NHS in crisis: 'Real risk' that patient care will suffer and waiting times will rise

The number of people using the NHS has risen significantly since 2010

The Coalition government will leave office with the NHS in the red for the first time in a decade and with waiting times at their highest in years, independent experts have said.

In a summary of NHS performance in England under the Coalition, the King’s Fund think-tank said the service was now under significant strain, with a “real risk” that patient care would suffer and waiting times would rise still further in the coming year.

Finances

Hospitals and other providers are heading for an overspend of more than £800m by the end of this financial year, tipping the NHS as a whole into deficit, the King’s Fund said.

This would be the first time the health service has overspent since 2005/06.

“That’s got to be paid by somebody,” said the chief economist John Appleby. "The Treasury could pick up the tab, but it’s likely the NHS is going to have to find the money in future years. It’s a fairly depressing time.” Around half of all hospitals have run up a deficit, many because of heavy spending on new staff – including expensive agency nurses and doctors – to improve safety in the wake of the Mid Staffordshire report.

The NHS budget will increase by £3.3bn next year, but this will be offset by £4bn of NHS spending being allocated to the Better Care Fund – the Government’s scheme to improve integration between health and social care. NHS England chief executive Simon Stevens has said the health service can make £22bn of savings in the next five years, and called for an £8bn annual increase in the budget by 2020. The King’s Fund, however, said this would be “the absolute minimum” that was needed.

Waiting times

In three key areas – A&E, cancer treatment and the 18-week wait from GP referral to starting specialist treatment, the NHS is now falling behind its waiting times targets.

Mr Appleby said it had now become the norm for many A&E departments to miss the goal of treating 95 per cent of patients in less than four hours. With finances under pressure and staffing costs already high, there are fears hospitals cannot do any more to bring down waiting times.

“We’re not a great position on waiting times,” said Mr Appleby. “My speculation would be that with the system under pressure financially next year we’re going to see some real problems with waiting times. That’s got to be addressed. Patients are going to really feel that.”

However, despite the deterioration in performance, patient satisfaction remains high.

Capacity

The number of people using the NHS has risen significantly since 2010 – outstripping population growth.

The number of A&E attendances has gone up by 1.5 per cent a year under the Coalition and the number of people being admitted to hospital has also risen.

However the number of hospital beds has fallen by 2.1 per cent annually. Cutting beds has been a long-term strategy of the NHS, with a greater emphasis placed on care outside the hospital. However, the King’s Fund said the percentage of overnight beds occupied on average had risen nearly two per cent to near the 90 per cent mark, with a “not insignificant” number of hospitals averaging 95 per cent and sometimes hitting 100 per cent occupancy: rates that could leave little time to ready beds for new patients, raising infection risks.

The number of delays in getting patients out of hospital – the problem of so-called bed-blockers – has also hit a seven-year high.

Staff

Doctor and nurse numbers are both up. There were more than 7,000 more full-time equivalent nurses in November 2014 than in May 2010, and more than 5,500 more consultants. The number of managers, meanwhile, has been slashed by 6,800. Having initially planned to cut the NHS workforce, the Coalition presided over a major investment in frontline staff as hospitals reacted to the recommendations of the Francis Report, which catalogued how short-staffing contributed to care failings at Stafford Hospital. However, the King’s Fund said staff are under significant pressure and morale is low, with 38 per cent reporting feeling unwell due to work-related stress.