Problems spreading beyond A&E as risk of NHS crisis grows – latest quarterly monitoring report from The King's Fund

The King's Fund is warning that problems in hospitals are spreading beyond A&E to other key areas of performance, increasing the risk of a NHS crisis.

The Fund's latest quarterly monitoring report, which follows widespread reports about pressures on A&E units, underlines that hospitals are stretched to the limit. The report shows that waiting times for treatment and other key performance indicators are worsening, as the NHS struggles to cope with increasing demand for services and the unprecedented financial squeeze.

  • The proportion of inpatients waiting longer than 18 weeks for treatment rose to 12.5 per cent in November – the highest level since this target was introduced in 2008.
  • The target that no more than 5 per cent of outpatients should wait longer than 18 weeks for treatment was breached in November – the first time this target has been missed since 2008.
  • Waiting times for cancer treatment continued to worsen in the second quarter of 2014, with only 83.5 per cent of patients receiving treatment within 62 days of urgent referral from their GP – the lowest proportion since the current target was introduced.
  • The number of delayed discharges from hospital increased sharply to more than 5,000 per day in November, an increase of almost 20 per cent since January.
  • The number of cancelled operations during November to January was up by a third on the same period in 2013.

While the increases in waiting times for hospital treatment are partly explained by the government’s policy of allowing a ‘managed breach’ of the 18-week targets while a backlog of long-waiters is cleared, current performance across a range of indicators suggests the health system is creaking at the seams.

The report also confirms that NHS finances remain under intense pressure, with more than 40 per cent of trust finance directors surveyed for the report forecasting that their trust will end the year in deficit. Repeating the pattern of previous reports, commissioners are more optimistic, with more than 90 per cent of clinical commissioning groups expecting to break even or finish the year in surplus.

The parlous state of hospital finances is underlined by the finding that more than 60 per cent of trusts are relying on financial support from the Department of Health or, in the case of some foundation trusts, planning to draw down their reserves. Despite this, over three-quarters reported that their organisation is planning to increase the number of permanent nursing staff it employs over the next six months, as hospitals continue to prioritise patient care above balancing the books.

Not surprisingly, given the increasing pressures on frontline staff, trust finance directors once again identified staff morale as their top concern, alongside A&E waiting times. The report also found that more than 80 per cent of those who responded were concerned about the ability of their organisation to meet its target to reduce emergency admissions under Better Care Fund plans, once again casting doubt on the credibility of the government's flagship policy for integrating health and social care.

Commenting on the report, John Appleby, Chief Economist at The King's Fund, said: 'While recent attention has focused on the problems faced by A&E units, performance against waiting time targets and other indicators has continued worsen. Taken together, the findings from this quarter's report show that services are stretched to the limit. With financial problems also endemic among hospitals and staff morale a significant cause for concern, the situation is now critical.'

Notes to editors: 

How is the NHS performing? is the latest of The King’s Fund’s quarterly monitoring reports. It covers the quarter from October to December 2014 (although time lags in the publication of data mean that reporting on some performance indicators covers different periods).

For further information or to request an interview with John Appleby, please contact the Press and Public Affairs team on 020 7307 2585 (07584 146035 if calling out of hours).

This quarter’s survey of NHS finance directors and CCG finance leads was carried out between 3 December and 17 December 2014. Of 252 NHS trust finance directors contacted, 73 responded. We also contacted 203 CCG finance leads, of whom 51 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.