14 May 2004
A chorus of approval rang out when Sir Nigel Crisp, NHS chief executive, published the organisation's annual report for the last financial year.
Waiting lists had fallen dramatically, he said. More patients had been seen, more staff employed and more operations had taken place.
'Something big is happening within the NHS,' he claimed. 'Not only are we hitting all our targets in order to speed up patient care, but by reforming the way we work we are also improving the quality of patient care. The NHS is using the extra funding to good effect, with major improvements in quality and quantity.'
The additional £5.9bn government spending had bought 'significant improvements in productivity', added Crisp. He pointed to only 48 patients waiting more than nine months for an operation; 97% of people being seen by their GP within 48 hours of booking an appointment; 94% of patients being treated within four hours of arrival in A&E; an extra 167,000 elective operations taking place in hospital, plus 200,000 procedures carried out in primary care and outpatients; with an extra 59,000 staff in the NHS.
Not surprisingly, Health Secretary John Reid glowed with happiness, saying he was 'delighted', but 'not complacent'. He emphasised that the direction of both waiting lists and waiting times is downward.
The NHS Confederation was just as positive. Nigel Edwards, its director of policy, said the report 'gives the lie to claims that extra investment in the NHS has been a waste of money'.
Similarly, Unison's general secretary, Dave Prentis, welcomed the 'good news for patients', which was 'a testament to the hard work and dedication not only of nurses and doctors, but of the whole NHS team'. He did, though, add a barbed comment: 'They [the figures] also show you don't need foundation hospitals to cut waiting lists and improve patient care.'
It was left to opposition politicians to try to spoil the mood. Paul Burstow, the Liberal Democrats' health spokesman, suggested that the figures were too good to be true. He referred to the 'hidden waiting lists' of patients denied immediate access to scans and tests.
A similar argument was made by Conservative spokesman Tim Yeo, who argued that health service managers' fiddling of the figures and people buying their own care because of long waiting times might have contributed to the improvements.
Yet the most damning criticisms come from those who might be regarded as the most objective academics who have closely monitored what has been happening in the NHS. Their real concern was with Crisp's claims of higher productivity.
Alan Maynard, professor of health economics at the University of York, said: 'The whole area of NHS productivity is a black hole, because we just don't measure things accurately and neither this government nor the Conservatives has wanted to do that.'
But Maynard conceded that the fall in waiting lists was real and demonstrated that England was outperforming both Scotland and Wales.
David Whynes, professor of health economics at the University of Nottingham, said that the real question was not whether the NHS figures were accurate, but what distortions the targets were generating. 'There are hundreds of things you could measure in the NHS,' he suggested.
'Some at any time will be doing well, but the impact is felt somewhere else. It's like having a half-inflated balloon if you press in one place it comes up somewhere else&We are essentially using accounting measures, rather than clinical measures.'
This view was echoed by Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. 'The measures being used are deeply flawed,' said McKee. 'But this government and the previous one have been happy to use them. We can't believe the figures, but things may actually be getting even better or worse.
For all the euphoria, the verdict, as yet, must be not proven.