23.04.15
NHS faces biggest challenge for many years – King’s Fund
The NHS is facing it biggest challenge for many years, with mounting deficits, worsening performance and declining staff morale, warns The King’s Fund.
Its latest quarterly monitoring report paints a gloomy outlook, saying it now appears certain that hospitals and other NHS providers in England overspent their budgets in 2014-15 by more than £800m. This is despite nearly £900m being provided by the Treasury or switched from capital budgets to plug the growing black hole in NHS finances.
According to the regular survey undertaken for the report, almost 60% of trust finance directors said that they were dependent on additional financial support or had drawn down their reserves in 2014-15.
The financial outlook for 2015-16 is even gloomier, with two-thirds of hospitals concerned about staying within budget over the next year. Although commissioners are more optimistic, 40% of finance leads from CCGs are also concerned about whether they will be able to balance the books in 2015-16.
Other key findings from this quarter’s survey of NHS provider finance directors and CCG finance leads include:
- For the third consecutive quarter staff morale tops the list of concerns raised by trust finance directors;
- Fewer than half (45%) of trusts feel confident that they will achieve the productivity targets for 2015-16;
- 90% of trust financial directors and 85% of commissioners are concerned about the financial state of their local health economies;
- There is a mismatch in expectations about demand for services between providers and commissioners; for example, 80% of trusts expect emergency admissions to rise this year, while 60% of CCGs expect them to fall;
- Three-quarters (75%) of trusts and two-thirds (68%) of CCGs think there is a ‘high’ or ‘very high’ risk of failing to achieve the productivity gains over the next five years outlined by the NHS Five Year Forward View.
The report also found that NHS performance continues to deteriorate, with key targets being missed with increasing regularity.
Performance against target waiting times for A&E is at its worst level since 2003, with 8.2% (more than 440,950 patients) waiting longer than four hours in A&E departments in the final quarter of 2014-15.
The number of delayed transfers of care has risen by over 20% compared to the same quarter last year and is now at its highest level since 2008.
In February 2015 the proportion of inpatients waiting longer than 18 weeks for treatment rose to 13%, the highest level since this target was introduced; however, the number of people still waiting for treatment after 18 weeks dropped, suggesting the policy of allowing a ‘managed breach’ of the targets is having an impact.
Commenting on the report, Richard Murray, director of policy at The King's Fund, said: “The health service enters the new financial year facing some of the biggest financial and performance challenges in its recent history. If last year was the most difficult for some time, this year promises to be much worse, with little confidence that the alarming deterioration in NHS finances can be arrested.
“Looking further ahead, while there is still significant scope to improve productivity in the NHS, efficiencies are becoming harder to generate and there is considerable scepticism that the £22bn in productivity improvements outlined in the NHS five year forward view can be achieved.”
Responding to the report, the Royal College of Nursing (RCN) called on the next government to prioritise staff morale.
“The NHS is being held together by its staff, and they cannot run on empty forever, morale plummeting year on year. It is not just the balance books that will feel the effects of this turmoil, it is patients who need the NHS to offer the best treatment, fast,” said Dr Peter Carter, chief executive and general secretary of the RCN.
He added: “This shocking picture is the consequence of dire financial circumstances, but it is also the consequence of continued organisational chaos, making it harder to tackle the demands of the future. Too many committed staff are feeling demoralised and defeated, leaving them at risk of burn out and jeopardising the quality of patient care.”
(Image source: Dominic Lipinski/PA Wire)
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