Austerity has led to NHS quality of care declining in key areas, study finds | NHS

The quality of care that the NHS provides has got worse in many key areas and patients’ long waits to access treatment could become even more common, research has found.

The coalition government’s austerity programme in the early 2010s led to the heath service no longer being able to meet key waiting time targets, the Nuffield Trust and Health Foundation said.

Austerity ushered in “really concerning deterioration across the board” in the overall quality of NHS care, as judged by patients’ experience and prevention of ill-health, not just speed of access.

The big fall in the government’s funding of the NHS produced “a turning point” that meant its quality of care began to decline between mid-2013 and mid-2014 and has got progressively worse since, the study concluded.

Analysis by the two thinktanks’ joint Quality Watch programme, which monitors more than 150 indicators of care quality over time, found that in England:

• Fewer people with long-term heath conditions such as cancer, diabetes and depression, are getting enough help to manage their condition.

• Breast cancer screening rates for women aged 53-74 have fallen.

• It has become harder for patients to see a named GP.

• Only 6% of midwives think their maternity unit has enough staff to do its job properly.

Jessica Morris, a Nuffield Trust fellow who leads the programme, said: “Through our Quality Watch tracking of over 150 key indicators we are seeing really concerning deterioration across the board. While some measures are holding up, the trajectory is worrying and if these trends continue patients can expect long waits for care to become even more commonplace than they are now.”

Warning that failings today would result in greater ill-health in future years, Morris added: “What is perhaps most concerning of all is that deteriorating performance on immunisations and child health suggests we are storing up major problems for the future.”

The study found that the largest collapse in performance against key targets was in the NHS’s ability to treat A&E patients within four hours, provide surgery within 18 weeks or get an ambulance to people quickly after a 999 call. Some delays were so great that they put patients at real risk of harm, it said.

Morris said: “There has also been a steep decline in preventive health care, mental health and care for children and young people, all of which risk creating a cycle of much greater need further down the line for other heath services.”

Vaccination rates among children are going down and 2021-22 was the fourth year in a row in which the NHS did not meet the threshold set by the World Health Organization for ensuring that 95% of children have the recommended jabs.

The research refutes Rishi Sunak’s insistence that the pandemic caused the record number of 7.2 million people waiting for treatment – for example for hip and knee replacements – that hospitals are facing. Covid has simply exacerbated a decline in quality of care, especially in access to urgent and emergency care, that was evident before the virus emerged in early 2020 and was also closely linked to staff shortages.

“Most indicators suggest that the pandemic has heaped unbearable pressure on services that were already struggling to meet expectations for quality and access prior to the pandemic,” Morris said.

Prof Dame Helen Stokes-Lampard, the president of the Academy of Medical Royal Colleges, said doctors had already witnessed and were worried by the decline in quality of care.

“The findings are of course deeply concerning but also won’t surprise any NHS doctor, as the fall in quality of care over recent years is something that troubles many of us,” she said. “While it may be an inconvenient truth for any government, it is a truth all the same, that when it comes to healthcare systems you really do get what you pay for.”

At a service in Westminster Abbey on Wednesday to mark the NHS’s 75th birthday, the NHS England chief executive, Amanda Pritchard, recalled that Nye Bevan, the health minister in the postwar Labour government who oversaw the service’s creation, on the day of its launch called it “the most civilised step any country has ever taken”.

The Very Rev Dr David Hoyle, the dean of Westminster, who conducted the service, likened the NHS’s birth to “building Jerusalem, because that’s what it was. It is the conviction that you can begin what the bible promises, you can see a new heaven and a new Earth.”

“Wards and work, agendas and appointments, balance sheets, lunch and laundry, hard decisions, soft hands, all making hope real”, he told the 2,200-strong gathering of NHS staff and volunteers. Rishi Sunak and Keir Starmer delivered bible readings as part of the event.

Labour’s Wes Streeting, the shadow health secretary, said: “NHS patients are let down on a daily basis and denied the care they need. Conservatives argue that it’s either Covid to blame, or the founding principles of the NHS – universal healthcare, free at the point of need. But the Conservatives have run down the health service over more than a decade, failing to train enough staff needed to treat patients on time.”

The Department of Health and Social Care has been approached for comment.

Some areas of healthcare have improved in recent years, the thinktanks also found, citing an ongoing fall in smoking rates, a drop in teenage pregnancy and high uptake of adult flu jabs.