The escalating level of demand for NHS services is resulting in waiting times reaching record levels.
So asserts the Quarterly Monitoring Report from The King’s Fund.
According to the authoritative think tank, there were an estimated 3.8 million patients waiting for treatment in June 2016; the highest level for nearly a decade.
Over one-million patients were admitted to hospital from Accident and Emergency departments in Q1 2016/17 alone, with the number of patients attending A&E also exceeding six-million.
The King’s Fund found that over 90% of beds in the healthcare system are currently occupied by patients; a figure that is considered higher than the safe level required for normal operation.
To further complicate the existing climate, nearly half of all NHS trusts believe that they will suffer a deficit by the end of the existing financial year, with only one-third confident of meeting the “control totals” set by NHS Improvement.
Richard Murray, director of policy at The King’s Fund, opined that hospitals are facing unprecedented levels of pressure, and that this must impact on target-driven performance.
“Hospitals are treating more patients than ever before. Winter usually brings a dip in NHS performance, but what is striking now is that key targets are being missed all year round. This reflects the impossible task of continuing to meet rising demand for services and maintain standards of care within current funding constraints”.
Murray also suggested that the current framework of performance within which the NHS is operating is completely unrealistic, considering the financial travails of the healthcare system.
“While new investment and actions taken to tackle overspending have reduced deficits among NHS providers in the first quarter of the year, it would be a mistake to suggest that the financial pressures which have engulfed the NHS have eased. Unless more is done to tackle rising demand, the ideas emerging from sustainability and transformation plans about cutting beds and reconfiguring hospitals will look even more unrealistic.”
Lara Carmona, associate director of policy, international and parliamentary for the Royal College of Nursing, pulled no punches when describing the current NHS environment and atmosphere.
“The NHS is now struggling to cope all year round. It is a pressure cooker and with bed occupancy at such constantly high levels and community services stretched, there is nowhere for the pressure to escape to. Frontline staff are working hard to deal with these challenges to provide the very best patient care they can”.
Carmona pointed out that the Royal College of Nursing has continually attempted to point out the problems inherent in the public healthcare system.
“The RCN has consistently highlighted the difficulties in treating more patients with too few staff and pressure to save money. It would now take very little for hospitals to be fully overwhelmed. The only solution is for the Treasury to recognise the scale of the problem, and to support hospitals in dealing with their financial difficulties. There must be no missed opportunities to protect patient care.”
Included in the missed targets was the number of patients who were medically fit to leave hospital but were still awaiting discharge.
In June 2016 that figure was 6,100, which is the highest on record and a 22% increase on June 2015.
Health services in England need “a dedicated fund to finance and drive forward essential changes”, according to a new report launched this week by the Health Foundation and The King’s Fund.
The report – ‘Making change possible: A Transformation Fund for the NHS’ – arrives as the Department of Health releases its 2014/15 accounts which reinforce the financial challenges facing the NHS at this time.
The purpose of the Fund would be to enable the shift to new models of care as set out in the NHS five year forward view, as well as helping to unlock the efficiency savings required to balance the books.
The report explains that the Fund would not only deal with the current urgent need for service change but would, in the long-term, become a fundamental part of the NHS and the way it is funded.
Key findings from the report include: (i) the NHS needs a single body (whether within an existing organisation or newly created) to oversee the investment for transformative change in the NHS. It should have strong, expert leadership which is credible to clinicians and managers; (ii) the Transformation Fund requires £1.5–£2.1bn a year in dedicated funding between now and 2020/21.
“While we recognise that it is challenging to provide additional funding for the NHS in the context of other services receiving cuts, the alternative is to risk a decline in quality and safety in NHS-funded care and a reduction to the services currently available”, said Anita Charlesworth, Chief Economist at the Health Foundation. “Without more resources specifically for transformation, the NHS will be unable to become more productive and the bill for additional running costs will only get larger. The Transformation Fund should become a fundamental part of the DNA of the health service from here onwards.’
Richard Murray, Director of Policy at The King’s Fund, added: “The fundamental task is to get a workforce of more than one million people to work differently. This would be a huge challenge at the best of times but is an even bigger task when services are under such intense pressure. This cannot be done within the existing resources – dedicated funding is required to deliver the changes needed.”
The NHS under the coalition government is under significant strain and patient care is likely to suffer according to an assessment of the NHS under the coalition published today by The King’s Fund.
The thinktank found that NHS performance under the coalition held up well for the first three years of the parliament but has now deteriorated to the point that waiting times are now at their highest levels for a number of years and several key targets have been missed.
And although the King’s Fund assessment found that that the coalition met its pledge to increase the NHS budget in real terms, with funding increasing by an average of 0.8 per cent a year in real terms over the parliament, it also reveals that hospitals and other providers of care are now overspending their budgets by more than £800m.
Other findings include: (i) target waiting times for A&E, hospital treatment and cancer treatment have all been missed towards the end of the parliament; (ii) hospital bed occupancy has increased to very high levels and delayed discharges have risen significantly over the past 12 months; and (iii) there are signs that NHS staff are under significant pressure and morale is an increasing cause for concern.
“The next government will inherit a health service that has run out of money and is operating at the very edge of its limits”, warns John Appleby, chief economist at The King’s Fund and the lead author of the report. “While the NHS has performed well in the face of huge challenges, there is now a real risk that patient care will deteriorate as service and financial pressures become overwhelming.
“More optimistically, with the economy recovering, there could soon be an opportunity to think about public spending choices and the kind of health services we want in a fresh light. Future debate about the NHS should focus not on how parsimonious we need to be but on how generous we want to be.”