Outlook for NHS and social care pessimistic as financial squeeze bites

Pessimism is growing in the NHS and social care as local leaders respond to mounting financial pressures, according to the latest quarterly monitoring report on service performance published by The King's Fund.

For the first time, the report includes a survey of directors of adult social services in English local authorities alongside its usual survey of NHS finance directors. Both surveys suggest that the financial squeeze is beginning to have an impact on quality and access to services in some parts of the country. A third of NHS finance directors report that the quality of patient care has worsened during the last year and more than a third of social services directors expect to have to cut social care services over the next year.

While most NHS organisations are on track to meet financial targets, it is clear that pressures are growing towards the end of the second year of the so-called Nicholson Challenge to find £20 billion in productivity improvements by 2015. The main findings from our survey of NHS finance directors are:

  • a third (16) report that the quality of patient care in their area has worsened during the past year; this compares with only about 1 in 6 who said the same thing in our last survey
  • more than three-quarters (39) expect to end the financial year in surplus, with only 3 anticipating a deficit; 34 are confident of achieving their cost improvement programme targets for 2012/13, with 9 expressing concern
  • in contrast, when asked how they felt in general about the financial state of their local health economy – not just their own organisation – over the next 12 months, around two-thirds (32) were pessimistic.

With local authorities grappling with the second year of a budget squeeze that will see an overall cut of 27 per cent in central government funding by 2015, directors of adult social services are pessimistic about the financial outlook:

  • nearly a third (18) predict an overspend on their budgets, with a similar number (17) expecting an underspend and 23 expecting to break even
  • the financial pressures are set to have a significant impact on access to services, with more than a third (21) of directors anticipating having to reduce services and nearly a fifth (12) expecting to increase charges over the next year
  • nearly three-quarters (43) said that they are pessimistic about the overall state of the local health and care economy over the next 12 months, with only 3 reporting any optimism.

The report also includes a dashboard of key NHS performance indicators. While these are mostly stable, the proportion of patients waiting more than four hours in A&E is at its highest level for this quarter since 2003/4. This remains within the government's target range, with the increase to some extent accounted for by the relaxation in the target and seasonal factors. However, with more than a quarter of trusts (65), reporting breaches of the target, it is clear that many hospitals are struggling to maintain performance in emergency care.

The main findings from the analysis of performance measures are:

  • 4.3 per cent of patients spent longer than four hours in A&E in the third quarter of the current financial year
  • waiting times for hospital treatment are stable, with the proportion of patients waiting longer than the operational standards having increased slightly for outpatients and reduced for all other waiting lists
  • impressive reductions in health care-acquired infection rates continue, with a 13.5 per cent drop in C difficile and a drop of nearly 12 per cent in MRSA year-on-year counts to November 2012.

According to the official statistics, delays in transferring patients out of hospital remain stable, despite more than 60 per cent (30) of NHS finance directors reporting that delayed transfers of care have worsened over the last year. With other feedback also suggesting delayed transfers have got worse, the report calls for further investigation into this issue.

Professor John Appleby, Chief Economist at The King's Fund said: 'The NHS faces unprecedented financial pressures, and there are growing worries that patient care will suffer. For social care, it will be increasingly difficult for councils to make further savings without directly cutting services or affecting quality. Health and care services have coped well until now, but it is clear that many organisations expect things to become much more difficult over the coming year.'

Notes to editors: 

How is the health and social care system performing? is the seventh of The King's Fund’s regular quarterly monitoring reports and is published on 14 February 2013. For further information or to request an interview with John Appleby, please contact the Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146 035).

The surveys of finance directors and directors of adult social services aim to provide a snapshot of opinion and are not intended to be a representative sample. Both were collected via an online survey between 7 December 2012 and 4 January 2013.

Of 143 NHS finance directors invited to join, 48 were available to give their views. The majority of the panel were from acute or combined acute and community trusts, with others from mental health, ambulance and specialist trusts. No responses were received from primary care trust clusters. Of 152 directors of adult social services in English local authorities invited, 58 participated. Just over a third of these were from unitary bodies, a further third from shire counties and metropolitan districts and the others from London boroughs or unspecified.

16 of 48 finance directors in this quarter’s panel said that they thought that quality of care had got worse in the past 12 months (with 6 saying it had improved). This compares with 7 (and 14) from a panel of 45 in the September 2012.

The increase in the proportion of patients waiting four hours or more for admission is in part explained by the easing of the total time in A&E target in June 2010, from no more than 2 per cent to no more than 5 per cent waiting longer than four hours.

The report also examines workforce numbers, showing a reduction of 24,313 full-time NHS posts from March 2010 to October 2012. This includes a reduction of around 8,000 managers (equivalent to around 18.5 per cent), and more than 4,000 nurses, midwives and health visitors. However, the number of consultants has risen continuously since 2009, and by 12.3 per cent during the same period.

A survey of 252 NHS Confederation member chairs and chief executives, published on 20 June 2012, found more than 60 per cent reporting that local authority cuts had impacted on delays to discharge in their organisations over the previous 12 months. This survey was undertaken for the NHS Confederation by Picker Institute Europe between 26 April and 16 May 2012.

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.