NHS Finance

Starved NHS ‘at point of no return’ and ‘no longer envy of the world’

The NHS is “underfunded, underdoctored and overstretched”, the Royal College of Physicians (RCP) said today in a stark new report arguing urgent action is needed to address the funding and staffing shortages in the health service.

The report showed that 85% of physicians believe that present healthcare funding is insufficient to meet the demand for services.

The NHS needs to deliver £22bn savings by 2020. NHS trusts’ combined deficit has been reduced to £461m after strict efficiency measures, but it is not clear how long this will be sustainable.

Dr Andrew Goddard, the RCP registrar, said: “It is clear to all of us working in the NHS that we are at a point of no-return and the NHS in its current form is unsustainable without a significant increase in funding.

“We can’t continue to provide ever-more expensive treatments to an ever-increasing group of patients and not expect the system to collapse. As doctors, we see the problems this creates on a daily basis, be it at the front door of the hospital, in A&E or in out-patients. Patients can see it too and realise that the NHS is no longer the envy of the world and isn’t fit for our changing world.

“There are some big decisions that society has to make and the political parties have to stop blaming each other for where we are and work together to build a health and social care system that is fit for the UK in the 21st century.”

Professor Jane Dacre, the president of the RCP, added: “As a doctor, I realise that this is a tough diagnosis for the NHS. However, a diagnosis is the first step towards working with colleagues to find solutions. We are keen to find the best treatment for the NHS over the coming weeks, months and years.”

The RCP argued that a new NHS budget must be created that meets the demand for services whilst setting realistic targets for efficiency savings and protecting funds for service transformation.

But Paul Briddock, director of policy at the Healthcare Financial Management Association (HFMA), said that an increase in NHS funding “may not be feasible”.

“The dialogue needs to focus on what the NHS can and cannot afford to deliver,” he added.

“The NHS is currently living beyond its means, and we share the report’s sentiment that this cannot be sustained in the long term. Many efforts are being made across the service – with finance teams, clinicians and management working closely together – but these changes take time and need to be implemented correctly.”

Chronic staff shortages could threaten patient care and seven-day NHS

Today’s RCP report also found that staffing shortages were so acute that 70% of doctors-in-training said they worked on a rota with a permanent gap, and 96% said there were gaps in nursing rotas. Hospitals also reported that 40% of consultant posts are going unfilled.

Hospitals are reportedly relying on unsustainable solutions to the staffing shortage. Nearly 50% of consultants reported being asked to fill junior roles, and more than 10% of doctors-in-training said their trust could not ensure patients were treated by staff with the appropriate level of clinical experience.

It added that these numbers are not sufficient for the government to deliver its goal of a seven-day NHS.

The report also warned that a fall in doctors coming from outside the UK as a result of the EU referendum result could be catastrophic, with 40% of doctors currently coming from outside the UK and 20% coming from the EU.

Candace Imison, director of policy at the Nuffield Trust, backed the report, saying: “These are critical issues which cannot be ignored. Gaps in rotas and recruitment are making it increasingly difficult for trusts to provide services, and taking a toll on doctors. We have grave concerns about the implications for morale.

“The NHS needs a sustainable funding settlement. Our work shows that under current plans, trusts are being asked to make savings over the next two years at a rate never before achieved – at a time when they are already visibly struggling after delivering efficiencies through years of financial pressure. We cannot carry on like this.”

Working hours reportedly harming trainees’ wellbeing

The report also discussed the harder working conditions for trainee doctors, who work an average of five hours a week more than their rostered hours.

This is reportedly having a negative effect on trainees’ wellbeing, with 74% working at least one shift a month without sufficient hydration, 56% working without a meal, and 80% reporting excessive workplace stress.

The RCP called for strategies to address the staff shortages, including incentivising work in medicine and creating new roles such as physicians’ associates.

Later this year, it will launch a new campaign to support doctors in dealing with workplace pressures.

Dr Johnny Marshall, director of policy at the NHS Confederation, said: “We look forward to working with the RCP and welcome its strong focus on developing the workforce. Their report represents an important contribution to the debate on the future of the NHS.”

Dr Marshall also urged the RCP to consider encouraging closer alignment between acute care and community providers, GPs and pharmacists.

(Image c. Peter Byrne)

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