Cracks are beginning to appear in NHS performance as a result of growing financial pressures and rising demand for services, The King’s Fund has warned.
25% of directors of NHS trusts surveyed for the Fund’s latest quarterly monitoring report say they expect to be in deficit in 2014/15, the highest number since the health policy thinktank began reporting on this in 2011.
And the nursing workforce grew almost 9,000 over the past six months to nearly 315,000, the highest on record. This underlines the difficult choice facing hospitals – whether to balance the books or maintain quality of services, with many choosing to recruit more nurses despite their budgets being stretched to the limit, it says.
While the A&E waiting-time target was just met over the April-June quarter, once all types of unit are included, hospitals with major A&E departments have now missed the target for 51 weeks in a row. And more than three million people had been waiting at least 18 weeks for hospital treatment at the end of the quarter, the highest number since 2008.
Other key findings of the Fund’s latest quarterly report are that:
- the average cost improvement target set by trusts for 2014/15 is 4.7%, with only 40% of finance directors confident of meeting their target;
- 4.9% of patients spent four or more hours in A&E over the last quarter, the highest level for this time of year since 2004/05;
- 9.9% of inpatients waited more than 18 weeks for hospital treatment during the quarter, the highest level since early 2011; and
- over 18,600 patients were waiting more than six weeks for diagnostic tests stood at end-May, up nearly 12,000 on May 2013.
This latest quarterly report “paints a picture of a service under huge pressure, with cracks beginning to appear in NHS performance. It once again underlines the need for new funding if services are to be maintained,” said The King’s Fund’s chief economist, John Appleby.
And while the increase in the nursing workforce signals a very welcome commitment to improving care, “it remains to be seen whether hospitals will be able to sustain current staffing levels when money becomes tighter later in the year,” he added.
The report also finds inconsistencies between the plans of hospitals and clinical commissioning groups (CCGs). While 55% of CCGs surveyed are planning a reduction in emergency admissions, only 8% of NHS trust finance directors are working on this basis. CCGs are also forecasting less elective activity, with only 32% expecting an increase in planned treatment compared to 69% of trust finance directors.
This disparity “points to a worrying mismatch between activity and funding, which could have serious financial consequences,” Prof Appleby warns.