The impact of NHS financial pressures on patient care

The health service is midway through a decade of austerity that has been characterised by real-term reductions in budgets and increasing patient demand. By improving productivity and (in some cases) by overspending, the NHS has shielded patients from some of the effects of this financial challenge.

However, national bodies, commissioners, providers and individual clinicians are increasingly faced with tough decisions about patient care as they try to prioritise funding and balance their budgets. Different approaches to taking these decisions – sometimes referred to as 'rationing decisions' – have been looked at in previous work by The King’s Fund.

This project aims to explore whether and how the slowdown in NHS funding since 2010 has affected patients’ access to high-quality care. While The King’s Fund has reported extensively on the size of the financial issues facing the health service, this will be our first piece of in-depth research examining what this means for patients.

Policy fellow @RuthRobbo explains the different ways rationing takes place in the #NHS. pic.twitter.com/p3dLtGepfa

— The King's Fund (@TheKingsFund) January 16, 2017

We will examine the impact of financial pressures by looking in detail at four services, each commissioned through a different route. These are:

• genito-urinary medicine clinics (local authority-commissioned public health service)
• district nursing (CCG-commissioned service via block contracts)
• elective hip replacement (CCG-commissioned service via tariff)
• neonatal services (NHS England-commissioned specialised service).

In each area we will:

• explore the impact of financial pressures on access to services, patient experience and patient outcomes (recognising that in some areas financial pressures may have driven improvements in care)
• identify barriers and enablers to maintaining access and quality while reducing cost per patient
• explore whether financial pressures are felt differently in different parts of the health system
• draw together our findings to highlight the common themes and put forward any general lessons for the NHS.

The research will include review of relevant literature, data analysis (where it is available) and interviews with patients, NHS staff and other key stakeholders.

If you work in one of these service areas or have used the service as a patient, we would like to hear your views on whether financial pressures have had an impact on the quality of patient care. Please contact Ruth Robertson, Fellow in Health Policy: r.robertson@kingsfund.org.uk. All discussions are confidential and we will not identify research participants in our publication.

A web feature, Six ways in which NHS financial pressures can affect patient care, was published in March 2016.

The main report from this research, Understanding NHS financial pressures: how are they affecting patient care? was published in March 2017.