NHS reforms


Tough task ahead for the NHS

Phillippa Hentsch, head of analysis at NHS Providers, paints a stark picture of NHS finances, workforce pressures and unsustainable targets for the coming year unless firmer action is taken by the government.

We wanted it. We campaigned for it. So it would be churlish now not to give a very warm welcome to the prime minister’s commitment to a serious long-term financial settlement for the NHS. But that does not alter the fact that what the NHS is being asked to deliver in the here and now looks well-nigh impossible.

A new report by NHS Providers, ‘Tough Task: The NHS delivering for patients and staff in 2018-19,’ presents a stark and worrying assessment of the challenges facing NHS trusts this coming financial year. It warns that patients’ experience of care will continue to fall below the standards trusts consider acceptable, with growing risks to quality and safety, adding to the burden on an already-hard pressed workforce.

This is not where trusts want to be. Looking back over the last 12 months, so much has been achieved in extremely difficult circumstances. The NHS helped more patients than ever before in A&E, it made progress in implementing ambitious plans for mental health, and it delivered more than £3bn of savings. But still it fell short of the demands placed on it. Waiting lists for routine surgery continued to grow, delays in A&E rose to record levels, and NHS trusts are now on course to record a £1bn deficit. In the year ahead, it is clear that we are setting the NHS up once again for an undeliverable task.

The planning guidance for the health service published last month set out a requirement for trusts to balance their books this year. That will require over £4bn of efficiency savings (20% more than for 2017-18). Trusts have also been told to substantially improve A&E performance and ensure waiting lists for routine operations don’t grow any longer. That is a very tall order. It is right to set the NHS challenging and stretching targets. But these objectives are – to say the very least – optimistic. Unfortunately, there is a glaring mismatch between the resources currently available and the political and public expectations for the NHS.

As a result, we risk damaging public confidence in the health service as trusts once again are seen to fall short. There is a real danger that this will demotivate and demoralise staff as they work towards targets that they know they cannot meet.

Next year

The message from trust chief executives and financial directors is clear. Only 5% of trusts are confident that their area can meet the four-hour A&E target next year, and more than half are worried they won’t be able to keep the lid on waiting lists. And, based on projected levels of demand and performance, the NHS would need to treat an extra 2.4 million people within four hours to meet the target of 95%. We estimate by the end of March next year the number of people breaching the 18-week constitutional standard for routine hospital treatment will reach 560,000 – a rise of nearly 80,000.

Given the widespread capacity challenges the NHS has seen this year in terms of beds and staff, affecting hospitals, mental health, community and ambulance trusts, we see little prospect of the health service meeting the performance objectives set for 2018-19. The scale of the financial challenge is also daunting. Despite an additional £1.6bn from the budget and a further £540m eked out of Department of Health and Social Care (DHSC) funds, the NHS’s budget is only increasing by 1.4% next year: that’s just 0.7% per head of the population. This is well below the 1.2% per person spending rise in 2017-18.

Trusts have been asked to sign up to and deliver financial targets (known as control totals). Our analysis suggests that doing so would imply – on average – a 5.7% cost improvement plan, equivalent to overall savings in excess of £4bn. This is 20% more than trusts are on track to deliver this financial year.

Where do we go next

The NHS is a can-do organisation. But we need to break the cycle of setting the NHS an undeliverable task, and then asking why trusts fall short.

So what must be done? We need to ensure that NHS trusts become a key part of the planning process, alongside the DHSC and the NHS’s central bodies. This will require significant cultural and practical change, but it is no longer credible to negotiate targets behind closed doors and then expect trusts to deliver them. We have argued consistently that the resources currently available to the health service – in terms of funding and workforce – mean it is being set up to fail. So thank you, prime minister, for committing to sustainable long term funding for the NHS. Let’s make sure to remember that workforce pressures get the same priority. And let’s see words backed up with action.

(Top image c. Marbury)


There are no comments. Why not be the first?

Add your comment


national health executive tv

more videos >

latest healthcare news

Lancashire County Council to pay £200k in legal costs after Virgin Care legal battle

17/08/2018Lancashire County Council to pay £200k in legal costs after Virgin Care legal battle

Lancashire County Council has agreed to pay £200,000 in legal costs to two NHS Trusts after their decision to hand a £104million cont... more >
Former inadequate West Midlands maternity unit upgraded by CQC

17/08/2018Former inadequate West Midlands maternity unit upgraded by CQC

Walsall Manor Hospital’s maternity services have been given an improved rating from the health inspectorate following assessments made in J... more >
Major hospital stalled by Carillion collapse will go ahead under government funding deal

16/08/2018Major hospital stalled by Carillion collapse will go ahead under government funding deal

The construction of a major Midlands hospital that had its future cast into doubt following the collapse of infrastructure giant Carillion has be... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now beyond doubt or dispute, other than in government, th... more > more last word articles >

the scalpel's daily blog

The NICE impact on falls and fragility fractures

10/08/2018The NICE impact on falls and fragility fractures

Falls should not be an inevitable part of ageing – and their snowball effect means the consequence of falls are far from limited to just hospital admissions, says Professor Gillian Leng, deputy chief executive and director of health and social care at NICE Almost a third of over-65s in the UK have a fall at least once a year, with a... more >
read more blog posts from 'the scalpel' >


Listening to the frontline

15/08/2018Listening to the frontline

Professor Wendy Reid, executive director of education & quality and national medical director at Health Education England (HEE), shares insig... more >
Medication without harm

15/08/2018Medication without harm

The World Health Organization’s (WHO’s) Third Global Patient Safety Challenge, ‘Medication without harm,’ is ambitious, b... more >
Stepping up the fight against AMR

15/08/2018Stepping up the fight against AMR

Professor Mark Baker, director of the Centre for Guidelines at NICE, explains what the organisation is doing to support the fight against antimic... more >
Population health for the 21st century

15/08/2018Population health for the 21st century

NHS Partners Network (NHSPN) chief executive David Hare discusses the themes covered at his organisation’s Confed18 panel debate on populat... more >


Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >
Tackling infection prevention locally

04/10/2017Tackling infection prevention locally

Dr Emma Burnett, a lecturer and researcher in infection prevention at the University of Dundee’s School of Nursing and Midwifery and a boar... more >
Scan4Safety: benefits across the whole supply chain

02/10/2017Scan4Safety: benefits across the whole supply chain

NHE interviews Gillian Fox, head of eProcurement (Scan4Safety) programme at NHS Supply Chain. How has the Scan4Safety initiative evolved sin... more >

health service focus

View all News