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NHS ‘creaking at the seams’ as problems spread beyond A&E

Problems in the NHS are spreading beyond A&E, with waiting times for cancer treatment and routine operations worsening as the “risk of NHS crisis grows”, warns the King’s Fund.

The Fund's latest quarterly monitoring report, which follows widespread reports about pressures on A&E units, underlines that hospitals are stretched to the limit. The report shows that waiting times for treatment and other key performance indicators are worsening, as the NHS struggles to cope with increasing demand for services and the unprecedented financial squeeze.

Professor John Appleby, chief economist at the King's Fund, said: “While recent attention has focused on the problems faced by A&E units, performance against waiting time targets and other indicators has continued worsen. Taken together, the findings from this quarter's report show that services are stretched to the limit. With financial problems also endemic among hospitals and staff morale a significant cause for concern, the situation is now critical.”

The report shows that the proportion of inpatients waiting longer than 18 weeks for treatment rose to 12.5% in November – the highest level since this target was introduced in 2008.

At the same time the target that no more than 5% of outpatients should wait longer than 18 weeks for treatment was breached for the first since 2008.

Waiting times for cancer treatment continued to worsen in the second quarter of 2014, with only 83.5% of patients receiving treatment within 62 days of urgent referral from their GP – the lowest proportion since the current target was introduced.

The number of delayed discharges from hospital – a key factor contributing to increased A&E pressure – increased sharply to more than 5,000 per day in November, an increase of almost 20% since January.

The number of cancelled operations also rose sharply to 13,000 between November and January, an increase of a third on the same period in 2013.

While the increases in waiting times for hospital treatment are partly explained by the government’s policy of allowing a ‘managed breach’ of the 18-week targets while a backlog of long-waiters is cleared, current performance across a range of indicators suggests the health system is creaking at the seams.

Dr Mark Porter, chair of the British Medical Association council, said:  “What’s happening in our emergency departments is directly linked to and reflective of wider pressures across the NHS. Every part of the system – from general practice, to hospitals, to community care – is struggling to keep up with demand, leaving some patients facing unacceptable delays for treatment. In some cases, this means patients who have been waiting weeks or months for treatment having their operation cancelled as they are about to be taken to theatre.

“That staff morale continues to be a greater concern for managers than the dire financial circumstances facing hospitals really underscores just how challenging conditions are for front-line NHS staff and should serve as a real wake-up call.”

The report confirms that NHS finances remain under intense pressure, with more than 40% of trust finance directors surveyed for the report forecasting that their trust will end the year in deficit. Repeating the pattern of previous reports, commissioners are more optimistic, with more than 90% of clinical commissioning groups expecting to break even or finish the year in surplus.

More than 60% of trusts are relying on financial support from the Department of Health or, in the case of some foundation trusts, planning to draw down their reserves. Despite this, over three-quarters reported that their organisation is planning to increase the number of permanent nursing staff it employs over the next six months, as hospitals continue to prioritise patient care above balancing the books.

Not surprisingly, given the increasing pressures on frontline staff, trust finance directors once again identified staff morale as their top concern, alongside A&E waiting times. The report also found that more than 80% of those who responded were concerned about the ability of their organisation to meet its target to reduce emergency admissions under Better Care Fund plans, once again casting doubt on the credibility of the government's flagship policy for integrating health and social care.

Dr Peter Carter, chief executive & general secretary of the Royal College of Nursing said: “The NHS is struggling and stretched far too thinly and the only solution is to look at the system as a whole.

“A&E departments are where the pressures are most visible, but this report shows that a lack of investment, poor workforce planning and fragmented services have affected patients across the whole NHS.

“Staff morale is low, thanks to years of pay restraint and unprecedented pressures. This has to be sorted out - not just for staff, but for patients too. The NHS needs to keep hold of its staff, not throw them away.”

A Department of Health spokesperson said: "The NHS is busier than ever which is why we have given almost £1bn this year for almost 800 more doctors, 4,700 more nurses, 6,400 more beds and treatment for an extra 100,000 patients.

“We are backing the NHS' plan for the future and have provided an extra £2bn in funding next year to transform out of hospital care and expect trusts to have strong financial grip to help achieve this.”

(Image source: Rui Vieira/PA Wire)

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