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Focus extra cash for NHS on services outside hospitals, say finance leads

Money should go to social care, community health, and general practice, survey results show

Caroline White

Friday, 22 June 2018

The additional monies promised by Theresa May for the NHS should focus on services outside hospital, including social care and community healthcare, says health think tank The King’s Fund in its latest quarterly monitoring report* on the health service, published today.

To inform the report, NHS trust finance directors and CCG finance leads were asked to identify their top three priorities for additional funding.

Some 90 NHS finance directors responded (38% response rate). The sample included 40 acute trusts; 40 community and mental health trusts; one specialist trust; one ambulance trust and eight provider organisations that were not categorised. And of the 119 CCG finance leads contacted, 34 responded. Between them these finance leads covered 44 CCGs (23% of all 195 CCGs).

Two thirds (67%) of NHS finance directors chose social care; community services, were picked by 53%; and mental health services were chosen by 47% of respondents.

The top three priorities identified by CCG finance leads were general practice (79%), social care (65%), and community services (65%).

The survey, which was carried out in May, before the Prime Minister’s recent announcement on NHS funding, suggests that new investment should prioritise services in the community and underlines the importance of increasing social care funding in the next Spending Review, says The King’s Fund.

The cash boost will not be available until April 2019. And the survey indicates that the NHS is in for another very challenging year.

Following on from last year’s NHS provider deficit of £960 million, the report highlights wide disparities in the financial position of different NHS organisations.

More than two in five (42%) of NHS trust finance directors and nearly two fifths (39%) of CCG finance leads surveyed expect to overspend their budgets this year. This is a significant concern at this point in the year and underlines the deterioration in CCG finances, on top of provider deficits which remain substantial, warns The King’s Fund.

Less than a quarter (23%) of NHS trust finance directors and only one of the 32 CCG finance leads surveyed are confident of getting back on track to meeting the four-hour A&E target by March 2019.

To help manage financial pressures, nearly 80% off CCG finance leads said their organisation is considering extending the number of low-value treatments and prescriptions that will no longer be funded.

Staff morale has risen to the top of the list of concerns among NHS trust finance directors, with nearly a quarter (24%) identifying this as one of their top three concerns, the highest proportion since 2013.

With more than 4 million patients on the waiting list, the report highlights how difficult it will be to meet the Prime Minister’s ambition of getting waiting times for hospital treatment back within target range. This will leave more patients waiting longer, often in pain, for the treatment they need.

Siva Anandaciva, chief analyst at The King’s Fund and lead author of the report, said: “Policy-makers have long sought to provide more care in the community, closer to people’s homes, to improve patient care and reduce pressures on hospitals.

“These attempts have, for the most part, failed and hospitals remain full to capacity, while underinvestment in community services continues. Our survey suggests that finally delivering this vision should he at the heart of the forthcoming NHS 10-year plan and that additional funding for social care must be a top priority for the forthcoming Spending Review.”

She added: “It is clear that the current NHS finance regime is broken, with huge deficits in some trusts and booming surpluses in others. The new funding settlement provides an opportunity to re-think the current system and to ensure that financial management in the NHS is proportionate, fair and effective.”


* How is the NHS performing? June 2018 quarterly monitoring report. Kin’s Fund, June 2018

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