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King's Fund: Mismatch in demand and funding has caused ‘unprecedented’ NHS pressures

Unprecedented demand for NHS services is outstripping funding, causing services to struggle to maintain standards of care, a new report has outlined.

A new report by the King's Fund, ‘How hospital activity and funding in England have changed over time’, revealed that both A&E attendances and admissions have increased, along with outpatient referrals, a change which is put partly down to an increasing and aging population.

However, the report’s findings – that financial and operational pressures have caused a record NHS deficit last year of £2.45bn and growing waiting times across secondary care – have led leaders like Stephen Dalton, chief executive of the NHS Confederation, to urge the government to take action.

“It is concerning that demand is outstripping funding and that this is set to continue. We need the government to act without delay on their promise for a review of longer term care,” Dalton said about the King's Fund report.

“The evidence of serious strains on health and care services is now overwhelming and the recent settlement on social care funding did not go far enough. A shortage in adequate social care puts real pressure on hospitals, as more people end up in A&E and cannot be discharged when they are fit and ready to go.”

The report found that between 2003/04 and 2015/16, attendances at major A&E departments rose by almost a fifth (18%), with resulting admissions rising by 65% over the same period to 4.1 million in 2015/16, mostly due to a greater number of patients admitted for shorter stays.

Referrals to outpatient services increased by 62% while the number of diagnostics tests undertaken more than doubled (109%) from 2006/07 to 5.3 million in Q2 of this year.

The King's Fund has speculated that demand has risen over a sustained period due to a number of factors, such as the gradual increase in England’s population - now 10% higher than 2003 – a 40% increase in the number of over-85s, rising expectations, earlier cancer referrals and technological advances.

However, government austerity measures have had a drastic impact on NHS funding, with spending rising an average 4.8% a year until 2010/11 when funding slowed significantly to around 1.2% a year to 2014/15.

“Looking ahead, the mismatch between funding and activity leaves NHS hospitals needing to achieve a step change in productivity growth, find ways to moderate demand, or overspend against budget,” the report concluded, suggesting the FYVW and more effective community care as potential solutions.

“An optimistic view would be that the unprecedented pressures facing the NHS and social care will be a more effective stimulus to change and improvement than the additional funds that have accompanied these previous efforts. A pessimistic view would be that the unrelenting focus on sustaining existing services will crowd out both the resources and leadership needed to do so.”

The Royal College of Nursing echoed the report’s call for more investment and better integration across the acute and community sectors, calling funding cuts to community nursing “nonsensical”.

Kathryn Yates, RCN’s professional lead for primary, community and integrated care, said that a decline in the community nursing workforce has led to many people’s conditions declining to the point where they need treating acutely, leading to a spike in “avoidable” hospital admissions.

“This situation is unsustainable, and investment is needed into community services, which can keep people well at home, as well as hospital care for those who really need it. Because neither part of the NHS has seen that investment, many patients are trapped in a revolving door, which is not only distressing but may worsen their conditions,” Yates said.

While last week communities secretary Sajid Javid provided a welcome boost to community care by announcing a new adult social care support grant and allowing councils to increase their social care precept to 3% in his local government finance settlement, Dalton warned that the announcement did not “go far enough” to relieve the demand on NHS services.

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