04.11.15
Stress levels, lack of realism and declining quality puts NHS at risk of ‘sudden collapse’
With 38% of staff falling ill due to work-related stress, growing waiting times for services and high vacancy levels across primary and hospital care, policy-makers need greater realism about the level of quality the NHS can provide within the funds available, a report has said.
The 2015 annual report, published by think tank the Nuffield Trust and Health Foundation, argued that current policy for the NHS is focusing on additions the health service could offer, such as seven-day working or enhanced cancer treatment strategies.
But the NHS is already struggling to preserve the quality of its existing services.
“In light of increasing demand for healthcare, policy-makers must focus on how to maintain and improve quality of care across all services and care settings, not just on new announcements,” the report said.
“There is not yet a convincing plan for how the NHS will achieve the extremely challenging efficiency savings of at least £22bn needed to prevent the £30bn projected funding gap by 2020.”
Two of the principal issues entrenched in declining quality of care were waiting times and staffing issues. The bodies found that waiting times are under the most severe strain in over a decade, and are unlikely to improve in the near future.
Performance against the four-hour A&E target in major units reached the lowest level in the last quarter of 2014-15, and the number of people waiting more than four hours after being admitted from A&E into hospital grew by 45% since 2013-14.
The target of ambulances attending 75% of life-threatening emergency calls within eight minutes was also regularly missed and reached a low of 61% in December last year.
On staffing, high levels of stress are continuing to affect employees’ health, with 38% of them still having to miss out on work as a result – a figure that has failed to improve in the last two years.
The organisations also found that high vacancy rates could already be reducing the quality of care patients receive in primary and hospital care.
Furthermore, their analysis identified areas of care quality variation, with marked disparities between child and adult diabetes services and differences between physical and mental health care.
Last year, for example, 26% of people waited more than 18 weeks for their first outpatient appointment under a mental health speciality – compared to just 6% of those waiting for a physical health appointment.
In a foreword, Nuffield Trust chief executive Nigel Edwards and Health Foundation policy director Richard Taunt said: “The warning lights on care quality that we observed last year now glow even more brightly. So far we have seen a gradual decline in some elements of quality. The problem with complex systems under high levels of stress is that they can suffer sudden and catastrophic collapse – often without a lot of warning.
“It is very difficult to predict whether crises in the quality or availability of services are likely to become more common – or even routine – or whether the gradual decline we are tracking through QualityWatch will continue. One thing that is clear is that patients cannot expect the speed at which they access care to improve anytime soon.”
The two healthcare experts also argue that measures included in NHS England’s Five Year Forward View could help mitigate the crisis, but would not address the immediate challenge facing the NHS – and solutions to maintain care quality and meet the financial challenge “do not appear to be in place”.
And to build on that, their analysis also found that the NHS has huge data gaps in understanding the quality of care it provides – from social care right down to underage mental health services.
“Put simply, we lack the answers to many of the questions most fundamental to understanding the impact of financial austerity on quality. We do not know the impact on the health and wellbeing of individuals as a result of 400,000 fewer people receiving publicly funded social care,” the report added.
“We know exceptionally little about patient safety in primary care, the point at which most people interact with the health service. We have virtually no data about the quality of services for children and adolescents with mental health problems. These data gaps are concerning – as is the lack of a plan in addressing them.”