NHS standards 'threatened by pressure to hit targets'

After three years in intensive care the NHS is growing gradually stronger but the weight of public expectation is putting its recovery at risk, a government panel of advisers warned yesterday.

Deaths from cancer and heart disease are falling and waiting times are shortening, but the pressure on hospitals to meet their targets is threatening standards of care, the experts said.

In their second annual report, the 30 members of the NHS Modernisation Board told ministers yesterday that plans to reform the NHS were "on schedule" but there were major challenges ahead.

Presenting their findings to Tony Blair at a 15-minute meeting in Downing Street yesterday, the experts' upbeat tone contrasted with the negative spin put out 24 hours earlier by the Whitehall press machine – intended to reduce expectations of the report.

Downbeat headlines yesterday warned the report would make "uncomfortable" reading for ministers, but the actual document is overwhelmingly optimistic in tone, promising that "fast and effective progress can be made" and saying the once distant ambition of a patient-centred NHS is "drawing visibly closer".

Mr Blair promised the panel of advisers that he remained committed to modernisation of the NHS "whatever else is going on" and commended the "huge sense of collective endeavour". But in response to complaints from panel members about negative press reporting, he said: "I wish we could get positive coverage. I think we will reach a critical mass where people are forced to see things positively."

On the important measure of waiting lists, the report records big progress in cutting the longest waits. There was a 61 per cent fall in the number waiting more than 12 months for inpatient treatment, and almost none waited more than 15 months. But it adds: "Achieving our targets for 2005 [a maximum six-month wait for inpatient treatment] will be a serious challenge."

Just how serious is spelt out, not in the report, but in figures collected by John Yates of Birmingham University's Health Management Centre. Writing in the Health Service Journal, Mr Yates notes that having cut 30,000 in the past two years from the list of people waiting more than six months, the NHS has to cut 237,000 over the next two and a quarter years to meet the target.

While in specialties such as heart surgery good progress has been made and those waiting more than six months have come down by 75 per cent since 2000, in others, such as orthopaedics, the six-monthplus waiting lists are unchanged. "The target of ensuring no patient waits more than six months for treatment by March 2005 looks much more difficult to achieve," Mr Yates writes.

The Modernisation Board commends other changes in the past year, including an increase in staff and beds, a fall in the number of operations cancelled on the day and a big expansion of patient choice. "The monolithic paternalism of the old NHS is starting to be replaced by new and innovative ways of working," the report says.

But capacity constraints and the commitment of senior medical staff remain the biggest problems.

Professor Peter Hutton, president of the Academy of Royal Medical Colleges, warned the Prime Minister of the damage that could be done by a target culture aimed at increasing the quantity of treatment. "The challenge facing us is to keep the balance between growing capacity and maintaining quality. I am glad that is now an openly discussed issue and no longer a point of friction between the colleges and the department," he said.

Carol Black, president of the Royal College of Physicians, called for "improved relations between the professions and management" – an apparent reference to the stalled negotiations over the consultant contract – among her top three priorities for the NHS. The others were improved standards of care and better relations between doctors and patients.

Paul Streets, chief executive of Diabetes UK, told Mr Blair there was still an issue about managing public expectations. "Many capacity investments will take some time to show a real change," he said.

* Prescription charges are to rise 10p to £6.30 from April, an increase of 1.6 per cent.

Curing the health service

What has been achieved:

* Heart disease deaths down 14 per cent since 1997

* Cancer deaths in under-75s down 6.5 per cent in three years.

* Nurses increased by 4.3 per cent

* Consultants increased by 5.7 per cent

* 12 month-plus waits down 61 per cent

* 84 per cent of patients seen by GP within two working days What there is still to achieve

* Heart disease deaths down 40 per cent by 2010

* Cancer deaths down 20 per cent by 2010

* No patient should wait longer than 12 months for in-patient treatment by March 2003; six months by 2005

* All patients should be seen by a GP within two working days by end of 2004