Third of trusts set to miss their control totals this year

NHS providers are increasingly struggling to meet financial targets and deal with rising demand, with a third forecasting they will not meet their control totals, according to the latest King’s Fund quarterly monitoring report.

In a bid to manage NHS finances, NHS England is now requiring trusts to agree to strict individual control totals, which set targets for the maximum deficit or minimum surplus they are expected to achieve.

There were signs of progress in August after NHS providers’ total deficit was below the targeted amount. However, of the sample of trust finance directors surveyed by the King’s Fund, 30% of those who had agreed a control total said they now expected to miss it, compared to 13% in the previous quarter. This suggests that NHS Improvement’s aim of reducing the overall deficit to £250m for this year is already out of reach.

Over half of trusts expected to end the year in deficit, with 86% saying their forecast position for 2016-17 would depend on significant financial support.

For CCGs, the picture was more positive, with nearly two-thirds forecasting a surplus, but 71% said they would need significant financial help.

Furthermore, 79% of trust finance directors and 90% of CCG finance leads said there was a high or very high risk of failing to achieve the productivity gains suggested by the Five Year Forward View.

In addition, the report included the aggregate NHS performance data for the past three months. This showed that trusts are struggling to cope with increased demand after emergency admissions increased by 4% in the past year.

In July to September 2016, 90.6% of A&E patients waited for more than four hours to be treated, which is the worst performance at that time of year for more than a decade. A similar rate of patients waited longer than 18 weeks to begin hospital treatment, the worst performance since targets were revised in 2012.

Delayed discharges were at a record high, representing 568,774 bed days, which is 29% higher than the same quarter last year.

Chris Ham, chief executive of The King’s Fund, said: “The NHS is treating more patients than ever before, and these findings show that rising demand is putting its services under increasing pressure.

He added that the NHS would need to use the controversial STPs to invest in out-of-hospital services, and that “the most pressing priority” for the Autumn Statement was to increase social care funding.

In a letter responding to Health Select Committee concerns about NHS funding, published yesterday, chancellor Philip Hammond insisted current social care funding promises would be enough to address the crisis.

A DH spokesperson said: “The NHS is performing well despite the pressures of additional demand and an ageing population, with nine out of 10 people seen in A&E within four hours.”

They said that the government was “investing an extra £10bn per year by 2020-21” in the NHS, which would help reduce the pressure on hospitals by supporting GPs and mental health services.

Hammond also defended using the controversial £10bn a year figure, despite the Health Select Committee arguing that this overstates the level of government funding for the NHS.

An NHS England spokesperson said: “This report merely repeats what others have been saying for some time: Record numbers of patients are accessing NHS services in England. Staff are dealing with the highest ever number of ambulance calls, A&E attendances and emergency admissions in our history. But despite this, the NHS is delivering a good service for the vast majority of patients."

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