Spend more on NHS or see services deteriorate further, hospital leaders warn

BMJ 2018; 360 doi: (Published 11 January 2018) Cite this as: BMJ 2018;360:k175
  1. Abi Rimmer
  1. The BMJ

A lack of funding and staffing shortages have made managing winter pressures “unsustainable,” NHS Providers has warned.

The organisation, which represents NHS hospitals and mental health, community, and ambulance services in England, said that the NHS had reached a “watershed moment,” and it called on the government to accept that the service could no longer deliver what was required of it within current levels of funding.

In a letter to England’s secretary of state for health and social care, Jeremy Hunt, the chief executive of NHS Providers, Chris Hopson, called for the government to “create a sustainable long term funding settlement for health and care.”1

Decisions on long term funding must be put in place no later than the next national budget in November, Hopson said, to prevent further deterioration in services, which were no longer able to meet the standards of care set out in the NHS Constitution.

The warning came as performance data for the NHS in England, published on 11 January, showed that in December 2017 the proportion of patients attending hospital emergency departments who were seen within four hours was 85.1%, below the 86.2% in December 2016 and the target of 95%.2

On the same day, 68 doctors who run emergency departments wrote to the prime minister warning that understaffing and underfunding were leading to overcrowding and premature deaths, because some patients were not seen quickly enough. They refuted Theresa May’s claim that the NHS was well prepared to deal with winter pressures, writing, “Our experience at the front line is that these plans have failed to deliver anywhere near what was needed.”

Hopson warned that the decision of the National Emergency Pressures Panel to postpone elective surgery3 would mean many trusts losing money. The decision “will mean that many more trusts than currently planned will lose access to financial and performance target-dependent funding and/or be financially penalised by commissioners,” he explained.

“This has a clear impact on their day-to-day financial stability as well as their ability to recover targets, invest in capital maintenance and transformation and reduce the provider sector deficit.”

Hopson said that he welcomed Hunt’s recognition of the need for a long term financial settlement for health and social care. “But urgent action is now needed on this issue if we are not to lose the hard won gains the NHS has made over the last 15 years,” he said.

“Failure to act now will lead to targets moving further out of reach. This would harm the quality of care, causing delays and distress for patients and weakening staff morale. It could also undermine public faith in the NHS.

“There is so much at stake. We can fix this, but there must be no more delay. The ball is now firmly in the Government’s court.”

Commenting on Hopson’s letter, a Department of Health and Social Care spokesperson said that the NHS had been given an extra £2.8bn over two years in the recent budget. The spokesperson said that the department knew there was a great deal of pressure in emergency departments and that flu rates were going up. “That’s why we recently announced the largest single increase in doctor training places in the history of the NHS—a 25% expansion.”


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