More bad news for NHS in ‘wake-up call’ performance and deficit figures

The NHS performance figures for March 2015-16, published today by NHS Improvement, add to the mounting evidence that the NHS is struggling to cope with unprecedented pressures.

The figures show that in 2015-16, A&E attendances increased by 2.9% to 20.7 million. In March 2016, providers saw the highest number of A&E attendances since records began, representing an increase of 7.5% compared to March last year.

Only 91.1% of patients were seen or admitted within four hours, below the 95% target, in 2015-16 – and quarter 4 (January to March 2016) was the worst ever for this, with only 86.6% of patients seen or admitted.

The number of patients who waited longer than four hours on a trolley for a bed increased by 26.3% to 387,809 in 2015-16, which NHS Improvement largely attributes to “sustained high levels of emergency admissions and a lack of beds to meet the demand”.

Overall, NHS providers’ end-of-the-year financial deficit hit £2.45bn, almost three times greater than last year’s and £461m worse than planned.

Dr Graham Jackson, chair of NHS Clinical Commissioners, said: “The deficit revealed in today’s NHS financial figures for 2015-16 may not at this point come as a surprise but nevertheless must serve as a wakeup call.

“We simply cannot keep doing more of the same – in order to ensure the long-term sustainability of an NHS that delivers high-quality care for patients, transformation is key.”

He added that although stabilising providers’ deficits was the immediate priority, in the longer term more funding must be shifted to out-of-hospital services such as mental health services and community and primary care in order to relieve the pressure on A&E.

In other performance measures, critical ambulance calls increased by 8.1% compared to the fourth quarter in 2014-15, and life threatening calls increased by 18.5%. Ambulance trusts failed to reach all targets on responding to calls, partly due to a pilot scheme allowing call handlers extra time to triage calls.

The median waiting time for starting elective treatment reached 6.4 weeks, almost a week longer than in 2014-15; 1.8% of patients waited longer than six weeks for a diagnostic test against a 1% target; and 82.1% of patients were referred for cancer treatment within 62 days in quarter 4, against an 85% target.

The main causes of the deficit included unplanned spending on agency staff, which cost £1.4bn despite the introduction of a cap designed to bring it down, and £145m on delayed transfers of care, which increased by 6% and £498m on fines.

However, Jim Mackey, chief executive of NHS Improvement, said NHS providers had done “a great job” in saving £724m and keeping the deficit below predictions of £2.8bn.

But Dr Amanda Doyle, co-chair of NHS Clinical Commissioners, said: “While across the system we will continue to look for any further efficiencies that can be made, this can only go so far.

“The NHS has been given a finite amount of money and we need to have an open and honest conversation about what it can and cannot be expected to deliver with this.”

The report is the second piece of bad news for the NHS this week following yesterday’s King’s Fund report, which found that 67% of providers ended the year in deficit and 65% of NHS trust finance directors and over half of CCG finance leads felt that patient care in their area had worsened in the past year.

Paul Briddock, director of policy at the Healthcare Financial Management Association, said: "The deficit on the provider side of the NHS is incredibly worrying and given this year end figure, may now call into question if it is still feasible to balance the department expenditure limit when all the numbers have been calculated."

(Image c. Peter Byrne)

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