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Real impact of NHS financial crisis ‘slipping under the radar’

Financial pressures being placed on the NHS is leading to care being harder to access and of increasingly lower quality, a new report released by the King’s Fund has warned.

The findings, called ‘Understanding NHS Financial Pressures’ studied four services: testing and treatment for sexually transmitted infections, district nursing, elective hip replacement and neonatal care – to explore the impact of financial pressures on patient care and found that a slowdown in funding has taken a while to show real effects but is now truly affecting the services patients receive.

The think tank also warned that the impact on services was slipping “under the radar” as public attention focused disproportionately on high-profile examples of rationing such as restricting access to some types of treatment.

The greatest effects were found in GUM STI testing and treatment and district nursing, as the report stated that care was becoming increasingly “episodic” as staff focus too much on the “nuts and bolts” of diagnosis and treatment without time to fully access the patients’ underlying needs.

The report also alluded to staff acting as “shock absorbers” as it said they had to work “longer hours and more intensively to protect patient care”.

Ruth Robertson, fellow in health policy at the King’s Fund and lead author of the report, said: “Longer waiting times for hospital treatment and restrictions to operations are just one small part of the picture.

“Our research shows that services like district nursing and sexual health, where we found evidence that access and quality are deteriorating for some patients, have been hardest hit by the financial pressures facing the NHS but that this is often going unseen.”

Robertson added: “This undermines the vision set out in the Five Year Forward View to strengthen community services and focus on prevention.”

The King’s Fund fellow called for further investment in community and public health services if the NHS wants to transform care and keep patients healthy and out of hospital.

She concluded: “Staff across the NHS are working hard to maintain service quality and protect patients in the face of growing pressures. This is not sustainable and is particularly worrying given the well-established link between staff wellbeing and the quality of patient care.”

Reaction

Saffron Cordery, the director of policy and strategy at NHS Providers, said that NHS Trusts have been working flat out to protect patients from the impact of the longest and deepest financial squeeze in the history of the health service.

“But as this report points out, the gap between what the NHS is being asked to deliver and the resources available is growing. The impact on patients is becoming increasingly clear, both in terms of access to treatment and the quality of care,” she stated.

“It is particularly worrying that these effects have been most pronounced in community services and public health. The vision outlined in the NHS Five Year Forward View was predicated on improvements in prevention, and providing more care closer to home rather than in hospital, to help balance the equation of rising demand and costs with no additional resources.”

Niall Dickson, CEO of the NHS Confederation, which represents health service organisations across England, Wales and Northern Ireland, added that the report reinforces “how difficult it is to transform services when budgets are so tight”.

There is simply not enough money to meet existing demand, never mind build up the new community services needed to create a sustainable system, he explained: “The system is under enormous pressure and it is becoming increasingly evident that in some places care is not as good or as quick as it once was.”

Royal College of Nursing chief executive and general secretary, Janet Davies added that the study “lifts the lid” on the dangers of trying to provide nursing care on the cheap.

“Patients waiting for district nurses at home are being let down as the funding pressures bite,” stated Davies, who also warned that nursing staff were “straining to hold things together” for their patients, going on to say they can “only hold down the fort for so long”.

“Nurses in our communities cannot keep absorbing the problems in the other parts of the NHS and social care system - neither for patients leaving hospital too soon nor vulnerable people who no longer receive enough social car,” she said. “Patients turn to A&E because of short-sighted cuts to primary, community and social care. But last week, the government directed funding towards emergency departments and not community services. We need to address the cause, not just the symptom.”

(Image: c. Peter Byrne)