Published: 08/12/2005 Volume 115 No. 5985 Page 3

Sir Nigel Crisp is right when he says that the NHS does not get the credit when it gets things right. The NHS chief executive will be particularly annoyed - but surely not surprised - that his annual end-ofyear activity report, published yesterday, will have been overshadowed by coverage of financial deficits, despite 'all the figures going in the right direction' (interview pages 20-21).

So it is worth recording that the report is indeed a tribute to the service's ability to maintain a steady course on improvement and efficiency in the stormy seas of reform. The major targets will be achieved this year - that may not seem so surprising today, but three years ago the achievement would have looked monumental. The plunging lines of Sir Nigel's graphs show the extreme efforts made in the last 18 months in particular.

The 99 per cent of patients seen within four hours at accident and emergency is especially impressive given an 8.8 per cent year-on-year increase in attendances.

One of the main areas of disappointment - and one shared by Sir Nigel - is the relatively small increase in procedures and case management carried out in primary care.

Arguably, next year will be when we should expect a marked leap, as investment in technology and the healthcare outside hospitals white paper concentrates minds. More worrying might be confidence levels in the quality of data about primary care activity. It is not nearly as good as information on secondary care, and that needs to change.