The NHS is improving and meeting many targets, but because much of the improvement comes from quick fixes, progress is not sustainable. The Audit Commission has compiled a database of performance indicators and other management information for all NHS Trusts and this finding results from comparing data with that gathered one year ago.Trusts are using a range of short-term solutions to meet targets and keep everyday services going. More than half of trusts have been diverting money for specific improvements to keep services running in the short term. Procurement of IT and medical equipment is being deferred, making it more difficult to improve areas like cancer care. Patients are being treated in private hospitals and one-off payments being made to consultants for extra sessions to reduce waiting lists. Hospital buildings are being allowed to deteriorate so maintenance money can be spent on patient care.
The Commission believes that the aims of the NHS Plan are at risk because of the current arrangements for measuring success. Waiting times are only part of the picture and a more rounded approach, looking through the eyes of the patient is required. It advocates a focus on a few major targets, such as reducing deaths from cancer, and allowing local health services to tailor plans to local needs.
Trusts are currently ranked on a narrow range of performance indicators and the Commission believes that more robust arrangements should be devised based on a broader range of factors. It supports its argument with evidence from some of the 29 top rated trusts where it found weak management and financial arrangements. The Commission supports freedoms being granted to high performing hospitals, but calls for a rigorous assessment for Foundation status so that freedoms are given to the right trusts on the right basis, ensuring that they have the capacity to maximise the impact of public expenditure.
The Audit Commission report has been welcomed by the NHS Confederation, which represents managers. Dr Gill Morgan, Chief Executive of the Confederation, said: “This report exposes the myth that there are too many managers in the NHS. Managers are leading change across the service. It makes clear that investing in good management is one of the key ingredients to really improving services for patients.”