NHS scorecard shows improvement but could do better, say inspectors

The NHS is meeting its targets, but failing to treat patients as customers entitled to good service, the health inspectorate said yesterday in its annual report for England and Wales.

The Healthcare Commission found nearly a quarter of patients are deterred from going to the GP by inconvenient opening hours.

Only half the people with depression get treatment for it - usually drugs and rarely psychological therapy.

More than a quarter of people who need urgent sexual health services have to wait more than 48 hours for an appointment at clinics.

Fifty-eight per cent of NHS dental practices are not taking on new patients, compared with 40% in 2001. But most people who do not have an NHS dentist would like one.

In London, patients found it equally difficult to register with an NHS GP, with four out of five practices unable to take on new patients.

Sir Ian Kennedy, the commission chairman, praised the NHS for meeting the targets set by ministers to reduce waiting times and improve outcomes, particularly for cancer and heart disease.

"But our health services still have a long way to go before we can say they are really putting patients first," he said.

"Being an NHS patient is too often a frustrating experience. Services can seem fragmented and designed more to suit the needs of those providing them than those using them."

The commission found 21% of outpatients and 26% of A&E patients said doctors did not always listen carefully to what they were saying. One in seven patients reported problems with their GP's receptionist.

More than a third were not given information on the side-effects of medicines, and half of those going to hospital with heart disease were not given advice about necessary diet changes before discharge.

The report said: "One of the key lessons for healthcare services is that failures most often occur in services that receive relatively little local or national attention by way of, for example, national targets."

The commission investigated maternity units with unacceptably high death rates and found that maternity services "are not as good or as safe as they could be".

In mental health, fewer than half the people needing services had access to emergency care. Almost 25% of mental health inpatients reported sharing wards with members of the opposite sex when they did not want to - in spite of government assurances that 98% of trusts complied with national guidance requiring single sex wards.

Sexual health services left 29% of people with symptoms of an infection waiting more than two weeks for treatment, increasing the risk that others may be infected.

Anna Walker, the commission's chief executive, urged the government to be cautious about increasing the number of targets. There was no evidence that doctors' clinical judgment was distorted by pressure to meet targets, but every effective target had unintended side effects, she said.

One example was the target to reduce the maximum wait for a GP appointment to 48 hours. Many practices met it by stopping patients booking appointments in advance, making it harder for those with long-term conditions to see the same doctor. The problem surfaced during the election campaign when Tony Blair was embarrassed by a question from Diana Church on the BBC's Question Time.

The report said a third of practices would not book appointments more than two weeks in advance. It investigated GP services in 25 primary care trusts and found nine where people had problems booking appointments in advance or out of office hours, with some patients having to wait up to three weeks for a routine appointment.

Patricia Hewitt, the health secretary, said: "Extraordinarily long waiting times are a thing of the past ... But there is still more to do if we are to make a truly patient-led NHS." She said reforms to dental services, mental health services in the community and maternity services were already being put in place.

Sir Nigel Crisp, the NHS chief executive, said: "The emphasis will now be on further improving the quality of service for all patients through delivering greater choice and more tailored services."

Angela Greatley, the chief executive of the Sainsbury Centre for Mental Health, said: "We still do not know for sure how long it takes for people to get access to mental health care ... If people who need mental health services are to get equal treatment to those needing other health care, it is vital that waiting times are monitored and published."

Dame Gill Morgan, the chief executive of the NHS Confederation which represents managers and trusts, said: "It is important that, in highlighting areas of the NHS where work is still needed, we don't detract from the majority of organisations which the report clearly demonstrates are delivering high quality healthcare that is valued by patients."