Some hospitals struggling despite strong overall NHS performance says latest monitoring report from The King's Fund

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NHS performance is holding up well but national statistics mask significant pressures in some local areas, according to the latest quarterly monitoring report on NHS performance published by The King's Fund.

The report looks behind national figures for waiting times and infection rates to find significant variations in performance between hospitals. New analysis for this quarter's report shows that:

  • although average waiting times remain within target range, 1 in 4 hospitals failed to meet the target threshold for treating at least 90 per cent of patients within 18 weeks of referral in August. (1)
  • 10 per cent of providers are breaching the target threshold that 95 per cent of patients should not have to wait longer than 4 hours in A&E – nationally, only 3 per cent of patients waited longer than 4 hours in the first quarter of 2011/12. (2)
  • while levels of hospital-acquired infections have reached a new low, 45 hospital trusts reported higher levels of C. difficile infections than the same period last year. (3)

With the financial squeeze beginning to bite, the report also highlights continuing concern about whether ambitious productivity targets can be met. Most of the NHS finance directors we questioned are uncertain or concerned about whether their trust will meet its target, with the majority expecting to face equally challenging targets of 4 per cent or more next year. More positively, only one of the finance directors expects their trust to be in deficit at the end of the financial year.

The main findings from our survey of 23 finance directors for this quarter's report were:

  • 8 of the 23 panellists were either concerned or very concerned about meeting their productivity targets for 2011/12, while four were uncertain.
  • 20 of the panel are confident that the measures being taken to meet their targets will not harm clinical quality, with only three uncertain about this.
  • 8 of the panel are expecting to face productivity targets of 6 per cent of more in 2012/13, with a further seven forecasting targets of between 4 and 6 per cent.
  • 15 panellists expect to end the financial year in surplus, with seven forecasting to break even and only one a 'technical' deficit.
  • in contrast, 15 are pessimistic about the financial state of their local health economy, with only three optimistic about this.

As with our last survey, the findings suggest that NHS providers are facing higher productivity targets than commissioners. This highlights the pressure on the hospital sector in particular to meet the 'Nicholson Challenge' to find £20 billion in productivity improvements by 2015. (4)

Professor John Appleby, Chief Economist at The King's Fund, said:

'While the NHS continues to perform well, a minority of trusts are struggling to keep waiting lists down and reduce hospital-acquired infections. Looking ahead, the challenge will be to maintain performance and deliver productivity improvements as finances tighten further. Six months into an unprecedented four-year period of financial restraint, the pressures already emerging in a small number of trusts highlight the scale of the challenge facing the NHS.'

Read the report: How is the NHS performing?

Notes to editors

How is the NHS performing? is the third of The King's Fund's regular quarterly monitoring reports and is published on 14 October 2011. For further information or to request an interview with John Appleby, please contact the Press and Public Affairs team on 020 7307 2632 (if calling out of hours, please ring 07584 146035).

(1) Based on analysis of data published by the Department of Health on 13 October 2011. In August 2011, 90.4 per cent of inpatients were treated within 18 weeks of referral. This is a slight reduction from 90.6 per cent in July 2011 and is down from 93.2 per cent in August 2010.

(2) Based on analysis of data published by the Department of Health on 12 August 2011. In the first quarter of 2011/12, 3 per cent of patients waited for four or more hours in A&E compared to 3.4 per cent in the previous quarter, and 1.6 per cent in the same quarter in 2011/12.

(3) Based on analysis of data published by the Health Protection Agency. 666 case of C difficile and 34 cases of MRSA were recorded in August 2011.

(4) The survey of finance directors aims to provide a snapshot of opinion and is not intended to be a representative sample. Of 53 finance directors invited to join the panel, 23 were available to give their views, which were collected via an internet survey between 14 September and 3 October 2011. The majority of the panel were from acute trusts, with others from mental health trusts, community trusts and PCT clusters.