PCT — DoH annual report

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The annual report of the DoH
The DH’s last annual report, essentially providing Parliament with an account of how the Department has spent the resources allocated to it — as well as future planned spend to 2007/08 — is worth a read. It describes the full set of policies and programmes, giving a full breakdown of spending within these programmes in a detailed annexe. Progress against the NHS Plan is a big element. The 135-page report is full of useful facts and figures but of course comes with the usual 'health warning'. There is coverage of almost every major issue affecting today’s NHS — see www.dh.gov.uk.

The quest for quality
In an essentially independent ‘mid-term’ report on the Government’s 10-year quality agenda since coming to power in 1997, the Nuffield Trust has published The quest for quality. This is a detailed analysis of the progress of the quality agenda first articulated in the White Paper The new NHS: modern, dependable, published in 1997. This introduced the concept of clinical governance, NICE and CHI, picked up again in 1998 in A first class service and then again in the NHS Plan. Co-authored by Professor Sheila Leatherman and Dr Kim Sutherland from Cambridge University, the conclusions are rather equivocal because, as the authors point out, the NHS remains data rich and information poor.

‘There are significant data and analytical weaknesses in the NHS which mean that carrying out a comprehensive, robust, definitive, transparent and defensible assessment is impossible,’ said Professor Leatherman. But the report did suggest the NHS was basically ‘on track’ for achievements in the areas of capacity, access, public perception, effectiveness and equity — which the authors believe combine the essential definition of quality. The authors added that the modernisation programme was the ‘most ambitious, comprehensive and intentionally funded national initiative to improve healthcare quality in the world.’

But there were problems highlighted including PCT commissioning, lack of clinical engagement, ‘targetitis,’ an over focus on process indicators rather than final health outcomes and the role of the ‘centre.’ ‘The greatest threat to the sustainability and progress of the quality agenda is likely to be the unrelenting and often damaging politicisation of the NHS,’ conclude the authors. Also see ‘Is the NHS getting better or worse?’ for a useful BMJ editorial review.

Journalist Harriet Sergeant has published an interesting critique on the new NHS. Managing not to manage: management in the NHS suggests that the NHS now has ‘more football referees than players, has managers spending most of their time coping with Whitehall’s relentless interference, and the closer you get to the ward, the less managed the system becomes’.