Department of Health: Key Progress Information
13 February 2004
Investment in the NHS
- In his 2002 Budget, the Chancellor announced the largest sustained increase in funding of any five-year period in the history of the National Health Service (NHS). Over the years 2003-04 to 2007-08, these plans mean that expenditure on the NHS in England will increase on average by 7.3 per cent a year over and above inflation - a total increase over the period of 42 per cent in real terms. This will take the total spent on the NHS in England from 56bn in 2002-03 to over 90bn in 2007-08. This is a significant increase over historic levels of growth, e.g. compared with just 3.0 per cent per annum under the previous administration
- Total (public plus private) health spend as a percentage of gross domestic product (GDP) in the UK for this year, 2003-04, is forecast at 8.1 per cent. The spending plans announced by the Chancellor mean that by 2007-08 we expect the UK share of GDP spent on health to be 9.4 per cent - well above the current European average
- The Government is determined to match the new resources with reform to ensure delivery of the priorities set out in the Public Service Agreement
- In the last five years of the previous administration the annual average real terms increase for the NHS was 2.6 per cent and 3.0 per cent over the entire 18-year period in office
Improving Access for both emergency care and planned care
Elective Care
Achieve a maximum wait of 9 months for all inpatient waits and reduce the number of 6 month inpatient waits by 40% by March 2004, as progress towards achieving a maximum 6 month wait for inpatients by December 2005 and a 3 month maximum wait by 2008
By December 2005 offer routine choice of hospital provider at point of booking for all patients
- During 2002/03 more than 5.3 million people were admitted to hospital.
- The overall inpatient waiting list stood at 973,126 at December 2003. This is 83,522 less than November last year and 184,880 less than March 1997.
- At the end of December 2003, the number of patients waiting over 12 months decreased by 47 from November 2003 to 25 and was 10,877 (99.8%) lower than December 2002 when the total was 10,902. Although there are a very small number of patients not being seen within the target of 12 months, this should not detract from the very real and significant achievement that the vast majority of Trusts have eliminated waiting times of over 12 months and are now concentrating on eliminating over 9 month inpatient waiters to meet the March 2004 targets.
- The number of people waiting more than 9 months at the end of December 2003 was 34,295 a fall of 59.8% in comparison to December 2002 figure of 85,321. This is 84,620 less than March 997
- At the end of December 2003, the number of patients waiting over 6 months had fallen by over 84,000 since December 2002 and 134,560 less than in March 1997.
- Seven out of ten inpatients are admitted for treatment within three months of joining the inpatient waiting list.
- At 31 December 2003, 39 trusts were already meeting next year's inpatient target of 9 months (six months ahead of target), and 10 trusts had already met the 2005 target of no 6 month inpatient waiters.
Outpatients
Achieve a maximum wait of 4 months (17 weeks) for an outpatient appointment and reduce the number of over 13 week outpatient waiters by March 2004, as progress towards achieving a maximum wait of 3 months for an outpatient appointment by December 2005.
- Around 8 million people attended a first outpatient appointment in 2002/03.
In the quarter ending December 2003:
- Only 218 patients, for whom English commissioners were responsible, were waiting over 21 weeks for an outpatient appointment, a fall of around 18,650 compared with December 2002.
- The number of provider patients waiting over 13 weeks for a first outpatient appointment with a consultant had fallen by over 93,600 compared with December 2002.
- The number of patients waiting over 13 weeks for a first outpatient appointment with a consultant had fallen by 118,200 compared with March 1997.
- Most patients receive their first outpatient appointment within 21 weeks. In the quarter ended 31 December 2003, 79.5% were seen within 13 weeks, 91.7% were seen within 17 weeks and 99.2% of patients were seen within 21 weeks of referral by their GP.
- In line with the NHS Plan the maximum waiting time for an outpatient appointment will be cut to 3 months by the end of 2005. As an initial step towards achieving this, from 1 April 2003, the Government introduced a maximum waiting time for first outpatient appointments of 21 weeks.
Emergency Care
Reduce to four hours the maximum wait in A and E from arrival, transfer or discharge, by March 2004 for those trusts which have completed the Emergency Services Collaborative and by the end of 2004 for all others.
- There were over 13.1 million A and E attendances during 2002/03 an increase of 2.1% over the previous year.
- By the end of March 2003 92.9% of patients were admitted, transferred or discharged within 4 hours of arrival at A and E. 90% figures maintained from April to June 2004.
- 2 million was made available for provide modern matrons to improve the patient experience in A&E from April 2003. Matrons in charge of NHS A&E departments will each receive a minimum of 10,000 to raise standards of cleanliness, hygiene and care as part of the government's drive to improve the patient experience.
- A 30 million Modernisation Agency Emergency Services Collaborative has been launched to provide front line support to all trusts in cutting A&E waits by reforming the way that services are delivered. The collaborative is now working with all trusts in England with a major A&E department, with all trusts completing their programme by September 2004.
- The NHS Plan included a commitment to increase the number of adult critical care beds in England by 30% between 2000 and 2003. This target has been achieved (32%) and capacity is at an all-time high
- 150 million has been invested in the A&E Modernisation Programme. This programme has enabled 180 A&E departments in need of modernisation to be upgraded and refurbished.
Ambulances
- In 2002-3, the number of category A (life threatening) emergency calls responded to within eight minutes rose by 16% from 722,000 to 834,000. As a result, 74.6% of category A (life threatening) emergency calls resulted in an emergency response arriving at the scene of the incident within 8 minutes (70.7% in 2001-02). For category B/C calls, 14 services responded to 95% or more calls within 14 or 19 minutes.
- The number of emergency patient journeys rose in 2002/3 by nearly 3% over the previous year from 3.1m to 3.2m.
Primary Care
By December 2004 ensure 100% of patients who wish to do so can see a primary health care professional within 1 working and a GP within 2 working days.
- There were about 300 million consultations in primary care during the past year. This represents around 90% of patient experience of the NHS.
- There are over 1,000 GPs with Special Interest operating with the NHS providing new or extended services closer to patients in areas such as dermatology, cardiology, and ear, nose and throat surgery.
- Treatments, which were provided in hospitals for inpatients are increasingly being undertaken in outpatients and community settings. During 2002/03 around 630,000 procedures were carried out by primary care staff that had previously been carried out in hospitals, an increase of around 30,000 (5%) over the previous year.
- Nationally at November 2003, 93.7% of people who wished to do so saw a GP within 48 hours and 93.6% were offered appointments to see a primary care professional within one day.
Coronary Heart Disease
Improve access to services across the patient pathway and increase patient choice by achieving the two week wait standard for Rapid Access Chest Pain Clinics; setting local targets to make progress towards the NSF goal of a 3 month maximum wait for angiography; and delivering maximum waits of 3 months for revascularisation by March 2005, or sooner if possible.
- The number of heart operations carried out each year has risen from 40,983 in 2000 to around 56,000 (as indicated by provisional figures) in 2003 - the NHS Plan target of carrying out 6,000 extra heart operations by 2003 was met a year early.
- No patient waits more than 9 months for heart surgery compared to 2,700 in March 2000.
- Since July 2002 patients waiting more than 6 months for their heart operation have been offered treatment at another NHS or private hospital.
- Latest information (for 2000-2002) for CHD mortality rates shows an 23.4% reduction against the 1995-97 baseline.
- During the past year there were around 17.6 million CHD drugs prescriptions. Since March 2000 prescriptions for statins has risen by around 30% every year to 19m in 2003, and NHS spending on statins has increased by 229m to over 546m annually.
- Over 76% of patients suffering a heart attack receive Thrombolysis within 30 minutes of arriving at hospital, compared to 38% in March 2000.
- Rapid access Chest Pain clinics are now established in every acute trust in England giving diagnosis or the "all clear" to patients within two weeks.
- Phase Two of the National Defibrillator Programme was completed in November 2002. 681 automatic external defibrillators are installed across 110 sites, over 5,000 site personnel are trained in basic life support and use of an AED. Evidence suggests 33 lives saved.
Cancer
Maintain existing cancer waiting time standards and set local waiting time targets so that by the end of December 2005 there is a maximum of one month from diagnosis to treatment, and two months from urgent referral to treatment of all cancers.
Reduce the rate of smoking, contributing to the national target
Extend breast screening to all women aged 65-70 by 2004
- Latest information (for 2000-2002) for cancer mortality rates shows a 10.3% reduction against the 1995-97 baseline.
- Nearly 99% of people with suspected cancer are seen by a specialist within 2 weeks of an urgent GP referral. The figure in 1997 was 63%.
- Between June and September 2003 nearly 98% of patients with breast cancer were treated within 31 days of diagnosis.
- The breast screening programme is being extended to women aged 65 - 70. As a result an extra 200,000 women have been invited to be screened since April 2001.
- Around 31,000 extra patients can now benefit from cancer drugs appraised by the National Institute for Clinical Excellence (NICE).
- Cancer patients can now benefit from 16 of the newest cancer drugs appraised by NICE.
- Over 950 of the most modern pieces of equipment to diagnose and treat cancer have been delivered to hospitals since April 2000.
This includes 49 new magnetic resonance imaging (MRI) scanners, 66 linear accelerators, 147 computerised tomography (CT) scanners and over 650 items of breast screening equipment
This means 44 per cent of MRI, 64 per cent of CT, and 48 per cent of linear accelerators now in use in the NHS are new since January 2000
- 242,000 people have successfully quit smoking through NHS smoking cessation services since April 2001.
- Around 234,400 people set a quit date through the smoking cessation services between April 2002 - March 2003. At the four week follow-up around 124,100 had successfully quit (based on self-report), 53% of those setting a quit date. Corresponding figures for April to June 2003 are 64,500 setting a quit date and 34,000 quitting (53%).
Mental Health
Reduce the duration of untreated psychosis to a service median of less than 3 months, and provide support for the first three years for all young people who develop the first episode of psychosis by 2004
Offer 24-hour crisis resolution to all eligible patients by 2005
Reduce the mortality rate from suicide and undetermined injuries by at least 20% by 2010
- 220 assertive outreach teams established for patients with severe mental illness and complex problems.
- 25 early intervention teams have been established to help young people experiencing their first episode of psychosis. 50 teams will be put in place by 2004 when around 7,500 young people will benefit from their services every year.
- 130 crisis resolution teams in operation which provide timely and effective intervention for people with mental health problems in the community, often in their own homes. There will be 335 such teams in place by 2004.
- 24 hour access to support people with mental health problems has been enhanced with the completion of training for 900 NHS Direct nurse advisors.
- Guidance on Support, Time and Recovery Workers who will provide non-medical support, has been published, backed by over 550,000 for pilots and a training programme to promote new ways of working.
- Latest data (for the 3 years 2000-2002) show a rate of 8.9 deaths per 100,000 population from suicide and undetermined injury - a reduction of 5.3% on 1999-2001. These are the lowest ever recorded
Improving the Patient Experience
Improve the 5 dimensions of the patient's experience as evidenced by increasingly positive local annual survey results, and other patient focused performance indicators, including those developed for the star ratings system
Strengthen accountability to local communities through improved engagement with them
Set local targets to contribute to national target of reducing the value of NHS building backlog maintenance by 25% by 2004
Introduce bedside TV and telephone systems in every major hospital by December 2004
Eliminate Nightingale wards for older people by April 2004
Introduce ward housekeepers in hospitals by 2004 and appoint modern matron to all remaining posts by April 2004
- 167 Nightingale wards for older people have been eliminated, as well as 263 for other patient groups.
- 98% of trusts now provide single sex sleeping accommodation. The additional criteria for the safety of mentally ill patients have been met in 96% of NHS trusts.
- Almost 90% of patients in acute hospitals have access to hot evening meals, 77% have access to food through ward kitchen services and over 71% can obtain a Snack Box benefiting over 100,000 patients every day.
- 47% of larger hospitals (over 100 beds) now have some kind of ward housekeeping service against a target of 50% by 2004. This has been supported by an investment of 14m.
- Over 51,000 patients in 109 hospitals have access to bedside TVs and telephones. 72 hospitals have either signed up with a supplier or are installing.
- An independent complaints and advisory service (ICAS) began offering support to complainants across England from 1 September 2003.
Older People
Increase by March 2006 the number of older people supported intensively to live at home to 30% of the total being supported by social services at home or in residential care
By December 2004 all assessments of older people will begin within 48 hours of first contact with social services and will be completed within four weeks (with 70% within two weeks); following assessment all social services will be provided within four weeks (with 70% within two weeks); al community equipment for older people will be provided by social services within seven working days
By April 2004 all general hospitals caring for people with stroke to have a specialised stroke service, and all health and social care systems to have established an integrated falls service by 2005
- During 2002/03 over 29% of older people supported intensively at home or in residential care.
- Delayed discharges for over 75's fell from 7,065 in September 2001 to 2,990 in September 2003, more than meeting the national target.
- During the year 2002/03 approximately 143,200 additional people received intermediate care services, compared with the 1999/2000 baseline.
- Over the last four years, the proportion of hospitals with specialist stroke units has gone up from 45 per cent to 73 per cent
- Research carried out in Oct/Nov 2002 showed that nearly three quarters of all hospitals have specialist multi-disciplinary teams for older people.
Drug Misuse
- There were approximately 128,200 drug misusers who were in treatment during 2001/02 and approximately 140,900 in treatment in 2002/03; an increase of 10% and an increase of 41% since 1998.
- Drug Action Teams (DATs) report an increase of 1,088 additional posts in 2002/03 and are projecting a further 680 in 2003/04.
- Average waiting times for treatment have fallen from 5-11 weeks (Dec 2001) to 2-5 weeks (Apr 2003).
Reducing Health Inequalities
Deliver a one percentage point reduction per year in the proportion of women continuing to smoke throughout pregnancy
Achieve agreed local teenage conception reduction targets
Contribute to a national reduction of death rates from CHD of at least 25% in people under 75 by 2005 (compared to 1995/97)
Contribute to a national reduction in cancer death rates of at least 12% in people under 75 by 2005 (compared to 1995/97)
- The cross-Government Teenage Pregnancy Strategy is on target, the latest data show that the under 18 and under 16 conception rates have both fallen by 10% from 1998, the base year for the strategy.
- Up to March 2003 the NHS smoking cessation services helped 314,079 to quit smoking and remain quit after four weeks (a key cut off point in smoking cessation). In 2002-03 there were 124,100 four week quitters against a target for the year of 100,000.
- Reductions in mortality for cancer (10.3%) and circulatory disease (23.4%) among people aged under 75 are on track to meet targets in Our Healthier Nation.
Physical Facilities
Introduce new providers from the independent sector and overseas to offer patients a greater choice over where they obtain diagnosis and treatment
Make improvements to up to 3,000 GP premises by end of 2004, and achieve the national target of 500 one-stop primary care centres by the end of 2004, 125 more by 2006, and a further 125 by 2008
Establish additional inpatient beds and hospital capacity to meet access and clinical priority targets
Establish new Diagnostic and Treatment Centres operational in time to make a contribution to meeting 2005 waiting targets
Plan for at least 40% of the total value of the NHS estate to be less than 15 years old by 2010
- 3,165 (75%) more intermediate care beds for older people in 2002-03 since 1999-2000
- Hospital schemes worth over 25m
Since May 97, 68 major hospital building projects worth nearly 11.3 billion have been approved to proceed. 24 are completed and operational; a further 10 schemes have reached financial close or equivalent and are under construction.
- Schemes worth between 20m - 25m
In this category there are 46 schemes, (40 PFI and 6 publicly funded), worth a combined total of approx. 1 billion. 17 of these schemes are operational, and a further 16 have reached financial close or equivalent.
- 23 NHS-Run treatment centres are now open. A further 6 are due to open during the first quarter of 2004. Over 157,000 First Finished Consultant Episodes (FFCEs) are planned for December 2005
- A further 24 NHS-run schemes are in development and all will be fully operational by the end of Dec 2005. In all, we expect NHS-run treatment centres to be providing at least 150,000 additional FFCEs by the end of December 2005
- Independent Sector Treatment Centres are part of the Waiting Booking and Choice programme to introduce 250,000 FCEs by Apr 05. With th a single exception all 17 schemes have now completed Preferred Bidder status. Two schemes reached Financial Close by end of 2003. The majority of the remaining schemes are expected to reach Financial Close by April 2004.
- The treatment centre programme has brought significant investment to the NHS, over 350m.
- 97% of Accident and Emergency departments that need it have been modernised
- Nationally, the number of GP premises refurbished or replaced since 2000/01 is 1,950. Current estimates suggest that over 2,700 premises will be refurbished by December 2004.
- SHAs report that 265 One Stop Primary Care Centres were in place by end of September 2003. Of these 78 are defined as being in rural areas (against a target of 100). Plans (LDP) are in place to develop 551 one-stop primary care centres by 2004.
- 42 NHS Walk-In Centres have opened serving some 11m people. Since the first opened in 2000, centres have seen over 4million people. 11 new centres announced in July 2003 and plans for a further 11 announced in January 2004.
- In 2000 the District Valuer (DV) judged that 11.3% of the estate by value was post-1995. The figure as at August 2003 is estimated at 20.5%, and it is estimated that the 40% figure will be reached by 2010.
Workforce
Increase the number of nurses employed by the NHS by 20,000 by 2005 (from a 2000 baseline), and plan to achieve increase of 35,000 by 2008 (from a 2001 baseline)
Increase the number of consultants by 7,500 and the number of GPs by 2,000 by 2004 (from a 1999 baseline); increase the number of GPs and consultants employed by the NHS by 10,000 by 2005 (from a 2000 baseline); plan to achieve an increase of 15,000 doctors by 2008 (from a 2001 baseline). This will include: 1,000 cancer consultants by 2005; and increasing total numbers of cardiologists to 685 and cardiothoracic surgeons to 217 by 2004
Increase the number of therapists and scientists employed by the NHS by 6,500 by 2004 (from a 1999 baseline), and plan to achieve an increase of 30,000 by 2008 (from a 2001 baseline)
- There has been an increase of 6,871 (32%) NHS consultants between September 1997 and June 2003.
- There has been an increase of 1,956 (7%) GPs between 1997 and June 2003.
- At September 2002 there were 367,520 NHS nurses, an increase of 48,660 since 1997, with a further estimated increase of 9,400 to March 2003.
- There has been an increase of 5,535 (11%) AHPs between September 1999 and 2002 with a further estimated increase of 800 to March 2003.
IM and T
Deliver broadband access to NHSnet for NHS clinicians and support staff by 2004
Implement electronic booking by December 2005
National prescriptions service - to be 50% implemented by December 2005 and 100% implemented by December 2007
Implement key elements of electronic records by December 2005
- 2.3bn available for investment in information technology by the NHS over three years from 2003/04
- Over 900,000 NHS staff have email addresses
- Nearly all GPs and consultants (98%) have desktop access to NHSnet for email and on-line access and browsing
- Two electronic booking 'enterprise communities' have moved to area wide booking. South East London and Dorset are both able to offer GPs a choice of more than one hospital to book into electronically
- A contract has been awarded to SchlumbergerSema for the provision of a National Electronic Booking Service for the NHS. This will be the first of its kind in the world. The contract, valued at 64.5m for the provision of core services, is due to run over five years. The contract calls for the first live electronic bookings to be made in Summer 2004.