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Concerns mount about staff morale as NHS performance slips

Given link between staff engagement and quality of care, this is worrying, warns health think tank

Caroline White

Thursday, 30 October 2014

Staff morale tops the list of concerns raised by NHS finance directors in The King's Fund's latest quarterly health check on the state of the NHS.

Nearly half (47%) of NHS finance directors surveyed for the report identified staff morale as one of their top three concerns— twice as many as in the previous quarter.

This should be a significant cause for concern, given the close link between staff engagement and quality of care, the report warns.

The report*, which covers the period June to September, draws on the responses of 90 finance directors, out of 248 contacted, and 43 CCG finance leads, 202 of whom were invited to comment. 

The report underlines the financial pressures facing the NHS, with nearly 40% of trust finance directors forecasting a deficit by the end of the year, the highest proportion since the survey began.

And nearly 60% wonder whether their trust will be able to meet its cost improvement target for the current year, suggesting that it is getting more difficult to find efficiency savings, says the report.

Commissioners are more optimistic about their financial position, with around 70% of CCG finance leads surveyed expecting to end the year in surplus. But it remains to be seen whether these surpluses will be enough to balance the predicted overspend among NHS providers and enable the Department of Health to balance its books at the end of the year, cautions the report.

It also highlights the impact of mounting pressures on NHS performance, with waiting times targets for A&E, hospital treatment for inpatients, and cancer treatment all missed across the quarter. 

Despite a reported £930 million of additional government funding to improve hospital waiting times and ease pressures in A&E, this points to a challenging winter ahead, it warns.

Key findings from this quarter's analysis of key performance data show that the number of patients waiting four or more hours in A&E was the highest it’s been for more than 10 years.

Some 12.1% of inpatients waited more than 18 weeks for hospital treatment, as referral-to-treatment waiting times reached their highest levels since 2008 (in part due to the government's policy of allowing a 'managed breach' of the targets for a backlog of long waiters).

And the target of 85% of cancer patients receiving treatment within 62 days was missed for the second consecutive month.

The number of cases of E coli seems to be on the rise although monthly counts of MRSA, C difficile, and other hospital-acquired infections remain low.

But the number of delayed transfers of care increased by 17.5% compared with the same period last year.

“The NHS relies on the dedication of its staff, so the growing concern about staff morale is worrying,” commented Richard Murray, Director of Policy at The King's Fund. “Given the close association between staff engagement and quality of care, this is a warning sign that should be taken seriously by NHS leaders.”

He added: “The number of trusts forecasting deficits indicates that financial problems are no longer confined to a small number of organisations and are now endemic across the health system. 

“At this time of year, A&E waiting times should be well within target range, so the fact that they are continuing to miss the 5 per cent target is also a significant cause for concern.”

* John Appleby, James Thompson, Joni Jabbal. How is the NHS performing? October 2014 - Quarterly Monitoring Report. The King’s Fund

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