The state of NHS finances are in the spotlight yet again with a fresh report citing fears by health leaders that the service will no longer be free at the point of use within the next decade.

Think tank the Nuffield Trust has published a damning report warning that a funding crisis is imminent and that maintaining quality patient care is becoming difficult. 

The analysis Into the Red? found that NHS and Foundation trusts as a whole were at least £100 million in the red in the last financial year – with 66 trusts in deficit in 2013/14, a much worse picture than the prior financial year's surplus of £383 million and 45 trusts in deficit.

Also, despite an overall underspend, 19 Clinical Commissioning Groups (CCGs) ended the last financial year in deficit and NHS England projected a £377 million overspend on specialised services.

Savings down, demand up

The report voices concern that, with austerity set to continue, there are "worrying signs that the long-term resilience of the NHS is under significant strain", with savings dwindling and demand rising.

Demand for hospital services has seen spend in this area grow by £1.1 billion in 2012/13 and again in the current year, while that spent on general practice fell by £10 million.

Maureen Baker, chair of the RCGP, said "yet again, patient care provided in general practice is being sacrificed at the expense of shoring up our hospitals". 

Demand for GP services is also on the rise, she stressed, but these are "on the brink of collapse due to NHS funding falling to an historic low". 

Closer to the precipice

The fact that cash flow has dropped again "pushes us even further towards the precipice and it is our patients who are bearing the brunt," Dr Baker warned, arguing that "the way relieve pressure on hospitals is to invest in general practice".

The issue of whether a 'free' service is sustainable has also reared its ugly head again, with the Nuffield's poll of 100 health and social care leaders showing that nearly half (47%) thought it was "either very or quite unlikely" that the NHS would remain free at the point of use in ten years’ time.

A report by Monitor last year also warned that the NHS is facing a funding gap of some £30 billion by 2021 if it is to provide a service free at the point of use and fit for the 21st century.

Pessimistic and unrealistic?

Nevertheless, health minister Lord Howe said Nuffield's predications are "pessimistic and paint an unrealistic picture of how our NHS is working". 

"We know some parts of the NHS are under pressure due to an unprecedented rise in demand - which is why in very tight economic circumstances, we have taken tough decisions to increase the NHS budget by £12.7 billion over this Parliament,' he said.

The Department of Health also stressed that the NHS is well on track to make its targeted £20 billion savings, "and we are confident that it will continue to make the savings necessary to meet rising demand".