NHS faces difficult winter as demand for care increases

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Big rises in demand for health care mean the NHS is heading into winter with its finances under pressure and performance against several key indicators at their worst level for more than a decade, according to the latest quarterly monitoring report (QMR) from The King’s Fund.

The report, which covers the period July to September, shows that the NHS is now treating more patients than ever before. Increasing demand for services is reflected in the number of GP referrals, which increased by about 3 per cent over the past year, while emergency admissions via A&E are 4 per cent higher than in the same quarter last year.

This is putting increasing pressure on NHS services, which are struggling to maintain standards of care as a result. The QMR shows:

  • 9.4 per cent of those attending A&E waited more than four hours, which is the worst performance for this time of year for more than a decade
  • 9.4 per cent of patients waited longer than 18 weeks to begin hospital treatment, the worst performance since targets were revised in 2012
  • July to September saw a record high of 568,774 bed days lost as a result of delays in discharging patients from hospital; this is 29 per cent higher than in the same quarter last year.

The rise in the number of delayed discharges underlines the impact on the NHS of cuts to social care budgets and other problems in co-ordinating care. The critical state of social care has led a number of health organisations, including The King’s Fund, to call for the Chancellor to make more money available for social care in next week’s Autumn Statement.

2016/17 is also meant to be the year the NHS stabilises its finances, but this is also proving a challenge with nearly a third of NHS trusts forecasting that they will miss their `control totals’ (new financial targets set for each NHS organisation); this is up from 13 per cent in the last quarter.

While most CCGs continue to forecast surpluses and have also set aside 1 per cent of their budget in a ‘risk reserve’ to help manage NHS deficits, 20 per cent of CCGs say they are relying on this money being released to meet their own financial targets and over 70 per cent are concerned about meeting efficiency targets. This creates the risk that the position may worsen later in the year.

For the first time, the QMR includes analysis of demand and activity in general practice. Analysis of data from more than 200 practices shows an almost 10 per cent increase in patient contacts (including telephone consultations) over the past two years, confirming the huge pressures on general practice.

Chris Ham, Chief Executive of The King’s Fund, said: ‘The NHS is treating more patients than ever before, and these findings show that rising demand is putting its services under increasing pressure.

‘The NHS needs to redouble efforts to manage demand and this will require investment in out-of-hospital services via the sustainability and transformation plans now being developed across England.

‘The most pressing priority for next week's Autumn Statement is to provide more funding for social care, following years of budget cuts. Not only would this benefit some of the most vulnerable people in society, but it would also help relieve pressure on the NHS.’

Notes to editors

See the latest quarterly monitoring report from The King's Fund here: http://qmr.kingsfund.org.uk/2016/21

The King’s Fund is an independent charity working to improve health and 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.

For further information, or to request an interview, please contact The King’s Fund Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146035).