NHS performance deteriorating as election approaches, concludes assessment by The King’s Fund

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The coalition government will leave office with health services under significant strain and a real risk that patient care will suffer as the NHS heads towards a deficit, according to a major assessment of the NHS under the coalition published by The King's Fund.

The report is the second in a two-part assessment of the coalition’s record on the NHS, the first part of which looked at the government’s reforms, concluding that the upheaval caused by the Health and Social Care Act was damaging and distracting. This new report assesses NHS performance under the coalition, finding that it held up well for the first three years of the parliament but has now deteriorated, with waiting times at their highest levels for a number of years and several key targets missed.

The report finds that the coalition has met its pledge to increase the NHS budget in real terms, with funding increasing by an average of 0.8 per cent a year in real terms over the parliament. Key findings include:

  • the numbers of doctors and nurses have increased, while management costs have been significantly reduced (1)
  • patient experience remains positive, while public satisfaction with the NHS is at its second highest level ever (2)
  • the number of health-care acquired infections has fallen, with cases of MRSA and C difficile at historically low levels (3).

However, with hospitals and other providers of care now overspending their budgets by more than £800 million, the report concludes that the NHS is likely to record a substantial deficit in the final year under the coalition. It finds that all areas of NHS care are feeling the strain, with general practice under huge pressure and concerns being raised about access to mental health services for vulnerable patients. Other findings include:

  • target waiting times for A&E, hospital treatment and cancer treatment have all been missed towards the end of the parliament (4)
  • hospital bed occupancy has increased to very high levels and delayed discharges have risen significantly over the past 12 months (5)
  • there are signs that NHS staff are under significant pressure and morale is an increasing cause for concern (6).

The report also finds that the NHS has made some progress in improving efficiency, but that it cannot continue to rely on limiting staff salary increases, reducing the prices paid to hospitals for treatment and cutting management costs to deliver savings. Looking ahead, it signals that, while further efficiencies can be found, additional funding of £8 billion a year by 2020 is the minimum requirement for the NHS to continue to meet patient needs and maintain standards of care.

John Appleby, Chief Economist at The King’s Fund and the lead author of the report, said: ‘The next government will inherit a health service that has run out of money and is operating at the very edge of its limits. While the NHS has performed well in the face of huge challenges, there is now a real risk that patient care will deteriorate as service and financial pressures become overwhelming.

‘More optimistically, with the economy recovering, there could soon be an opportunity to think about public spending choices and the kind of health services we want in a fresh light. Future debate about the NHS should focus not on how parsimonious we need to be but on how generous we want to be.’

Notes to editors

The NHS under the coalition government - Part two: NHS performance is published by The King’s Fund on 26 March 2015. 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).

(1) Between September 2009 and September 2014, the number of nurses increased by 2.5 per cent (8,108 FTE), the number of consultants by 16.7 per cent (5,789 FTE), and the number of GPs by 2.3 per cent (835 FTE). At the same time the number of management staff reduced by 17.3 per cent (7,345 FTE).

(2) A number of patient surveys show that patient experience remains high and is improving across many services. Public satisfaction with the NHS increased to 65 per cent in 2014, its second highest level ever, having fallen from 70 per cent in 2010 to 58 per cent in 2011.

(3) Cases of MRSA and C difficile had decreased significantly before the coalition took office and have continued to fall to 34 and 445 respectively in January 2015. This compares to 59 and 1,019 in May 2010.

(4) In the third quarter of 2014/15, 7.4 per cent of patients spent longer than four hours in A&E. This is up from 2 per cent in the final quarter before the coalition came into office and is the poorest performance since 2003.
11.3 per cent of inpatients and 5 per cent of outpatients waited longer than 18 weeks for treatment in January 2015. This compares to 7.1 per cent and 1.8 per cent  respectively in May 2010. The targets for both have been breached in recent months for the first time since 2008.

The target that 85 per cent of patients with suspected cancer should be treated within 62 days has been missed for four consecutive quarters, having never previously been missed since it was introduced at the end of 2008/9.

(5) Occupancy rates for general and acute beds in hospitals increased to 89.5 per cent in the third quarter of 2014/15, up from 87.7 per cent in the same quarter in 2010/11, with one in six trusts reporting occupancy levels above 95 per cent. Occupancy rates above 85 per cent are generally considered likely to lead to bed shortages and expose patients to risks.

(6) 38 per cent of staff reported that they had felt unwell due to work-related stress according to the 2014 NHS Staff Survey. Staff morale has topped the list of concerns raised by trust finance directors in the regular survey undertaken for our last two quarterly monitoring reports.

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.