Growing concern about staff morale as NHS performance slips

Staff morale tops the list of concerns raised by NHS finance directors in The King's Fund's latest quarterly monitoring report.

Nearly half (47 per cent) of trust finance directors surveyed for the report identified staff morale as one of their top three concerns, twice as many as in the previous quarter. The report suggests this should be a significant cause for concern given the close link between staff engagement and quality of care.

The report underlines the financial pressures facing the NHS, with nearly 40 per cent of trust finance directors forecasting a deficit by the end of the year, the highest proportion since the survey began. Worryingly, nearly 60 per cent are also concerned about whether their trust will be able to meet its cost improvement target for the current year, suggesting that it is getting more difficult to find efficiency savings.

Commissioners are more optimistic about their financial position, with around 70 per cent of CCG finance leads surveyed expecting to end the year in surplus. It remains to be seen whether these surpluses will be enough to balance the predicted overspend among NHS providers and enable the Department of Health to balance its books at the end of the year.

The report also highlights the impact of mounting pressures on NHS performance, with waiting times targets for A&E, hospital treatment for inpatients and cancer treatment all missed across the quarter (July – September). Despite a reported £930 million of additional government funding to improve hospital waiting times and ease pressures in A&E, this points to a challenging winter ahead.

Key findings from this quarter's analysis of key performance data include:

  • 5 per cent of patients spent four or more hours in A&E over the quarter, the highest level at this time of year for a decade
  • 12.1 per cent of inpatients waited more than 18 weeks for hospital treatment, as referral-to-treatment waiting times reached their highest levels since 2008 (in part due to the government's policy of allowing a 'managed breach' of the targets while a backlog of long waiters 
  • 84 per cent of cancer patients received treatment within 62 days, missing the target that 85 per cent should new treated within 62 days for the second consecutive quarter (1)
  • monthly counts of MRSA, C difficile and other hospital-acquired infections remain low, although the number of cases of E-coli appears to be increasing
  • the number of delayed transfers of care increased by 17.5 per cent compared to the same period last year.

Richard Murray, Director of Policy at The King's Fund said: ‘The NHS relies on the dedication of its staff, so the growing concern about staff morale is worrying. Given the close association between staff engagement and quality of care, this is a warning sign that should be taken seriously by NHS leaders. The number of trusts forecasting deficits indicates that financial problems are no longer confined to a small number of organisations and are now endemic across the health system. At this time of year, A&E waiting times should be well within target range, so the fact that they are continuing to miss the 5 per cent target is also a significant cause for concern.'

Notes to editors: 

How is the NHS performing? is the latest of The King's Fund's regular quarterly monitoring reports. It covers the quarter from July to September 2014. For further information or to request an interview with Richard Murray, please contact the Press and Public Affairs team on 020 7307 2585 (07584 146035 if calling out of hours).

This quarter's survey was carried out online between 9 September and 23 September 2014. Of 248 NHS trust finance directors contacted, 90 responded. We also contacted 202 CCG finance leads, of whom 43 responded.

The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.

(1) Figures for cancer waits are for the first quarter (April – June).