Published: 10/04/2003, Volume II3, No. 5850 Page 9

Almost nine out of 10 senior NHS managers have seen improvements in their local services over the last year, according to a survey by HSJ and the NHS Confederation.

The snapshot survey of around 150 senior managers took place just ahead of this week's rise in national insurance payments to increase NHS funding - a move which is set to increase further the scrutiny of the service.

Just 3 per cent of respondents thought local services had deteriorated in the last 12 months, while 88 per cent thought the NHS in their area had improved.

The survey of chief executives, chairs and medical directors of acute trusts, primary care trusts and health authorities asked managers to identify the three most significant barriers to improving patient services.

The findings, published today, just after chancellor Gordon Brown outlined his Budget, showed that lack of money was still seen as the biggest obstacle to success. Eighty-three per cent of respondents regarded financial constraints as a significant barrier to improvements. Staff shortages, lack of time, and excessive targets were also key areas of concern.

But 77 per cent were confident that their local NHS services would improve over the next three years.

The survey - which included 64 chief executives - revealed a mixed picture in terms of staff morale. Of those surveyed, 32 per cent believed it was improving and 19 per cent believed it was declining.

Confederation chief executive Dr Gill Morgan said: 'With the national insurance rise due to hit taxpayers' pockets this month, the spotlight is on the NHS as never before to demonstrate where the money is going and the difference it will make to patient care.

'But as questions are raised about whether the investment is delivering results, little attention has been paid to the views of those working in the service.'

And she said the fact that budget constraints were still the key concerns of managers reflected a combination of years of historical underfunding with the aspirations of the service to improve.

Top priorities: progress in specific services lead the way

Respondents were asked to name the three most important improvements your organisation has made to the patient experience in the last year. In order of importance, they are:

Improvements to specific services like cancer care and chronic disease management;

Reductions in waiting times;

Greater patient and public involvement;

Improvements to A&E;

Increases in staff;

lnvestment in better facilities.

What are the three most significant barriers to improving the service to patients?

In order of importance:

Budget constraints;

Staff shortages;

Lack of time;

Too many targets;

The reporting burden;

Lack of clinical engagement.