On this page our Chief Executive, Anna Walker, talks about key messages from our State of Healthcare report 2008. To listen to an interview with her, click on the arrow at the left-hand side of the box below.

Transcript

Interviewer (I): What does this report tell us about the state of healthcare in England and Wales?

Anna Walker (AW): It tells us there have been some really significant improvements over the last five to 10 years. The health of the nation is we believe improving, the deaths, early deaths from the major killers in the country, heart disease, stroke and cancer, have come down dramatically.  In the case of heart disease and stroke, the figures are around 44% to 50%, so some really major dramatic improvements.

The other issue, which is much to be celebrated on behalf of patients, is that waiting times have reduced dramatically.  It's hard to believe that six years ago trusts were being asked to ensure that their waiting lists were no longer than 18 months and they are now delivering, by and large, at 18 weeks on behalf of patients. That is a very major transformation. 

We also see, through our annual health check, significant improvements of performance by individual organisations.  So when we started doing the annual health check three years ago, 60% of trusts performed in the bottom 2 categories, the "fair" and the "weak"; now, 60% of the trusts are in the top two, "excellent" or "good".

I: What does this report tell us about maternity services in England?

AW: We have done, as the Healthcare Commission, a lot of work on maternity services.  The work began when we carried out some investigations into trusts where we had serious concerns.  That led us to carry out an in-depth review of maternity services.  Our conclusions from that are that most women will receive good quality of care.  However, there are still some weaknesses in our maternity services and we've sought to highlight these.  In particular, there were no clear-cut standards for maternity services in place and information was not being collected routinely on maternity services. 

We are very pleased now that the Royal Colleges have got new standards in place which should help improve maternity services going forward on behalf of babies and women.

I: Are children well served by our healthcare system?

AW: What our work shows on that is that children are well served when they go for specialised children's care.  Where children are being looked after in hospital, in areas which are not just about children, then the training and the experience, of those providing care, is much less good and the care can therefore be less good. 

We also have concerns over certain types of children's healthcare, more still is needed on mental healthcare for children, and children with complex needs, particularly those with disabilities face issues.  And it is clear that we need to do more on safeguarding of children, and in the light of the Baby P case, we now have an in-depth review underway, on how trust boards assure themselves that they have safeguarding and standards in place, on behalf of children like Baby P. 

I: What are the issues faced by people with a mental health problem?

AW: There have been huge improvements in our mental health services, particularly the development of mental health services in the community.  People who have got mental health issues would prefer to remain in the community, but obviously that needs to be safe for them and for the community.  There are some very good community mental health services in place; however, further work is needed on supporting those people to live more independently, to help them find a job if they've given up their job, or to help them live independently.

We also think that between us we all have to tackle the issues about violence in in-patient mental health units.  Some of that is part of them being mental health units, but still this is not acceptable on behalf of patients, or on behalf of staff.  It's a complex issue to put right but we need to tackle it. 

I: What about for people with a learning disability?

AW: When we started work, we carried out two or three investigations where there had been serious concerns about quality of care in learning disabilities.  We made a report on those individual instances, but what we came to recognise was that there was no performance assessment system in place for those with learning disabilities, so we have put national indicators in place for the first time, this year, against which we will measure performance and we believe that that needs to be continued into the future. 

There is one other very important issue on learning disabilities and it is that, it is clear that, basic healthcare for those with learning disabilities isn't as good as it should be, their needs tend to get over-looked because they've got learning disabilities, and we believe that that is something that needs to be rectified too. 

I: What do we need to focus on the future?

AW: Going forward into the future we need to focus on ensuring that those trusts who continue to perform poorly, weakly, the issues that underlie that are tackled.  We think, too, that although patients overall are very positive about the experience of their healthcare, they are also telling us that there are some issues that they would like trusts to look at further. 

To ensure that people have enough information about their care, that they have choices at different times in their care and that they are always treated with dignity and respect.  These things are really important as part of patient experience and we believe they need to be looked at.

And one final and very important area, our work has shown that you get what you measure, so where measurements are in place, performance tends to have improved.  Now what we are saying now is that it's very important that we all measure the outcomes that we want from care.  It's great that our waiting times have improved but we now need to consistently ensure we get the right outcomes from care by measuring the right information.