Waiting times for hospital treatment have reached their highest level for three years as the NHS spending squeeze begins to bite, according to a new quarterly monitoring report published by The King's Fund.
The new report - the first of a regular update that will be published by the Fund every quarter – provides a snapshot of the state of the NHS by combining analysis of key performance data with the views of a panel of NHS finance directors. (1) It highlights the pressure building within the health system as budgets are squeezed and the NHS struggles to deliver productivity improvements. Among the key findings:
- Most of the finance directors surveyed are already warning that they are unlikely to meet productivity targets in 2011/12.
- The panel outlined a range of plans for making services more efficient but nearly half identified ward closures and cuts in services among the main ways of meeting productivity targets in their area.
- In February 2011, nearly 15 per cent of hospital inpatients waited over 18 weeks for treatment – the highest level since April 2008.
- The proportion of patients waiting more than four hours in A&E rose sharply at the end of 2010, reaching its highest level since 2004/05.
- The proportion of patients waiting more than six weeks for diagnostic services fell back in February, reversing a steady increase since June 2010.
- Levels of hospital-acquired infections have fallen to their lowest level in recent years, while delays in transferring patients out of hospital remain stable.
With the NHS needing to find £20 billion in productivity improvements by 2015, many of the panel of 26 NHS finance directors surveyed stressed the difficulty of continuing to manage demand for services, meet targets and maintain quality with the financial squeeze beginning to bite. While most were confident they had met their productivity targets for 2010/11, over two-thirds said they may not meet their targets for 2011/12. Most of the panellists called on the government to be more realistic about the challenges involved in finding the savings needed.
The panel highlighted a range of plans for improving productivity in their area including workforce changes, redesigning services to improve efficiency and reducing lengths of stay in hospital. Only six identified back office efficiencies among the main ways productivity targets will be met, with a number sceptical about the savings to be made through this route. 12 of the 26 panellists identified closing hospital wards and reducing services among the main ways that savings will be delivered in their area.
The analysis of key performance data highlights a steady increase in waiting times for hospital treatment since waiting times targets were relaxed in June 2010. In February 2011, nearly 15 per cent of inpatients waited more than 18 weeks before being admitted to hospital – the highest proportion since April 2008. (2) The latest data for A&E waits also shows a sharp increase in the third quarter of 2010/11, with 3.5 per cent of patients waiting for more than four hours, compared to 2 per cent the previous quarter. (3) While these rises in part reflect seasonal factors, they are not explained by this alone.
The proportion of patients waiting more than six weeks for diagnostic services fell back to 1.46 per cent in February 2011. This reverses a steady increase since June 2010, although this is still twice the level recorded in February 2010. (4) Levels of hospital acquired infections continued to fall, with 711 cases of C. difficile and 46 cases of MRSA recorded in February 2011. This represents a reduction of over two-thirds since hospital acquired infections peaked in 2008. (5) The number of delayed transfers of care – patients unable to leave hospital because appropriate care in the community has not been arranged fell slightly in March 2011. (6)
Professor John Appleby, Chief Economist at The King's Fund said:
'This report will provide a regular health check on the state of the NHS as it comes to terms with the new financial climate and implements the government's reforms. It highlights significant concern among NHS finance directors – who are well placed to report on the stresses in the system – about the prospects for the year ahead. With hospital waiting times rising, the NHS faces a considerable challenge in maintaining performance as the financial squeeze begins to bite.'
Notes to editors:
How is the NHS performing? is published on 20 April 2011. For further information, a copy of the full report, or to request an interview with Professor John Appleby, please contact the Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146 035).
(1) The panel of 26 finance directors was drawn from acute trusts, mental health trusts and primary care trusts from all the English regions. It aims to provide a snapshot of opinion and is not intended to be a representative sample. The survey was carried out from 3-17 March 2011.
(2) Based on analysis of data published by the Department of Health on 14 April 2011. The data is up to date to the end of February 2011.
The previous government set a target that 90 per cent of patients should be treated within 18 weeks of referral to hospital from their GP. In June 2010, the current government announced that performance management of this target would cease as part of its drive to end targets with 'no clinical justification'. The right to hospital treatment within 18 weeks is enshrined within the NHS Constitution.
(3) Based on analysis of data published by the Department of Health on 11 February 2011. The data is up to date to the end of December 2010.
(4) Based on analysis of data published by the Department of Health on 6 April 2011. The data is up to date to the end of February 2011.
(5) Based on analysis of data published by the Health Protection Agency on 5 April 2011. The data is up to date to the end of February 2011.
(6) Based on analysis of data published by the Department of Health on 15 April 2011. The data is up to date to the end of March 2011.
(7) The King's Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.