The Scalpel's Blog

04.04.18

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)

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

CQC finds ‘significant improvements’ at specialist London NHS trust

25/03/2019CQC finds ‘significant improvements’ at specialist London NHS trust

Significant improvements have been found by inspectors at the Royal National Orthopaedic NHS Trust (RNOH) in a “major step forward” f... more >
Heart surgeries cancelled and patients warned of fatal infection risk due to deaths at Edinburgh hospital

25/03/2019Heart surgeries cancelled and patients warned of fatal infection risk due to deaths at Edinburgh hospital

NHS Lothian has written to nearly 200 patients who have undergone heart surgery in the last six months warning them of a potentially fatal infect... more >
Medical director promoted to chief executive at under-investigation trust

25/03/2019Medical director promoted to chief executive at under-investigation trust

The Countess of Chester Hospital Trust (COCH) has announced that its medical director has been appointed as its new chief executive. Susan G... 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, that the NHS is inadequately funded. Even the secretary of state has argued that it will need more mon... more > more last word articles >

the scalpel's daily blog

What progress are we making to transform our population’s mental health?

25/03/2019What progress are we making to transform our population’s mental health?

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at the National Institute for Health and Care Excellence - NICE - provides her view of the newly published NICE impact report on mental health. Mental health conditions are the largest single cause of disability in the UK, with one in 4 adults experienci... more >
read more blog posts from 'the scalpel' >
332 304x150 NHE Callout banner.

comment

What progress are we making to transform our population’s mental health?

25/03/2019What progress are we making to transform our population’s mental health?

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at the National Institute for Health and Care Excellence - ... more >
Staying curious with the Shadow Board Programme

20/03/2019Staying curious with the Shadow Board Programme

Kirstie Stott, director of The Inspiring Leaders Network, discusses organisational and system curiosity alongside the work of the Shadow Board Pr... more >
Fiction as Therapy

20/03/2019Fiction as Therapy

Elaine Bousfield of ZunTold Publishing – a press specialising in fiction for children and young people – discusses ‘Fiction as ... more >
Capturing funds for the NHS estate

20/03/2019Capturing funds for the NHS estate

Aahsan Rahman, department head of town planning at NHS Property Services (NHSPS), looks at an alternative and perhaps underutilised funding sourc... more >

health service focus

View all News

interviews

How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... 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 >