Twenty-two percent of hospitals are on track for posting a deficit by the end of the year as the NHS grapples with growing financial pressures, according to findings of the latest quarterly report by The King's Fund.

Moreover, the survey revealed that just 47% of NHS finance directors expect to meet productivity targets for the current financial year, which suggests that the £20 billion efficiency savings target is slipping further out of reach.

"The growing number of hospitals set to overspend their budgets shows that for some, it is no longer possible both to maintain the quality of services and balance their books," warned Professor John Appleby, Chief Economist at The King’s Fund. 

The findings also showed that staff morale is now top of the list of concerns identified by hospital finance directors, which, The King's Fund says, is particularly worrying given the proven relationship between staff satisfaction and quality of care.

And while 61% of finance leads from clinical commissioning groups (CCGs) - which took control of about two-thirds of the NHS budget last April - were confident of meeting their own productivity targets, one in eight also predicted a deficit by the end of the financial year.

On the flip side, analysis of key performance data shows that the NHS is doing fairly well coping with winter pressures, and trusts are more confident about quality of care in December 2013 than they were a year ago, the report shows.

Healthcare-acquired infections remain historically low with just 420 cases of C. difficile and 40 cases of MRSA reported in November last year.

A&E target met

The number of patients waiting more than four hours in A&E fell within the government’s target range of 5% overall, although 26% did breach this target during the period.

And waiting times for hospital treatment were also on target, but in another indication that pressures on hospitals are mounting, the number of outpatients having to wait more than 18 weeks for treatment has, at 3.5%, reached its highest level since 2008, the Fund noted.

But looking forward, this quarter’s survey found that finance directors are "more depressed than ever about the financial state of their local health and care economies", the Fund said, with 86% of trust directors fairly or very pessimistic about the next year financially, as were 65% of CCG finance leads.