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NHS patient care ‘will worsen’

Published on 04/10/12 at 10:43am
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Patient care will worsen over the next few years and the NHS will not meet its £20 billion productivity target by 2015, according to senior managers in a range of NHS organisations.

These are among the key points in the King’s Fund’s latest quarterly monitoring review of the NHS, which found that more than 40% of finance directors said they expect patient care to worsen over the next few years.

A mixture of the existing savings programme and structural changes wrought by the Health and Social Care Act are creating great pressure - something that opponents of the coalition’s reforms repeatedly predicted.

The influential think tank found that, 18 months into the current four-year period in which the NHS is meant to save £20 billion, most respondents thought there was a ‘very high’ or ‘high’ risk that the NHS as a whole would not deliver.

Negative consequences for the quality of patient services will come as savings and productivity gains become harder to create next year - and this will not be helped by the end of the two-year public sector pay freeze in April 2013, the report suggests.

Half of those surveyed were ‘fairly’ or ‘very’ pessimistic about their local health economy’s finances over the next year, and no one was ‘very optimistic’.

There were some bright spots: the NHS has managed to maintain the reductions in waiting times it achieved by the middle of 2009, and is continuing to reduce healthcare-acquired infection rates, such as MRSA.

Moreover, most finance directors are confident of delivering planned cost improvement targets of just under 5% on average, and nearly all of those surveyed said they would end this year in surplus or break even.

However, there are warnings too as emergency care appears to be emerging as a flashpoint, with the proportion of patients waiting longer than four hours in A&E departments at its highest for this quarter since 2004-05.

And the report points to a possible emerging upward trend at the next stage of the chain, in the numbers of patients waiting more than four hours to be admitted to hospital via A&E - the so-called ‘trolley waits’.

The King’s Fund concedes that there has almost certainly never been a time when the NHS has not faced organisational challenges - but it believes 2013 will be particularly challenging.

“The continuing need to generate unprecedented productivity improvements overlaid with implementation of the coalition’s reforms of the service mean that many organisations will face difficult decisions over the next year,” the report says.

According to respondents, NHS organisations are currently most concerned about:

  • the 18-week referral-to-treatment waiting time target
  • further reductions in healthcare-acquired infections (already at an all-time low)
  • the A&E four-hour wait target.

The King’s Fund says finance directors also report worries about rising emergency admissions - and coping with consequent financial penalties - and increases in demand generally at a time when tariff prices are being squeezed in real terms.

Adam Hill

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