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NHS plans for this year ‘impossible to deliver’ on all fronts despite long-term funding

Patient experience of care is likely to continue to deteriorate next year even despite the prime minister’s promise to deliver a long-term funding settlement for the NHS, an NHS Providers report has argued.

The report, based on analysis of recent official data and a survey of NHS trust leaders, uncovered “widespread scepticism” about the NHS’s ability to meet performance and financial targets in 2018-19.

It stated that patients’ experience of care will continue to fall below acceptable standards, with growing risks to quality and safety.

By failing to be set achievable tasks for trusts, NHS Providers has warned that there is a risk of creating a “toxic culture, based on pretence,” which can weaken accountability, damage morale and erode public confidence in the NHS.

The report specifically highlighted concerns in three key areas: A&E, planned hospital treatment and trust finances.

A&E performance is the worst it has been since data collection started in August 2010, with just 85% of patients being seen and treated, admitted or discharged within four hours. Trusts have been told to raise overall performance to 90% by September 2019, with the majority reaching 95% by March 2019, but the report concluded that this appears impossible.

Based on projections of this increased demand, the report argued that the NHS would need to treat an extra 2.4 million people within four hours in order to meet the target of 95%.

But just 5% of trust leaders were confident that they could improve A&E performance in their local area to the level required.

NHS Providers warned that similar performance pressures are being experienced across other services, such as mental health, community trusts and ambulance services.

Trusts have been told that the waiting list for routine hospital treatment must not grow in the coming financial year, and that the number of waits of over 52 weeks must be halved – yet the report warned that it is “inevitable” that trusts will struggle to meet the expected levels of demand over the next year.

Currently, the waiting list for routine hospital treatment is around four million – the highest since records began in 2007.

A lack of beds and staff, combined with the pressures of emergency care and winter cancellations, means that admissions have dropped, and waiting list are reportedly likely to rise above four million.

Of those surveyed by NHS Providers, just 14% of trust leaders were confident that their services would be able to avoid lengthening waiting lists.

Similarly, trusts have been told to break even next year, yet in December 2017 the sector was forecast to end the year with a £930m deficit.

NHS Providers warned that the average cost improvement plan would need to be 5.7% of relevant turnover, equivalent to overall savings of over £4bn – 20% more than trusts were on track to deliver in 2017-18.

Only half of trusts indicated that they would sign up to their control total, and just 35% of these were confident that they could meet this.

The main reasons for rejecting control totals were that they were too ambitious. But trusts that do not sign up for control totals and meet performance targets will miss out on “sustainability funding,” which NHS Providers says will make their situation even worse.

The organisation’s chief executive, Chris Hopson, called the NHS a “can-do organisation,” but warned: “Our analysis shows the levels of performance expected and the savings demanded for next year are beyond reach.”

He welcomed Theresa May’s commitment to increase long-term funding but said that it will make “no immediate difference” for trusts in the next year.

“This report also shows – as the prime minister argued – that this is not just about funding,” he continued. “Trusts are struggling with major workforce shortages and they need help from the government here too.”

Top image: EunikaSopotnicka

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