Reporting on the health of the health service

From 1 April 2013, the Secretary of State for Health will be under a new duty to produce an annual report relating to the performance of the health service in England. This will be the principal method by which Parliament will hold the Health Secretary to account for health service performance. In a bid to show the direction that the NHS is headed, the Secretary of State’s first annual report has been published a year earlier than is required by law. Commenting on the reason for early publication, Andrew Lansley, the current Secretary of State for Health, said: “The future of the NHS depends on shared objectives and ambitions and open reporting is central to that. This report, therefore, highlights the key achievements of 2011/12, as demonstrated by NHS performance data and public health initiatives such as the ‘Responsibility Deal’ which aims to engage industry and other partners in promoting healthy living. In future years, the report will focus increasingly on outcomes, reflecting how measuring performance of the health service will evolve over time. This will include the changes in my role as the Secretary of State, as set out in the Health and Social Care Act 2012.” While promoting the fact that there is some positive data in the report, Andrew Lansley did acknowledge that the NHS has a number of significant challenges to face. He said: “Compared to other countries, we continue to lag on performance on some key outcomes including life expectancy for women, cancer survival, and conditions related to obesity. Looking forward, there will be continued pressure on budgets across the health and care system, so there will need to be sustained efforts to ensure that every penny of public money is spent as effectively as possible, delivering the best possible outcomes for patients. To do this, we must embrace innovation across the service, recognising the opportunity we have to improve quality, including patients’ own experiences of care.

Meeting expectations

 “Looking forward, health and care services need to respond flexibly and innovatively to continue to deliver safe, effective and compassionate care that meets people’s expectations and provides better value from public spending. There will be more focus on preventing ill health and on reducing deterioration in health.” Andrew Lansley believes that the health service needs to evolve to meet new challenges, such as obesity and alcoholrelated diseases, which are both having an increasing effect on the health service and the public’s health. Increasing rates of obesity and higher levels of excessive alcohol consumption have resulted in a higher incidence of diabetes, arthritis and chronic liver disease, all of which are preventable. Estimates suggest that the number of people with diabetes in England could rise from 3.1 million in 2009 to 4.6 million by 2030.1 Levels of excessive alcohol consumption have grown steadily over the past 50 years. It is estimated that in an average community of 100,000 people, each year 2,000 will be admitted to hospital with an alcohol-related condition; 1,000 will become a victim of alcoholrelated violent crime; over 13,000 will binge-drink; over 3,000 will be showing some signs of alcohol dependence; and over 500 will be moderately or severely dependent on alcohol. In 2010, the Health Survey for England2 reported that 26.4 million people in England were of excess weight, with 11 m being obese. Obesity is major driver of demand for health services. The latest estimate of the cost to the NHS of overweight or obesity-related conditions is £5.1 bn each year.3 Prevalence of mental health conditions is also continuing to rise and Andrew Lansley believes that these challenges will require a different approach, changing lifestyle and behaviour rather than a reliance on hospital-based services. The economic and social costs of mental health problems in England have recently been estimated at £105 bn, and treatment costs are expected to double in the next 20 years.4 An investment of around £400 m has been made to complete the roll out of the Improving Access to Physcological Therapies (IAPT) programme, which supports the NHS in implementing National Institute for Health and Clinical Excellence (NICE) guidelines for people suffering from depression and anxiety disorders. This should be completed by April 2015 and a stand-alone programme for children and young people will also be initiated and models of care for people with long-term physical conditions, medically unexplained symptoms and severe mental illness will also be developed. Evidence has shown that this approach could save the NHS up to £272 m and the wider public sector could benefit by more than £700 m.