bowel cancer testing kits sent out for 60-69 year olds; by 2009, 2 million people will be screened each year and 3,000 cancers detected
- 99 per cent of urgently referred patients seen within 2 weeks; over 99 per cent start first treatment within 31 days; and 96 per cent start treatment within 62 days of urgent referral.
- £520m investment in equipment
“[in 1990s] Coordination of care between all the healthcare professionals involved in cancer was often lacking and standards of care varied widely across the country. The need for change had been recognised in a report from the Chief Medical Officers for England and Wales (The Calman-Hine Report) in 1995, but no significant investment had been made and progress had been very limited.”
“In 1997, waiting for assessment, referral and treatment for cancer was a major source of anxiety to cancer patients and to the public at large. Many patients reported that their condition deteriorated while they were waiting. Less than two thirds of patients referred urgently by their GP with suspected cancer were seen within 2 weeks.”
“Major progress has been made with treatment of cancer over the past ten years. This applies to surgery, radiotherapy, chemotherapy, hormonal therapies and novel treatments.”
“We know that patients’ experience of cancer care has improved in recent years. A survey conducted by the National Audit Office (NAO) in 2004 showed considerable improvements in comparison with a survey commissioned by the Department of Health in 2000.”
“The improvements in screening, diagnostics, treatment and care have been delivered through a combination of investment and reform.”
Mental Health 10 years On: Progress on mental health care reform
Louis Appleby, National Director for Mental Health
Key points of report:
- 1999: 10-year reform programme launched
- Key achievements:
- Annual investment up by over £1.5bn
- Increased staff: 1300 consultant psychiatrists, 2700 clinical psychologists and almost 10,000 mental health nurses
- 7-fold increase in use of modern anti-psychotic drugs
- specialized community services: 343 crisis resolution teams, reducing admissions to hospital; 252 assertive outreach teams providing intensive support; 118 early intervention teams for young people
- hospitals refurbished and modernised
- Suicide rate among general population has fallen by 500 per year
“The national patient survey shows that 77 per cent of community patients rate their care as good, very good or excellent. The suicide rate has fallen to the lowest figure on record - and records began in 1861. The WHO has said that England has the best services in Europe.”
“A conservative estimate of the real terms increase since the NSF is therefore more than £1.5 billion, an unprecedented rise.”
“Mental health wards had become neglected places, physically and therapeutically impoverished.Now there are modern wards in many parts of the country, providing single rooms, bright surroundings and outdoor space, and a programme of work is in place to replace or refurbish all remaining unsuitable wards.”
“Since 1997 suicide in the general population has fallen by around 500 deaths per year. Our current suicide rate is lower than any on record (records began in 1861) and is one of the lowest in Europe. Suicide in young men, which had doubled since the 1970s, has now fallen for six consecutive years - better recognition of risk by front-line agencies may partly account for this.”
“…recently Dr Matt Muijen, WHO head of mental health in Europe, said publicly that England has the best mental health services in Europe and that this is acknowledged in other countries. Interestingly, he also said we had a “culture of criticism” that prevented it from being acknowledged here.”
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