Published: 18/04/2002, Volume II2, No. 5801 Page 10

The government stands accused of a 'hyperactive' approach to quality assurance and improvement in the NHS, risking confusion and delaying real changes to service provision.

A report from the King's Fund, examining Labour's first five years in power, says there has been too much focus on the establishment of new bodies, and not enough clarity about how their roles and responsibilities slot together.

While the overall verdict of FiveYear Health Check is that the government is on the right track to meet its goals, the report raises serious questions about conflicting policies and the overwhelming number of initiatives faced by staff.

The report expresses doubts about the numerous quangos and initiatives set up in the drive to improve patient care. 'Putting these organisations in takes time and money, and risks confusion as their new roles and responsibilities emerge. It...delays real impact on those who work in the NHS and how they go about that work.'

The report says many of the organisations are too new to be assessed. But claims for others are open to doubt, it says. In particular, it criticises the lack of transparency about the criteria for cost-effectiveness used by the National Institute for Clinical Excellence.

The report questions the government's claim that the performance assessment framework shows 'real improvements across most indicators', saying that data needs to be interpreted with care.The star-rating system is too new to be evaluated, but again the report urges caution. 'The reason for improvement may well not lie with the performance system but with other factors, not least the extreme focus of management and political attention on a handful of underperforming trusts, ' it says.

The report also accuses the government of confusion in its policies towards the private sector: 'Policy towards the private sector lacks substantive practical or principled justification.'

A Department of Health spokesperson said that 'setting up systems and structures to make the NHS a properly 'national' service was bound to involve a great deal of change in a relatively short space of time', but stressed that the overall aim was devolution of control of the NHS to the frontline.