The NHS once again failed to hit key access targets during the final quarter of the year, according to latest quarterly monitoring report from The King’s Fund, which also highlighted that financial predictions remain gloomy.

Performance on the A&E target - the number patients admitted, transferred or discharged within four hours - remained well under the 95 percent standard at 85.1 percent. In fact, 2.5 million patients spent longer than four hours in A&E, an increase of over 685,000 on the year before.

March also marked the 13th month in the row during which the NHS failed to hit the 18-week referral to treatment target, although performance continued on an upward trend with the proportion of patients waiting more than 18 weeks for treatment falling under 10 percent (the target is 8 percent). But also of note, for the first time since the 18-week target was introduced in April 2012, it was not met for a full year.

The standard on waiting times for cancer treatment - that no more than 15 percent of patients should wait more than 62 days following urgent referral from their GP - was also missed again during the quarter, with 19 percent of patients waiting more than two months for treatment, marking the worst performance on record and the 13th quarter in a row that the target was missed.

However, writing in a blog, James Thompson, a senior research analyst at the think tank, pointed out that “though the access standards were not achieved, more than 400,000 more patients received elective care within 18 weeks (from referral) and almost 6,000 more patients received treatment for cancer within 62 days in 2016/17 compared to 2015/16.

“So, the NHS is treating more patients than ever before, but not enough to maintain the level of activity needed to meet national standards”.

On the financial side, 43 percent of trust finance directors said they expect to overspend their budget in this financial year, although this is a slightly lower proportion than a year.

Moreover, 50 percent of clinical commissioning group (CCG) finance leads say that achieving this year’s financial forecast is likely to depend on delaying or cancelling spending, while 69 percent of trust finance directors (and 72 percent of CCG finance leads) believe there is a high or very high risk of failing to achieve productivity gains suggested by the NHS Forward View, according to the report.

The report concludes that the underlying reality is that demand for services is continuing to outstrip the rate at which the NHS budget is growing.

“With NHS leaders effectively acknowledging that the service cannot continue to achieve the current set of finance and performance targets, the questions now are: what level of access is acceptable across the full range of NHS services, when can this be achieved and how much will it cost?,” said Thompson.

“Local NHS leaders will be forced to make tough decisions about priorities and this is likely to have a direct impact on what care patients can access and how long they have to wait for it,” predicted Richard Murray, director of policy at The King’s Fund.