27/03/2015 08:14 GMT | Updated 27/05/2015 06:59 BST

NHS Performance This Parliament Underscores the Need for Reform in the Next

The health service is under considerable strain. With key targets on A&E and cancer waiting times in breach, the King's Fund recently argued NHS performance is at its lowest since the 1990s. The financial situation is also precarious. The hospital sector is forecast to be £800 million in deficit by the end of 2014-15.

The last Parliament has been tough for the health service, but the next will be more difficult still. The incoming Government will be expected to return services to previous levels of performance. Meanwhile the NHS will need to undergo considerable reform if it is to keep pace with the rising demand associated with an aging population. If it does not, the health service will require an additional £22 billion by 2020, even under generous assumptions regarding productivity and funding growth.

NHS England's plan to meet this challenge is set out in the Five Year Forward View. Thankfully Simon Stevens' compelling vision has been endorsed by the three major parties. No other public service is in a similar situation, but this consensus has only materialised because current performance is so removed from future ambition.

The Forward View foresees the creation of new, integrated models of care. Patients will be shifted outside of hospital settings, and services better coordinated. However the Coalition has recently overseen a proportionate expansion of general and acute services. Alternatives to A&E have failed to make further inroads following a decade of growth. And while important initiatives such as the integrated care pioneers are welcome, delayed transfers have increased by 59 per cent in the last five years.

NHS England also envisages greater choice for patients over where and how they receive care. However the proportion of expenditure on non-NHS providers has seen only modest growth under the Coalition, edging up from 8.5 per cent to 9.1 per cent. Meanwhile patient choice has stalled. Despite the commitment to "no decision about me without me," the number of patients who can remember being offered choice has fallen 11 per cent.

Finally, the Forward View rests on the assumption of a more efficient and dynamic health service. Here too the NHS starts from a low base. The Coalition did find considerable efficiencies last parliament - an estimated £20.5 billion between 2011-12 and 2014-15 - but these have largely been achieved through one-off measures, such as squeezes on prices paid to hospitals. Accounting for over half the NHS budget, the workforce will also need reform. But staff reductions in 2010-12 have been more than offset by hiring in the wake of the Francis Report. The NHS workforce is now larger than ever before.

This assessment should not obscure the real progress the Coalition has made in some areas. The friends and family test is a welcome development; the better care fund offers hope for future NHS integration; and the renewed focus on mental health is long overdue. However the present challenge is so much greater than these successes. If the next administration wants to see NHS finances and performance strengthen over the next Parliament, it will need to accelerate radically implementation of the vision set out in the Forward View.