Increased A&E pressure and agency staff costs put foundation trusts further into red

BMJ 2015; 350 doi: (Published 23 February 2015) Cite this as: BMJ 2015;350:h1021
  1. Zosia Kmietowicz
  1. 1The BMJ

NHS foundation trusts in England became “less operationally resilient” in the last three months of 2014, with increased demand for services and their finances overstretched, especially in the acute care sector, the health sector regulator Monitor has reported.

Foundation trusts failed for the third quarter in a row to meet targets set for waiting times in accident and emergency departments, for treatment for cancer, and for elective care, said the quarterly update on performance.1

It showed that the trusts saw 2.7 million people through emergency departments between October and December 2014, the same as in the previous quarter but 8% higher than in the same period last year. Subsequently, hospitals admitted 570 000 for further treatment, 40 000 more patients than in the same three months in 2013, said the report.

The sector failed to meet the emergency department target for 95% of patients to be seen within four hours for the fourth quarter in a row, with a performance of 92.4% in the last three months of 2014. Trusts have blamed the missed target in part on patients’ lack of rapid access to GPs and poor capacity of community and social care, which resulted in rising demand and delayed discharges.

Winter pressure also meant that ambulance foundation trusts dealt with 933 000 calls between October and December 2014, 13% more than in the same period last year, while some ambulance trusts have staff vacancy rates of up to 24%.

In terms of elective care, performance improved slightly, with 89.6% of admitted patients starting treatment within 18 weeks of referral, below the 90% target but better than the previous year’s figure of 88.1%.

But trusts continued to miss the target to begin treating 85% of patients who have cancer detected through screening within 62 days. And overall trusts had a combined waiting list of 1.65 million, 40 000 fewer than the number in July to September 2014 but still 2.5% higher than last year’s figure.

The size of the combined deficit reported by trusts has grown to £321m (€435m; $500m), an increase of £67m since the last report in November. The deficit is now five times the planned figure and is set to reach £375m by the end of the financial year. Overall 78 (53%) of 149 foundation trusts were in deficit, most of them (60) being acute care trusts.

The growing deficit is the result of under-delivery of planned cost savings and recruitment problems, which have also contributed £400m in unplanned agency staff costs. Also contributing to the deficit is the fact that more emergency work is being paid for on a marginal tariff, which is displacing hospital’s elective activities, which attract higher tariffs, said the report.

David Bennett, Monitor’s chief executive, said, “Trusts are working harder than ever to overcome the challenges they face while still meeting patients’ expectations for quality care. However, the NHS needs to move rapidly towards more joined-up, efficient models of care if it is to deal with this continuing growth in demand for services.”

Commenting on the latest figures, Siva Anandaciva, head of analysis at NHS Providers, said that trusts were at “a critical point, and this situation is simply not sustainable.” She added, “The NHS needs and deserves a commitment to transformation, a more stable multi-annual financial planning framework, and a more realistic answer to the funding challenges it faces in the short and medium term.”

In a similar vein Richard Murray, director of policy at the health policy think tank the King’s Fund, said that if a solution to trusts’ financial problems was not found “then patients will bear the cost as staff numbers are cut, waiting times rise, and quality of care deteriorates.”

He added, “The prolonged slowdown in funding that the NHS is facing means that even well managed organisations are struggling to avoid significant debt. Emergency support is needed for otherwise sound organisations that are running up deficits as a result of the unprecedented pressures on their budget.

“A new health and social care transformation fund should also be established to meet the cost of essential changes to services. This is a big ask in the current financial climate, but the money to do this cannot be found from existing NHS budgets.”


Cite this as: BMJ 2015;350:h1021


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