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Report reveals impact of financial cuts on patient care

King’s Fund researchers investigate impact of cuts on four services

Ingrid Torjesen

Tuesday, 14 March 2017

A new report by the King’s Fund has revealed the unseen impact on patient care of financial cuts and other pressures in four service areas.

The report, Understanding NHS financial pressures, looked in detail at four services – testing and treatment for sexually transmitted infections, district nursing, elective hip replacement and neonatal care – to explore the impact of financial pressures on patient care.

The researchers found that the slowdown in funding – which started in 2010/11 – has taken time to have an impact but is now affecting patient care in ways that often go “under the radar”. The findings suggest that community and public health services have been hit hardest, while acute and specialist services have so far been relatively protected.

In some parts of the country, local authority spending on genitourinary medicine (GUM) services (STI testing and treatment) has been cut by more than 20% between 2013/14 and 2015/16, with further cuts planned. This has resulted in fewer clinics and reductions in staff in some areas, which could put patients and the general population at greater risk of infection, the report warns.

Funding constraints and workforce shortages have led to a growing gap between demand and capacity in district nursing services, the report says. This is being compounded by pressures from other services, including gaps in social care, hospitals discharging patients with more complex needs and a shortage of out-of-hours GPs resulting in district nurses undertaking tasks usually performed by GPs, such as signing death certificates.

Evidence is emerging that financial pressures may be starting to have an impact on patients’ access to elective care such as hip replacement. The number of procedures recorded in 2015/16 was slightly lower than the previous year, average waiting times have increased and more patients are waiting longer than 18 weeks for treatment.

There is no clear evidence that recent financial pressures have had a significant impact on patients in neonatal care services so far, the researchers found. However, longstanding pressures, such as staff shortages, mean many units do not meet recommended levels for nursing and medical staff. High levels of occupancy are also a longstanding challenge in some units, which can lead to babies being transferred a long way from home, increasing strain on families.

Ruth Robertson, a Fellow in Health Policy at The King’s Fund and lead author of the report, said: “Longer waiting times for hospital treatment and restrictions to operations are just one small part of the picture. Our research shows that services like district nursing and sexual health, where we found evidence that access and quality are deteriorating for some patients, have been hardest hit by the financial pressures facing the NHS but that this is often going unseen.

“This undermines the vision set out in the Five Year Forward View to strengthen community services and focus on prevention. If the NHS wants to transform care and keep patients healthy and out of hospital it will need to invest more in community and public health services.”

Niall Dickson, Chief Executive of the NHS Confederation, said: “This report reinforces how difficult it is to transform services when budgets are so tight. There is simply not enough money to meet existing demand, never mind build up the new community services needed to create a sustainable system.”

The report also highlighted that there had been a rise in the use of block contracts by commissioners in an attempt to control costs, and that this meant that providers, faced with rising patient demand, were having to tighten criteria for access to services.

David Hare, NHS Partners Network Chief Executive, echoed the report’s concerns that “the rise in block contracts for elective procedures is having an adverse impact on patient care as demand is rising”, and called for “a greater focus on ensuring patients are allowed to choose their care provider with the funding following their decision”.


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