NHS trusts forced to compromise on quality and waiting times amid financial squeeze, CEOs warn

Staff are putting their hands in their pockets to feed patients in face of cost of living crisis, NHS chief reports

The squeeze on the NHS’ finances will “without a doubt” compromise quality and access to frontline services next year, trust chief executives have warned.

More than three-quarters of NHS trust chiefs, responding to a survey by NHS Providers, have warned they expect this coming winter to be the worst their services have ever faced.

NHS trusts are facing increased efficiency targets this year and next with the majority warning they are unlikely to end the year in balance.

It comes as the chancellor, Jeremy Hunt, is due to set out the autumn budget this week, and follows reports of NHS A&E waiting times hitting a record low in October.

Hospitals and community services across the country are set to face unprecedented strike action from nurses, who voted in favour of industrial action last week, following a Royal College of Nursing ballot.

The Independent reported the NHS is likely to cancel thousands of operations during the nursing strikes.

However, trust leaders are likely to have to plan for further strikes as tens of thousands of NHS staff, such as those in non-clinical roles, are also being balloted on strike action by unions Unison, Unite and GMB.

One NHS chief warned their services would be able to “manage” a nursing strike however isn’t sure how their trust would manage should Unison join the strike also.

They added: “And we’re pretty confident Unison strike will join with it [the RCN], then that’s going to get more hairy.”

Following a poll of trust leaders, NHS Providers found one in five reported they will have low or very low-quality services in two years’ time.

More than three-quarters said they are worried they will not have enough staff, or those with the right skills, to deliver services within the next two years.

Saffron Cordery, the interim chief executive of NHS Providers said: “Cost of living challenges, rising inflation, staff exhaustion and the below-inflation pay rise the NHS saw earlier this year have certainly contributed to the RCN ballot in favour of strikes, which we’re likely to see roll out before Christmas.

“This means trusts are dealing locally with problems that have their origins in national decisions. They are having to be resilient in the face of significant factors, some of which are outside of their control.

“Industrial action is inevitably going to put strain and pressure on the relationships between trust leaders and their staff…We have to push for the government to get around the table with the unions, either averting strike action before it happens, or entering into negotiations and talking about the resolution strategy now, rather than further down the line.”

NHS chief executives have warned the squeeze on financial budgets will inevitably hit frontline services.

One trust chief said next year is going to be “grim” and “without a doubt” healthcare leaders in their region would have to make “very serious decisions” over where to reduce services, such as rationing children’s language and speech therapy.

The chief executive also raised concerns over the impact of poverty on patients as a key challenge for trusts.

She said: “What my staff see every day is the effect of serious, terrible poverty... think there's moral damage that goes to staff, staff also end up putting their hands in their pockets to feed people, to feed somebody's cat [for example].”

Another trust chief said: “We haven’t cut the services yet. We don’t quite know what the financial settlements will be for next year, but I think we are increasingly moving towards that point, whether that’s cutting services or rationing…we know the finances are going to be tight. So that’s going to impact the quality [of services], or access times…

“Effectively, we see the impact on access times, and I think that’s what you will potentially increasingly see, moving forward is an increasing, increasing wait time.”

He said while hospitals would close their doors, services in the community such as minor inquiry units would be closed down.

NHS Provider’s report comes as the Richmond Group of Charities has warned the NHS and social care system are in the "most perilous position in memory".

The group, which covers charities that represent 14 million people said systems were reaching "crunch point" which could mean the NHS and social care services are "completely unable to respond to local needs in a growing number of places".

Responding to NHS Provider’s report, general secretary and chief executive for the Royal College of Nursing said Pat Cullen, said: “NHS leaders are having to cry out for help on the eve of the government’s spending announcements.

“Their fears are the same as ours - patients are being put at risk by the lack of investment from government.”

She added: “No nurse ever wants to strike, but we have been forced into this situation because low pay is pushing nursing staff out of the profession.”