Was 2013 the NHS's annus horribilis?

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It has been a bruising year for the NHS in England.

Report after report has laid bare what has been going wrong.

It kicked off with the publication in February of the Francis Inquiry into events at the Stafford Hospital, which accused the service of betraying patients.

By the start of the summer, another 14 hospitals with the highest death rates were being hauled over the coals for their failings in their care.

But it didn't stop there.

As autumn came, another review - this time on complaints - was scathing about the attitude of the NHS to complaints.

Start Quote

This year we have had the diagnosis, now we need the treatment”

End Quote Peter Carter Royal College of Nursing

The report, led by Labour MP Ann Clywd who had broken down on radio over the care given to her late husband, said there was a culture of "delay and denial".

Of course, controversy has surrounded the health service before.

After all who can forget how 2012 was dominated by rows over the NHS reforms?

But that was about how the service was structured.

This year has been about the very basics - the quality of care - and so in that sense it has felt different.

So can the NHS can look forward to calmer times in 2014?

Royal College of Nursing general secretary Peter Carter hopes so.

'Real difference'

How the reviews have piled up in 2013

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  • February - The Francis Inquiry into the Stafford Hospital scandal said patients were "betrayed" by a system that put corporate self-interest first. A total of 290 recommendations proposed changes from top to bottom. The government responded by commissioning four new reviews into mortality rates, healthcare assistants, patient safety and complaints.
  • July - A review by NHS medical director Prof Sir Bruce Keogh into the 14 trusts with the highest mortality rates uncovered a host of problems not previously picked up by the official regulator. It led to 11 being placed in special measures.
  • July - The Cavendish Review into healthcare assistants called for mandatory training for the workforce, saying some were being allowed to work after simply watching a DVD.
  • August - A review carried out by Prof Don Berwick, a former adviser to US President Barack Obama, called for patient safety to become a "top priority" in the NHS.
  • October - A review led by Labour MP Ann Clywd into complaints said the NHS has a culture of "delay and denial".
  • November - In response to the Francis Inquiry - and the subsequent reviews - ministers published a blueprint for a "profound transformation", including the introduction of safe staffing levels and new standards for healthcare assistants.
  • November - NHS England published a review of urgent and emergency care, which proposes the creation of a two-tier A&E system with between 40 to 70 major units.
  • December - NHS England set out a vision for seven-day working in the health service with better access to diagnostics and consultants on a Saturday and Sunday.

It is his members who have often been in the firing line, but he believes this could be a watershed moment for the NHS.

"What has happened this year is probably unprecedented in the history of the NHS," he says.

"There has never been a year like it with all the reviews.

"But what is pleasing is that what we have been talking about is really important - staffing numbers, training for healthcare assistants - these are all the things that make a real difference to patients.

"We now have to build on what has happened. We don't want all these recommendations to disappear over the next 12 months."

Encouragingly, Mr Carter believes, there are already signs that the reviews are resulting in tangible change.

Earlier this month Health Education England announced there would be an 9% increase in nurse training places, meanwhile the government has asked the National Institute for Health and Care Excellence to look how safe staffing ratios could be established.

'Mismatch'

"These are huge movements in the right direction, but we need more. This year we have had the diagnosis, now we need the treatment," Mr Carter adds.

But, as always, it is unlikely to be plain-sailing for the health service.

According to Chris Hopson, chief executive of the Foundation Trust Network, the giant hurdle in the way of further progress is money.

"This is perhaps the trickiest position the NHS has ever been in," he says.

"We are looking at a period of 10 years where money will be incredibly tight and what we are seeing now is a mismatch between what is being asked for and what is achievable.

"These are all good ideas, but can we afford them? Not in the current financial envelope in the timeframe being talked about.

"So what we now need is an honest debate about what is possible and what is not and whether we want to invest more money in the health service if we want to do everything we are talking about."

But as 2014 looms into view it is impossible not to consider another factor in this equation.

An election is now less than 18 months away and it seems likely the NHS will be playing a major part.

Is that going to be a blessing or a curse for the future of the health service?

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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