Political interference and obsession with target setting are the biggest threats to the NHS achieving long term health quality improvements, warns a report due to be published later this month.
But the report, which analyses the mid-term achievements of the government's 10 year initiative on quality, will conclude that the long term health improvement goals, outlined in the NHS Plan in July 2000, will be met if these issues are tackled.
The 300 page report, Quest for Quality, to be published on 27 November, has been written by Professor Sheila Leatherman, senior associate at the Judge Institute of Management in Cambridge and a former senior executive of United Healthcare, one of the largest managed care companies in the United States.
Speaking last week at a conference in London on working differently (sponsored jointly by the BMJ and the Nuffield Trust), Professor Leatherman said: "The NHS is not broken; it's a bit worn and weary. You could say it was malnourished before 2000," but, she added, performance was improving across the NHS.
"Great strides have been made but there is still a way to go—particularly more intensive care beds, more stoke units, and more scanners and technology," she added.
Public dissatisfaction with health services is an international phenomenon, she said. But universal care free at the point of delivery means that the NHS fares much better than mixed public and private systems or insurance only based systems in the United States and other Western countries, she contended.
The strengths of the NHS lay in its massive injection of new resources and public support, she said, adding: "Many of us working in the US are quite envious."
But she pointed out that the extra billions given to the NHS were not trickling down to where they were needed.
And she criticised the "top down and paternalistic" approach to improving quality, calling for an independent body to assess and interpret performance data. "There is a lack of objective, transparent evaluation. We need independent audit."
There was "a lot of rhetoric" about patient and public involvement in health, but little progress had been made in giving the public a voice, she said.
Professor Leatherman said the target culture had been "discredited." "Some goals are implausible and unrealistic targets are being set. Even though we are improving performance, we are never going to hit these targets. We have to discard those things that don't work," she urged.
She felt that political interference also needed to be reduced. "As an outsider, I was surprised at the level of politicisation, which is one of the greatest threats to success," she said.