Patient care worsens as NHS deficits persist

Patient care in England in hospitals and in the community has worsened in the past year, most finance leaders say. The latest quarterly monitoring report by the King’s Fund said that the findings on quality of care were the most worrying since it began tracking this in 2012.1

Altogether, 65% of trust finance directors and 54% of finance leads at clinical commissioning groups (CCGs) thought that patient care had worsened in their local area in the past year. Of 241 NHS trust finance directors, 87 (35% response rate) responded to regular surveys for the report from 8 April to 3 May 2016, along with 42 of 149 CCG finance leads (22%).

The report underlined the increasing strain on the NHS in 2015-16. It said that 8% of patients—more than 1.85 million—had spent longer than four hours in emergency departments, the worst performance since 2003-4.

During 2015-16 the number of patients waiting for hospital treatment was also estimated to have risen to 3.7 million, an increase of 17% (almost 500 000 patients) on the previous year and the highest number since 2007.

Delayed discharge from hospital was the most worrying concern among trust finance directors and was the second biggest concern among CCG finance leads, after waiting time targets in emergency departments. At the end of March 2016 more than 5700 patients were delayed in hospitals, an increase of 15% over the year and the highest number since 2008, the report said.

The latest survey also confirmed that 67% of NHS providers ended 2015-16 in deficit (including 9 in 10 acute trusts). Providers ran up a deficit of £2.26bn (€2.95bn; $3.31bn) in the first three quarters of last year and were expected to end the year £2.8bn in the red.2

Deficits reaching £1.4bn are predicted for 2016-17 despite £1.8bn of extra NHS funding that the chancellor announced last November, the report warned. Nearly a fifth of CCGs also reported that they expect to overspend their budgets this year.

On top of this, the NHS is expected to deliver £22bn in efficiency savings by 2020-21—something that Chris Ham, head of the King’s Fund, has said is unachievable.3

John Appleby, King’s Fund chief economist, said, “Our latest survey confirms what we already knew, that 2015-16 was a very difficult year for the NHS, reflected in huge deficits and worsening performance.

“2016-17 is a watershed year for the NHS in which it has been tasked with eradicating deficits and improving performance. Despite significant additional funding and a huge effort to contain deficits, it is clear that this is going to be a Herculean challenge.”

Stephen Dalton, acting chief executive of the NHS Confederation, said that the report outlined “the alarming reality that ongoing financial strain on the NHS is impacting our members’ efforts to deliver high quality care.” He said that “fundamental change” was needed in how care was provided in financially challenging times.

“Hospitals must be allowed to focus on treating those that need to be there. We also need to make sure that people receive the care where and when they need it most—often this will be in their own homes or within their community,” said Dalton.

He added, “We now need to see government and national bodies providing the right support to allow our members to drive locally led change. In particular, the underfunding of social care services continues to put immense pressure on NHS services and hamper efforts to improve care.

“As a starting point, this must be addressed by the government if the NHS is to have hope of delivering a sustainable high standard of care.”