The NHS is now in its eighth year of austerity and it is no surprise that our latest Quarterly Monitoring Report finds it stuck in a Groundhog Day of deficits and slipping financial plans. The risks were always high that a continued malaise on finance would begin to damage patient care (rather than just the Chancellor’s fiscal forecast) and the evidence is that this is indeed happening. But where is the pressure on hospitals greatest? And what must be done to relieve it?
Our recent survey provides us with answers from multiple sources. 51 per cent of NHS trust finance directors and 59 per cent of clinical commissioning group (CCG) finance leads said patient care has worsened over the past year. CCG finance leads also set out a painful list of the measures they are having to consider in order to live within their budgets, with more than 80 per cent extending waiting lists, more than 60 per cent looking to stop funding for lower-value treatments and more than 50 per cent looking to use eligibility criteria (such as smoking or obesity) to reduce access.
Of course, at the same time waiting times in the NHS have continued to rise, whether in A&E or for planned care. The good news is that the rate of decline on A&E has been slowed to a snail’s pace, the bad news is that this was partly done by de-prioritising the 18-week referral-to-treatment standard for planned care. Despite waiting lists crossing the four million mark this year (and still rising), Trust finance directors now rate the 18-week standard much lower on their list of concerns—the de-prioritisation message has been heard loud and clear and is not encouraging for anyone waiting for treatment.
Unfortunately, although this was done to allow the NHS to focus on A&E, only 28 per cent of trust finance directors and 4 per cent of CCG finance leads think they will manage to meet the four-hour waiting time for A&E by March 2018 (the next milestone set by national NHS bodies). For many in the NHS “March 2018” seems like the distant future, given that to get to March you first have to get through the winter period.
“More than 50 per cent of CCG leads are looking to use eligibility criteria—such as smoking or obesity—to reduce NHS access”People wait in A&E mainly because they are waiting for a bed in the hospital. So why doesn’t the NHS just open more beds to admit all the patients who need a one from busy A&Es? Partly this is about money, but it is also about the workforce. In particular, the nursing workforce is at the top of the list of anxieties for hospitals. For the first time in years, the number of nurses registered to work in the UK is falling, as is the number of nurses and health visitors employed in the English health service.
Our survey found 65 per cent of trusts were still looking to increase the number of nurses they employ. However, it is one thing to look for them, and quite another to find them. These same trusts overwhelmingly reported difficulties in recruiting and/or retaining sufficient nursing staff. Underlying problems in the nursing workforce received an extra twist from the EU referendum as the longstanding “get out of jail” card for the NHS on staffing—international recruitment—has suddenly stopped working.
The upcoming Budget cannot do much to help the NHS on staffing but it clearly could on money. With most minds in the NHS focusing on winter, it may not have sunk in that next year, 2018/19, is not only not the end of austerity for the health service but, on current plans, it represents a sharp tightening of austerity as planned growth in the NHS budget falls almost to zero. In the Budget we will see whether the government truly has the nerve to hold to its plans, or whether, at rather the 11th hour, it will relent.
