Published: 13/05/2004, Volume II4, No. 5905 Page 6 7

Health secretary John Reid has paid tribute to 'the hard work and dedication of thousands of people' as he announced that the NHS hit its key end-of-year targets.

The maximum inpatient wait of nine months was achieved - bar 48 patients - by the end of March, and the maximum outpatient wait of 17 weeks was hit.An ambitious milestone to deal with 94 per cent of all accident and emergency patients within four hours was also achieved.

NHS chief executive Sir Nigel Crisp said the service was doing so well that next year's six-month targets could even be met early, adding that early success 'would allow us to do other things'.

Presenting his annual report, Sir Nigel claimed the results showed that 'something big is happening within the NHS'.

And he said that the extra£5.9bn spent on the NHS in the last financial year had meant that 'waiting times had fallen faster and further this year than ever before', and that 'death rates from the major killers - cancer and coronary heart disease - are falling quickly'.

Sir Nigel was confident that the report showed the NHS had made measurable improvements in productivity and was using its extra funding to 'good effect, with major improvements in quality and quantity'. But he conceded that the government has not yet come up with 'an adequate way of measuring the overall productivity of the NHS'.

NHS Confederation policy director Nigel Edwards said that 'a review of the measure of NHS efficiency is long overdue because current statistics simply fail to include the work of vast sections of the service'. He alleged that the 'current crude number-crunching approach to productivity' failed to capture improvement across large parts of the NHS.

The King's Fund said that now was the time for the NHS to switch its emphasis to chronic conditions.

And chief economist Professor John Appleby said the NHS needed to keep its eye on the ball if continued improvements were to be sustained. He flagged up a 6 per cent increase in emergency admissions over the last year as 'worrying'.

Professor Appleby added that rather than measure the productivity of NHS services, the government should find ways to measure improvements in patients' overall health.

Greater Manchester strategic health authority chief executive Neil Goodwin told HSJ that he believed the NHS was changing and argued that it was now important to focus on 'moving beyond the initial targets and make change sustainable in a community-based setting'.

East and North Hertfordshire trust chief executive Nick Carver said that the report showed evidence of what was happening on the ground. Last year the trust experienced problems when it identified 57 patients in breach of the government's 12-month inpatient target, but Mr Carver believed that the trust had managed to turn its problems around.

'Staff have worked very hard.

With A&E waiting times for example we are currently achieving 92 per cent, however it gets more challenging to achieve the extra few percent. We have to try and work more scientifically, ' he said.

He said that over the next year it was important for the NHS to view challenges 'as whole-systems challenges' and to ensure that acute trusts work in genuine partnership with primary care trusts.

He expressed that it would be necessary to develop standards which measured this.