Cuts are putting quality of care at risk, say NHS managers

BMJ 2013; 346 doi: (Published 13 February 2013) Cite this as: BMJ 2013;346:f982
  1. Andrew Cole
  1. 1London

A growing number of local NHS managers in England believe that the quality of care in their organisation is worsening as the effects of the drive to make £20bn (€23bn; $31bn) in NHS efficiency savings begin to bite, says the latest quarterly monitoring survey by the health think tank the King’s Fund.

The survey looked at service performance between October and December 2012, and for the first time it questioned directors of adult social services as well as NHS finance directors.1 All the 48 finance directors who responded (of 143 who were invited) were confident that they would balance their books this financial year, but two thirds were pessimistic about the financial outlook for their wider health economy, a view shared by three quarters of the 58 social service directors who responded (of 152).

A third of finance directors said that the quality of care of patients in their area had worsened in the past year. This compares with around one in six who said the same thing in the previous survey.

The report also detects growing pressure on hospital emergency departments, with the proportion of patients waiting more than four hours in this quarter the highest since 2003-04 (4.3%). There was a similar upward trend in “trolley waits”—patients waiting in the emergency department to be admitted as an inpatient (4.1%). Waiting list numbers for inpatient and outpatient treatment remain stable, but there has been a fall in the past two years in the number of people having to wait more than 18 weeks, from over 10% to around 5%.

The King’s Fund survey shows that NHS staff numbers fell by 2.3% from March 2010 to October 2012. The number of nurses, midwives, and health visitors fell by 4243 in full time equivalent terms, from 311 787 to 307 545 (1.4%), while that of managers fell by 18.5% from 43 608 to 35 533. In contrast, the number of consultants rose by 12.3% to 38 343, meaning that there are now more consultants than managers in the NHS.

The survey also shows that numbers of hospital acquired infections continue to fall. The incidence of meticillin resistant Staphylococcus aureus infections fell by nearly 12% from this time last year, while Clostridium difficile infections fell by 13.5%.

Many financial directors reported that the reduced local authority budget settlements were having a knock-on effect on healthcare organisations. Meanwhile some social service directors said that collaboration with the NHS was harder because of the financial pressure on acute care trusts. A third predicted that they would have to cut some services next year.

Nearly two thirds of the finance directors reported that delays in transferring patients from hospital had worsened in the past year, despite the fact that official figures from the Department of Health suggest no significant change over this period. The King’s Fund calls for further investigation to establish the reasons behind this apparent “dissonance.”

How is the Health and Social Care System Performing? is the seventh of the regular quarterly monitoring reports by the King’s Fund. It was based on online responses from 48 finance directors and 58 social service directors between December 2012 and January 2013.


Cite this as: BMJ 2013;346:f982


View Abstract

Log in

Log in through your institution


* For online subscription