Problems in hospitals are now spreading beyond A&E to other key areas of performance, increasing the risk of a crisis in the NHS, health policy think tank The King’s Fund has warned.

Hospitals are now stretched to the limit as the NHS struggles to cope with increasing demand for services and the unprecedented financial squeeze, says the Fund’s latest quarterly monitoring report, which finds that:

- the proportion of inpatients waiting longer than 18 weeks for treatment rose to 12.5% last November, the highest since this target was introduced in 2008;

- waiting times for cancer treatment continued to worsen in second-quarter 2014, with only 83.5% of patients receiving treatment within 62 days of urgent referral from their GP, the lowest proportion since the current target was introduced;

- the number of delayed discharges from hospital increased sharply to more than 5,000 per day in November, up almost 20% since January; and

- the number of cancelled operations during November-January was up by a third on the same period in 2013.

The increased waiting times for treatment are partly explained by the government’s policy of allowing a “managed breach” of the 18-week targets while a backlog of long-waiters is cleared; however, current performance across a range of indicators suggests the NHS is creaking at the seams, says the Fund.

Over 40% of trust finance directors surveyed for the report say they expect their trust to end the year in deficit, although more than 90% of clinical commissioning groups (CCGs) expect to break even or finish the year in surplus.

More than 60% of trusts are relying on financial support from the Department of Health or, in the case of some foundation trusts, planning to draw down their reserves. Nevertheless, over three-quarters of trusts say they plan to increase their numbers of permanent nursing staff over the next six months, as hospitals continue to prioritise patient care above balancing books. 

The finance directors continue to identify staff morale as their top concern, alongside A&E waiting times, and 80% of those responding were also concerned about the ability of their organisation to meet its target to reduce emergency admissions under Better Care Fund plans; this once again casts doubt on the credibility of the government’s flagship policy for integrating health and social care, says the Fund.

Taken together, these findings show that services are “stretched to the limit. With financial problems also endemic among hospitals and staff morale a significant cause for concern, the situation is now critical,” warned the Fund’s chief economist, John Appleby. 

British Medical Association (BMA) chair of council Dr Mark Porter responded that what is happening in A&E is directly linked to and reflective of wider pressures across the NHS. 

“That staff morale continues to be a greater concern for managers than the dire financial circumstances facing hospitals really underscores just how challenging conditions are for front-line staff and should serve as a real wake-up call,” he added.