13.03.15
Performance pressures affecting even best hospitals – Nuffield Trust
Deteriorating access to services is starting to affect patients attending even the best-performing hospitals in the NHS, a think-tank has claimed.
The Nuffield Trust’s latest report looked at how all 156 hospital trusts in England have performed over the course of this Parliament against six national targets, including A&E, the 18-week target for a hospital bed, cancer referral and diagnostic tests.
It revealed that the vast majority of patients in the English NHS continue to receive services and treatments within the target timescales.
However, performance has declined more recently. For example, half of the six measures Nuffield examined – A&E, inpatient treatment and diagnostic tests – missed their target in the last quarter.
The report highlighted this decline in performance is across the board and not restricted to specific hospitals.
Holly Dorning, research analyst at the Nuffield Trust and co-author of the report, said: ““The vast majority of patients are still receiving care within the target times, but our analysis shows that deteriorating access to services is starting to affect patients attending even the best-performing hospitals.
“We’ve known that hospitals have been struggling to meet the four-hour A&E target for a while. But the fact that we are starting to see problems in other areas, like access to planned treatment, is a real concern. As this study makes clear, warning lights are now starting to flash across the wider hospital system.”
The report also revealed that national performance against the target for 90% of inpatients and 95% of outpatients to start treatment within 18 weeks held up between 2010-11 and 2013-14, but has deteriorated over the past year. Performance against diagnostic tests has followed a similar pattern.
Responding to the report, a Department of Health spokesperson said: “The NHS is busier than ever, as innovative treatments and medicines mean people are living longer with complex conditions like heart disease or diabetes.
“We've increased the NHS budget this Parliament, but ultimately we want to reduce pressure on services through our plans to increase access to primary care and look after people better in the community.”
The Nuffield Trust’s analysis also questions the assumption that access to care deteriorates as hospitals are asked to treat more patients. It added that the response to declining performance is crucial, and must be dictated by a deeper understanding of the nature of the decline.
Report co-author Ian Blunt, senior research analyst at the Nuffield Trust, added: “While looking at a narrow set of targets can only tell us so much about the quality of care, this analysis does suggest that some of the recent reductions in performance are systemic.
“There are no quick fixes for growing waiting times and we need to be prepared to see further breaches of targets in the future.”
Rob Webster, chief executive of the NHS Confederation, added that the NHS is often viewed as a single organisation when it is not – the NHS is in fact a complex system.
“The Nuffield Trust is absolutely right to highlight that target delivery and performance reflects system issues and that system solutions are needed,” he said. “Our members tell us the whole system is under more pressure than ever. Tackling this requires commissioners and providers to work together across the whole system to help drive down waiting times. They will do this by working to change the way care is delivered. They will need support to make this a reality.”
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