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Ongoing pressures putting NHS at risk of ‘serious lapses in care’

This is despite improvements in care quality in key areas, say think-tanks

Caroline White

Friday, 09 December 2016

Continuing pressures on the NHS are increasing its vulnerability to serious lapses in care, warn health think tanks, despite impressive gains in quality improvement in key areas, warn the Nuffield Trust and the Health Foundation, in a joint report.

‘Quality at a cost’, the latest annual statement from the Nuffield Trust and Health Foundation’s joint QualityWatch programme, coincides with the latest combined monthly performance figures for October from NHS England, confirming relentless rise in demand and A&E attendances back above 2 million.

The report, which assesses a range of care quality measures across the NHS in England, shows that standards have improved in several areas of healthcare, but that improvement in other areas has slowed, pointing to lengthening waiting times and ongoing financial pressures as evidence that the NHS could face serious challenges in maintaining care standards.  

The fact that the financial squeeze didn’t immediately affect the quality of patient care is testimony to the hard work and goodwill of NHS staff, says the report.

It notes improvements in some areas of public health and prevention, including childhood obesity among 4-5-year-olds and a fall in the prevalence of smoking during pregnancy.

Patients’ experience of hospital care has also improved, with 84% reporting they were treated with dignity and respect in 2015, compared with 80% in 2011.

And more stroke patients than three years ago get a brain scan within an hour, having their swallowing assessed, and have occupational therapy input into their rehabilitation. 

But lengthening waiting times for emergency and planned care is a cause for concern, says the report. Nearly four in 10 ambulances took longer than eight minutes to reach life-threatening emergencies in September 2016, and patients waited a week longer to see a consultant in 2016 than they did in 2012.

Progress towards eradicating some healthcare-associated infections has also stalled, amid an increase in the number and rate of less well monitored infections. Combined with very high levels of bed occupancy, this risks patient safety, says the report, pointing to cases of E coli, which increased by almost a fifth between 2012-13 and 2015-16

In addition, last year, people with mental ill health reported much lower rates of satisfaction for inpatient care than those who were not mentally ill. 

The deterioration in waiting times did not begin until some years into the current decade of austerity, explains the report, suggesting that NHS staff efforts to boost productivity and meet targets may have delayed the impact of financial pressures. Other areas of patient care may experience a similar delayed decline as the financial squeeze continues, it says. 

Lead report author, Dr Liz Fisher, said: “In the face of considerable pressures, our analysis shows that there are improvements to the quality of healthcare for patients that we should recognise and celebrate. These are even more impressive when understood in the context of growing demand for healthcare and the tightest funding settlement for decades.

“But elsewhere, in areas such as ambulance response times, the news isn’t so good. The next 12 months will prove a crucial test for the resilience of the health service.” 

Nigel Edwards, Chief Executive of the Nuffield Trust, warned: “Slowing improvement in some areas of quality, combined with longer waiting times and ongoing austerity suggests the NHS is heading for serious problems. It seems likely that a system under such immense pressure will be unable, at some point, in some services, to provide care to the standards that patients and staff alike expect.” 

Dr Jennifer Dixon, Chief Executive of the Health Foundation, said: “More can be done to improve efficiency within the NHS, and ideas and innovative thinking to improve and transform services are in ample supply within the health service. But, the NHS needs a chance to deliver them through intelligent investment, support and time.” 

However, reflecting on the monthly performance figures, NHS Providers chief executive Chris Hopson said these were an indication that “every month the warning signs become clearer. NHS hospitals, community and mental health trusts and ambulance services cannot keep up with the growing demands being placed upon them.”

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