The NHS will struggle to meet its target of delivering £20 billion in productivity improvements by 2015, The King's Fund has warned.

Only 10% of NHS finance directors surveyed for the think tank's latest quarterly monitoring report rated the chances of meeting the target as better than 50/50. 56% identified a high or very high risk that the target will not be met, while 34% rated the likelihood of success as 50/50.

This quarter’s survey includes clinical commissioning group (CCGs) finance leads as well as Trust finance directors. Only 33% of Trusts said they expect to meet their cost improvement targets for 2013-14 - a sharp drop on the same quarter last year, when nearly three-quarters were confident of meeting their targets. However, 72% of CCG finance leads say they expect to meet their organisation’s targets.

Analysis of NHS performance data for first-quarter 2013-14 shows most indicators are broadly stable, although A&E waiting times remain comparatively high, says the Fund. The survey also found that:

- the number of healthcare-acquired infections continues to fall;

- waiting times for hospital treatment remains stable, although the median waiting time for outpatients has crept up to more than five weeks,

- the proportion of patients waiting over four hours to be admitted from A&E to hospital has fallen back to 4.5%; and

- the number of delayed transfers of care remains stable.

At 89%, the vast majority of Trust finance directors and CCG finance leads told the survey they expect their organisation to be in surplus or break even in 2013-14, while 11% expect to be in deficit. 

31% said patient care in their area had got worse over the past year, while 14% felt it had improved and 55% said it had stayed the same. 72% were pessimistic about the prospects for their local health economy over the next 12 months - just 10% were optimistic about this.

“Now, just over half way through the so-called Nicholson Challenge, it is clear the NHS will struggle to meet its £20 billion productivity target, with potentially serious consequences for patient care,” warned Professor John Appleby, chief economist at The King’s Fund.

"The reality for many hospitals is that they face an uncomfortable choice between whether to prioritise the quality of service for patients or allow performance in some areas to slip in order to balance the books,” he added.