Significant improvements have been made in healthcare services but there is still a way to go before everyone gets world class care, Professor Sir Ian Kennedy, chairman of the Healthcare Commission, said yesterday (Tuesday).

Sir Ian will make the comments at the launch of the Commission's independent report to parliament on the state of healthcare in England and Wales.

He says: "Let's be clear that healthcare has improved. Cuts in waiting times have been genuinely dramatic and millions more people are seeing their doctors sooner. People are living longer because of improvements in health and in the quality of care. We should acknowledge and celebrate these successes.

"But we should also be clear that there is still some way to go before everyone gets world class care. People are getting healthier, but there is serious disparity in both general health and in the care available to the haves and have-nots.

"Most organisations offer patients a good overall experience, but some lag behind. We need more attention on ensuring that patients get personalised care and fair access to services. Purchasing and providing primary care affects millions of patients and all our work shows that it is not as good as it should be."

He added: "We are close to being able to offer all patients a minimum guarantee on standards - in the NHS and the private sector - but we're not there yet. Safety is being taken more seriously but we need leadership from trusts' boards to drive this through, particularly in relation to falls and healthcare-associated infection.

"We welcome Lord Darzi's admirable vision of a world class health service for all. Our report on the state of healthcare sets out the progress made and the gaps that will need to be closed to make that vision a reality."

The Commission makes six recommendations to the government and healthcare providers: improve the planning and commissioning of services; improve access outside the waiting time targets; promote a culture of safety more effectively; improve healthcare for children and young people; demonstrate more sensitivity to the needs of the individual; and use information better.

Key findings from the 2007 State of Healthcare Report include:

1. The health of the population is improving with significant increases in life expectancy, but there are major disparities around the country, particularly in poorer areas where there are often fewer GPs.

- Men are living over four years longer than they were 20 years ago, while women are living three years longer.

- Men from more deprived areas live for a decade less than those in wealthier areas. Looking at local authority areas, for example, Kensington and Chelsea has the highest life expectancy for both men and women, at 82.2 years and 86.2 years respectively. The lowest life expectancy for men is in Manchester at 72.5 years, and for women in Liverpool at 78.1 years.

- In poorer areas, where people tend to experience worse health, there are 18% fewer GPs than in the least deprived areas (54 per 100,000 people compared to 66).

2. Patients are positive about hospital services overall but some organisations perform poorly. Beneath the headline figures there are concerns about aspects of care such as dignity and privacy.

- National analysis of the Commission's survey of 80,000 inpatients at acute hospital trusts shows that 89.2% (149) were ranked "satisfactory" on patient experience, 7.8% (13) were "below average" and 3% (5) were "poor". Eleven of those in the latter two groups were rated as "below average" or "poor" for the second year running. The survey also shows concern about specific issues such as help with eating - one in five patients who wanted help eating did not get it.

- Almost a third of the complaints about hospitals referred to the Commission for independent review relate to dignity and respect, nutrition and other aspects of basic personal care. They included: patients left in soiled bedding and clothing; no regular baths or showers or oral hygiene; inappropriate or inadequate clothing.

3. There have been dramatic improvements in waiting times but there are hidden waits for some services, which are not measured and therefore difficult to address.

- Government standards say no patient should wait longer than 26 weeks for a hospital appointment. In 2006/07, 83% of trusts met this, leaving some 350 patients with longer to wait than 26 weeks. This is a vast improvement on figures for 2000 when 264,000 patients waited this long.

- Waiting time targets do not apply fully to some services, making it difficult for problems to be addressed and patients needs to be met. Evidence suggests that a two-year wait for those referred for psychological therapies is not uncommon. People in some areas are still waiting between 12 and 24 months to have hearing aids fitted.

4. NHS trusts are performing better overall on quality of services, but the performance of primary care trusts (PCTs) has declined, with many not getting to grips with the needs of their communities so as to provide services to match.

- Overall, the quality of NHS services is improving with 46% of trusts rated 'excellent' or 'good' in 2006/07, compared to 40% in 2005/6. But for PCTS, only 26% were 'excellent' or 'good' in 2006/7 compared to 33% in 2005/6. Many PCTs went through a reorganisation over the period but this does not provide a complete explanation for the underperformance.

- The Commission says PCTs form the bedrock of healthcare. They control more than three-quarters of the budget, purchasing services from other providers, including hospitals. They are directly responsible for providing services handling more than 80% of NHS contact with patients, including those carried out by GPs and dentists.

- The report says that many PCTs do not fully understand the health needs of their local people, making it difficult for them to buy targeted services. For instance, last year 2.3 million people did not have their BMI index recorded as planned, with GPs not recording the data, which provides vital statistics on levels of obesity. The number of people diagnosed with heart failure is also considerably less (140,000) than expected, indicating that GPs may not be picking up on signs of serious illness. There is also a poor understanding of the sexual health of local populations at a time when sexually transmitted infections are rising rapidly.

- Where there is a known need, PCTs are not always providing the services required. Some 60,000 people with serious long-term conditions did not get the care from community matrons that was originally planned. Forty-one per cent of PCTs failed to purchase sufficient crisis services for people who are seriously mentally ill, resulting in 5,000 fewer people receiving the service than planned. Some 85% of PCTs did not have arrangements for providing education programmes for patients with diabetes in their area. And 2,000 GP practices did not fulfil their PCT's plans to establish registers for those people at risk of coronary heart disease, designed to help prevent these patients from becoming seriously ill.

5. There is progress towards a stronger culture of safety and grounds for cautious optimism in reducing healthcare-associated infection. But trust boards need to show stronger leadership.

- On safety more generally, there has been an encouraging increase in reporting of incidents. Reported figures show more than 229,000 known incidents causing low or moderate harm and more than 9,400 incidents causing severe harm or death.

- Only 58% of NHS trusts complied with all the government's nine core standards on safety, with infection control, decontamination of medical devices and medicines management the biggest areas of concern.

- Infection control is arguably of greatest public concern; latest figures suggest grounds for cautious optimism. Cases of MRSA fell from 7,096 in 2005/2006 to 6,381 in 2006/2007. There are early signs that increases in cases of Clostridium difficile are slowing. Between 2005 and 2006 the number of cases increased 7% to 55,620, compared to a 16% rise from 2004 to 2005.

- By the end of October 2007 the Commission had visited 87 trusts to check their performance in meeting the requirements of the hygiene code. Only one trust needed to be issued with an improvement notice, suggesting that organisations are taking the issue seriously. But there was a need for stronger leadership from trusts' boards to improve monitoring, isolation facilities, training, and compliance with policies and procedures.

6. New figures show that more independent healthcare providers meet core standards, mirroring a similar trend among NHS trusts. But there are concerns about compliance among independent providers of mental healthcare.

- The proportion of independent healthcare establishments that met the government's national minimum standards - including those that were not inspected as they were considered not to be at risk - was 63% in 2006/07 compared to 50% the year before. Five per cent of independent establishments failed five or more of the standards.

- Although NHS trusts must meet a different set of standards, the broad picture is similar. The number of trusts that were "fully met" on government core standards rose from 49% in 2005/06 to 55% in 2006/07. Six per cent of trusts were judged "not met" on core standards overall.

- In the independent sector, non-compliance was greatest on national minimum standards covering: monitoring of quality of treatment (C4); ensuring patients get care from appropriately recruited, trained and qualified staff (C9); and taking account of patients' views (C6).

- Independent mental health providers, which mostly look after NHS patients, performed worse than others in the sector. Non-compliance was greatest in relation to national minimum standards for: ensuring patients receive care from appropriately recruited, trained and qualified staff (C9); providing treatment in safe and appropriate premises (C17); and ensuring patients are resuscitated appropriately (C27).

- Independent providers of mental health services need to focus on ensuring patients are appropriately and safely restrained. In 2006/7, 17% of establishments failed a standard in this area compared with under 9% in 2005/2006.

7. The NHS often fails to meet the needs of children and young people and there are concerns about other groups requiring specialist care, such as people with mental health problems and with learning difficulties.

- Paediatric hospital services are generally good at looking after children, but other more general services are not. Some 70% of specialist inpatient services were rated "good" or "excellent" by the Commission, but 28% of emergency and day case services were "weak". Transition from children to adult services is not managed well in services for people with mental health problems, diabetes and disabilities, and those requiring palliative care services. Vulnerable children such as those with disabilities, those in care and young offenders face particular problems in getting appropriate care. One in 20 NHS trusts are not yet compliant with child protection standards.

- On specialist wards for people with mental health problems and people with learning difficulties, more than half of the inpatients were found to be in mixed-sex accommodation.

- Levels of violence in mental health services remain high, although there are signs of it being dealt with better. The report includes new data from an audit into violence in the sector, which found that almost one in 20 patients reported being assaulted. Forty-six per cent of nurses reported being physically assaulted, and 72% said they had been threatened or made to feel unsafe. On older people's mental health wards, almost two-thirds of nurses reported physical assault by patients.

8. There have been dramatic improvements in responding to the big killers - cancer, circulatory and respiratory disease - but five-year survival rates for cancer, and mortality rates for respiratory disease, are worse than in other comparable countries.

- The mortality rate for people under 75 diagnosed with cancer fell by almost 17% between 1996 and 2005, which suggests that some 60,000 fewer people died prematurely.

- Despite this improvement, the UK survival rates do not compare favourably with most of Europe. For instance, the survival rate for lung cancer in Holland and Spain is around double that in England, which stands at 6.5% for men and 7.6% of women.

Notes:

The full report is available here.

Healthcare services in England provide care for 50.7 million people. During 2006/2007, people in England visited their GP practice almost 300 million times, made around 19 million visits to accident and emergency (A&E) departments and made over five million calls to NHS Direct. They attended nearly 1.2 million appointments with independent inpatient, day case and surgical outpatient services and made over three million visits to independent outpatient services.

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

Healthcare Commission