New NHS funding must focus on services outside hospitals

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New funding must focus on services outside hospital including social care and community health services, according to NHS finance directors surveyed for the latest quarterly monitoring report from The King’s Fund.

Providing more care outside hospitals and closer to people's homes has long been a goal for NHS policy-makers. A survey of NHS trust finance directors and clinical commissioning group (CCG) finance leads carried out for the report asked them to identify their top three priorities for additional funding:

  • The top three priorities for investment identified by NHS trust finance directors were social care (chosen by 67 per cent of respondents), community services (53 per cent of respondents) and mental health services (47 per cent of respondents).
  • The top three priorities identified by CCG finance leads were general practice (79 per cent of respondents), social care (65 per cent of respondents) and community services (65 per cent of respondents).

The survey – which was carried out in May, before the Prime Minister's recent announcement on NHS funding – suggests that new investment should prioritise services in the community and underlines the importance of increasing social care funding in the next Spending Review. 

The new funding announced by the Prime Minister will not be available until April 2019. In the meantime, the survey indicates that the NHS is in for another very challenging year. Following on from last year’s NHS provider deficit of £960 million, the report highlights wide disparities in the financial position of different NHS organisations. 

The survey found that more than two in five (42 per cent) of NHS trust finance directors and nearly two-fifths (39 per cent) of CCG finance leads surveyed expect to overspend their budgets this year. This is a significant concern at this point in the year and underlines the deterioration in CCG finances, on top of provider deficits which remain substantial. Other key findings from the survey include:

  • Less than a quarter (23 per cent) of NHS trust finance directors and only one of the 32 CCG finance leads surveyed are confident of getting back on track to meeting the four-hour A&E target by March 2019.
  • To help manage financial pressures, nearly 80 per cent off CCG finance leads said their organisation is considering extending the number of low-value treatments and prescriptions that will no longer be funded. 
  • Staff morale has risen to the top of the list of concerns among NHS trust finance directors, with nearly a quarter (24 per cent) identifying this as one of their top three concerns, the highest proportion since 2013. 

With more than 4 million patients on the waiting list, the report highlights how difficult it will be to meet the Prime Minister's ambition of getting waiting times for hospital treatment back within target range. This will leave more patients waiting longer, often in pain, for the treatment they need. 

Siva Anandaciva, Chief Analyst at The King’s Fund and lead author of the report, said:

'Policy-makers have long sought to provide more care in the community, closer to people’s homes, to improve patient care and reduce pressures on hospitals. These attempts have for the most part failed and hospitals remain full to capacity, while under-investment in community services continues. Our survey suggests that finally delivering this vision should he at the heart of the forthcoming NHS 10-year plan and that additional funding for social care must be a top priority for the forthcoming Spending Review.

'It is clear that the current NHS finance regime is broken, with huge deficits in some trusts and booming surpluses in others. The new funding settlement provides an opportunity to re-think the current system and to ensure that financial management in the NHS is proportionate, fair and effective.'

Read the latest quarterly monitoring report

Notes to editors

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

This report details the results of an online survey of NHS trust finance directors carried out between 10 and 31 May 2018. We contacted 235 NHS trust finance directors and 90 responded (38 per cent response rate). The sample included 40 acute trusts; 40 community and mental health trusts; 1 specialist trust; 1 ambulance trust and 8 provider organisations that were not categorised. In addition, we contacted 119 clinical commissioning group (CCG) finance leads, and 34 responded. Between them these finance leads covered 44 CCGs (23 per cent of all 195 CCGs). 

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 health and care is available to all.