This year's annual statement from QualityWatch, a joint research programme from the Health Foundation and the Nuffield Trust, comes at a difficult time for the NHS. In September, figures from Monitor and NHS TDA showed that this summer, two-thirds of acute hospitals in England were in deficit. In 2015/16 the NHS will have a hole in its finances to the sum of £2bn. By the end of the decade, spending pressures are expected to increase by £30bn, with most estimates suggesting that productivity savings will meet just a third of this.
As financial pressure mounts, the NHS is working hard to meet rising demand.
While there is no inexorable relationship between funding and the quality of care, as financial pressure mounts, the NHS is working hard to meet rising demand. The QualityWatch annual statement provides much needed independent scrutiny of the quality of care delivered to patients and services users in England.
Signs of stress
What does this year’s statement tell us? Looking over the last ten years, quality has been on an upward path. Things are better - overall the NHS and social care system provides higher quality than a decade ago, with real improvements in a number of areas including hospital safety, staffing levels and patient satisfaction. The UK continues to lag behind other OECD countries on some important outcome indicators, but on at least one area (breast cancer mortality) the gap appears to be narrowing.
But there are signs of stress. Waits for emergency and planned hospital care are rising – the average patient now waits four days longer for planned treatments than they did in 2010, and for over a year major accident and emergency departments have breached the target for 95% of patients to be admitted or discharged within four hours of arrival.
Caring for the most vulnerable
A key test of any health system is how it cares for the most vulnerable in society. On World Mental Health Day, the basic message is that mental health services for children and adults are becoming harder to access in England.
There was a 17% rise in inpatient admissions for people detained under the Mental Health Act between 2008/9 and 2012/13.
There was a 17% rise in inpatient admissions for people detained under the Mental Health Act between 2008/9 and 2012/13. This has led some to suggest that declining hospital beds and increased pressure on them from emergency admissions may be resulting in increased detentions to secure access to inpatient care. Some areas of England reported between 8% and 37% of their admissions were from out of area in 2013 - meaning vulnerable people being treated away from their families and friends.
Average waiting times for patients needing a specialist mental health assessment grew by a third between 2010/11 and 2012/13, reversing previous progress. By 2013 patients needing care for mental ill health waited almost twice as long for an assessment as those with physical ailments, and were on average a fifth less likely to be seen by a consultant within 18 weeks.
Given this imbalance between waits for mental health and physical health care, the announcement earlier this week that the government will introduce waiting time targets for some groups of people with mental health problems in England is clearly welcome, but it is just a start.
Cracks in mental health care are also showing outside of hospital and in the services for children. For example, half of Early Intervention in Psychosis (EIP) units (which help young people aged 14 to 35 to recover from a first episode of psychosis), report that the quality of their service had decreased in the past year .
Cause for concern
So this year, despite the limitations of national averages which mask variation and real deterioration (and improvement) across the country, the QualityWatch annual statement sends a signal of a service under pressure. With current available measures of quality, we see through the glass darkly, but the sight is cause for concern.