Patients face longer waits for treatment and the deterioration of care unless billions in additional funding is found, experts have warned in the wake of damning end-of-year financial figures.
The report from NHS Improvement, which oversees health care, shows trusts in England ended last year nearly £1bn in the red and were unable to hit waiting time targets for A&E, diagnostic tests and even some cancer treatment.
More than 2,600 patients waited over a year for treatment in 2017-18, a staggering 75 per cent increase from 1,513 the previous year as the NHS scrapped non-urgent operations to direct resources to the emergency services.
Across England, only 88.4 per cent of patients were seen within four hours of attending A&E, a deterioration on last year’s performance and well below the 95 per cent target specified in the NHS Mandate.
While the NHS budget was in balance overall, this is only because of savings in neglected mental health, community and ambulance services which can be used to shore up “epic” patient demand in A&E, the report shows.
The staff budget was overspent by nearly £1.5bn as trusts sought to fill 100,000 full-time vacancies because employees have quit or cut down their hours in response to eight years of government pay restraint.
The figures make it highly unlikely that the NHS can achieve targets and deliver further efficiency savings being demanded by the Treasury in exchange for a long-term deal to increase funding.
“Unless the long-term funding settlement promised by the prime minister provides the stability the service desperately needs, it is clear that standards of care will continue to deteriorate and patients will wait longer to access NHS services,” said Siva Anandaciva, chief analyst at The King’s Fund think tank.
“While a difficult winter no doubt had some effect, the challenges facing the NHS are not the consequence of a few bad months – they are the result of rising demand for services, a prolonged funding squeeze and a growing workforce crisis.”
He added that the existing funding system is “fundamentally broken” with NHS bodies being told to agree to annual financial targets which “they have no hope of achieving”.
The 234 NHS trusts in England had a net deficit of £960m last year, £464m more than planned. But the bulk of this was made up by a £1.7bn deficit among acute hospital trusts – the only ones with A&E departments – where 89 of 136 organisations were in the red.
Only five A&E departments managed to meet the 95 per cent target during January, February and March.
The financial position is a £1.5bn improvement on the deficit in 2015-16, driven largely by new rules to cap spending on costly agency staff, and comes despite A&Es seeing 220,000 more people this winter.
“Despite epic challenges, NHS staff up and down the country displayed incredible resilience and saw more patients than ever before within four hours,” said Ian Dalton, chief executive of NHS Improvement.
“More than two-thirds of providers ended the year on budget or better than planned. Given rising demand and record vacancies, this is an important achievement.”
“These figures reveal both sides of the same coin – a cash-starved NHS forced to run without enough staff to treat people safely,” said Janet Davies chief executive of the Royal College of Nursing.
“For as long as hospitals remain £1bn in the red, patients will pay a heavy price.”
A Department of Health and Social Care spokesperson said: “The prime minister and Jeremy Hunt have committed to a long-term plan with a sustainable multi-year settlement for the NHS to help it manage growing patient demand, which will be agreed with NHS leaders, clinicians and health experts.
“It is testament to the hard work and dedication of staff that despite ever-rising demand and significant winter pressures, 277,150 more patients were seen within four hours in A&E in 2017-18 compared 2016-17, and the majority of trusts’ finances are in good order.”
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