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Current approach to NHS 'is simply no longer sustainable'

NHS staff coping with record A&E attendances and bed occupancy, and trusts further in deficit

Louise Prime

Tuesday, 11 September 2018

Frontline NHS staff had to cope with record A&E attendances and high bed occupancy levels in the first quarter (Q1) of this financial year, according to the latest figures from NHS Improvement, which also showed that the NHS provider sector ended the quarter even further in financial deficit than the same quarter last year. NHS Providers warned that the figures “show that our current approach is simply no longer sustainable”.

In its Quarterly performance of the NHS provider sector: quarter 1 2018/19, NHS Improvement reported that:

  • 6.23m people attended A&E in the quarter to 30th June, 3.7% more than in Q1 last year; and there were more than 1.14m emergency admissions via A&E (type 1), 6.2% more than the same period last year.
  • Despite intense operational pressure, A&E staff saw 5,602,531 patients in under four hours (the operational standard) compared with 5,427,860 in the same period last year.
  • Freeing bed capacity will improve providers’ ability to perform elective work and prepare for winter. Overall, providers made progress in reducing delayed discharges. In the quarter ending 30th June there were 274,815 acute bed days lost to patients awaiting discharge who did not need to be in an acute hospital bed – a reduction of 74,863 bed days delayed compared with Q1 last year.
  • Results are mixed on performance standards for planned care. Providers failed in aggregate to achieve the waiting-time standard of only 1% of patients waiting over six weeks for 14 of the 15 key diagnostic tests: 26.3% waited more than six weeks (driven by an increase in waiting times for endoscopy tests). At the end of June 2018, 87.4% of patients waiting to start treatment (incomplete pathways) had been waiting no longer than 18 weeks, compared with the standard of 92%; in the same period last year the figure was 90.0%.
  • Operational pressures continue to have a material impact on NHS finances. The provider sector reported a year-to-date deficit of £814m – £22m better than planned but £78m worse than Q1 last year.
  • Providers achieved savings of £495m (2.3%) which, although “significant”, were £64m below the “ambitious plan” for cost improvement targets, and their continued focus on productivity is critical.
  • Staff vacancies are increasing and are forecast to rise more throughout the year.
  • Agency spend remains under control, but there are high levels of vacancies that are difficult to fill.
NHS Providers chief executive Chris Hopson said this morning that NHS trusts are doing all they can against rapidly increasing demand, growing workforce shortages and continuing pressure on finances – and A&E staff have treated more patients within the four-hour standard than ever before. But he warned: “However hard they run, they don’t seem able to outpace the increase in demand.”

He pointed out: “We have argued for some time that the underlying deficit in the trust sector is over £4bn, and it’s good that we now have the facts on full, open and honest display. This will enable us to have the debate that we need on how the underlying deficit should be addressed as part of the forthcoming NHS long-term plan.

“The figures also show that our current approach is simply no longer sustainable. The long-term plan will also need to set out how we transform the NHS at pace to move to a more sustainable model of providing care.

“In short, trusts are doing absolutely everything they can to provide the best possible patient care but it’s an extremely challenging environment – and that applies to the rest of the NHS and social care frontline too”.

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