NHS performance is continuing to hold up well, but concerns abound that quality of care may suffer from financial pressures.

This is according to a new survey of 45 NHS finance directors, undertaken by the King’s Fund think-tank, which found that the majority are confident of delivering average cost improvement targets for this year of around five percent.

But next year is seen as a potential turning point, according to those surveyed, with savings becoming more difficult to deliver and most directors skeptical that the NHS will be able to meet its target of finding £20 billion in productivity improvements by 2015 – the so-called QIPP challenge.

Significantly, the survey found that 40% of the finance directors expect the quality of care to worsen over the next few years, given that they have to save around £5 billion from the NHS’ £105 billion budget every 12 months.

The main findings from the survey were:

•    35 of the panellists expect to end this financial year in surplus, with only 3 anticipating a deficit
•    33 are confident of achieving their cost improvement programme targets for 2012/13, while only five expressed concern
•    27 panel members believe there is now a very high or high risk that the NHS will not meet its target to deliver £20 billion in productivity improvements by 2015; just 4 judged there to be little risk of failure
•    19 of the panel said that they expect patient care to worsen over the next few years, with only eight anticipating improvement; this compares with 14 who felt care had improved in the last 12 months, and just seven who believed care had got worse.

The report also highlights a reduction of 29,000 full time NHS posts since March 2010. This includes a reduction of nearly 6,000 nurses, midwives and health visitors and around 8,000 managers (a drop of around 18%). In contrast, the number of consultants has risen by 8 % during the same period.

The QIPP agenda began in 2009 and has more or less delivered on target each year, but much of these savings have come from cutting staff. This, however, is no longer an option, leaving many NHS managers concerned as to where the next batch of savings can come from.