NHS performing well despite financial pressures

The latest quarterly monitoring report from The King’s Fund shows that NHS performance is continuing to hold up, despite warnings from MPs this week about the scale of the financial challenge it is facing. The report shows that performance against key indicators for waiting times and infection rates remains on track, although national statistics mask significant variation in performance between hospitals.

This quarter’s report focuses on delays in transferring patients out of hospital. It finds that the number of patients experiencing delayed transfers of care has fallen to its lowest level since this data has been collected, with the number of days delayed also having fallen in December. This is to be expected as the data follows a strong seasonal pattern - the long-term trend on both measures remains stable.

  • In December 2011, 3,659 patients experienced a delayed transfer of care, a 5.6 per cent fall on the same month last year.
  • The total number of days delayed fell to 112,999, a 3 per cent fall on December 2010, although the average delay increased slightly to 31 days.

These findings suggest that additional funding provided by the government to promote joint working between health and social care services has had a positive impact. However, there is no room for complacency, with 10 out of 23 NHS finance directors questioned for the report indicating that delayed discharges are increasing in their local health economy, suggesting some local variation.

This quarter’s survey of NHS finance directors confirmed that many NHS organisations are using ‘demand management’ techniques to meet productivity targets.

  • 15 of the 23-strong panel indicated that their organisation is restricting funding for certain procedures of services.
  • 16 said that their organisation is taking steps to manage referrals from GPs.
  • One of the panel indicated that their organisation is employing minimum waiting times, a practice recently criticised by the Secretary of State and due to be outlawed from March.

The survey also suggests that the NHS is delivering against productivity targets, although there is concern about the financial position outside their own organisation.

  • 16 of the 23 finance directors are confident of meeting productivity targets, with six concerned about this.
  • 15 of the panel expect their organisation to be in surplus at the end of the financial year, with five expecting to break even and three forecasting a deficit.
  • Only four of the panel were optimistic about the financial position of their local health economy, with 13 pessimistic about this.

Despite the pressures created by the need to find £20 billion in productivity improvements by 2015, national statistics show that performance on waiting times and infection rates remains good, despite problems in some hospitals.

  • Waiting times from referral to treatment in hospital remain stable and continue to stay just within target range.
  • The proportion of patients waiting more than four hours in A&E fell for the third successive quarter but otherwise remains higher than at any time since the third quarter of 2004/5.
  • The number of C difficile cases fell to a new low, although the number of MRSA infections increased for the first time in a number of months.

Professor John Appleby, Chief Economist at The King’s Fund said:

‘The NHS continues to perform well, despite significant financial pressures. However, less than a year into a financial squeeze that will last for several years, the pressures already emerging in some trusts highlight the scale of the challenge ahead. Our analysis suggests that new funding to promote joint working between health and social care has, for the time being at least, ensured that delayed discharges remain stable.’

Read the January 2012 quarterly monitoring report

Notes to editors: 

How is the NHS performing? is the fourth of The King’s Fund’s regular quarterly monitoring reports is published on 28 January 2012. For further information or to request an interview with John Appleby, please contact the Press and Public Affairs team on 020 7307 2632 (if calling out of hours, please ring 07584 146035).

The survey of finance directors aims to provide a snapshot of opinion and is not intended to be a representative sample. Of 53 finance directors invited to join the panel, 23 were available to give their views, which were collected via an internet survey between 9 and 16 December 2011. The majority of the panel were from acute trusts, with others from mental health trusts, community trusts and PCT clusters. There was a reasonable spread across the regions.