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One in five hospitals heading into the red and morale is low, survey shows

But most hospitals are coping well with winter pressures

Caroline White

Wednesday, 22 January 2014

More than one in five hospitals will be in the red by the end of this financial year, shows a survey of NHS trust finance directors carried out for health think tank, The King’s Fund, for its latest quarterly monitoring report on the state of health and social care.

The 22% figure, which represents an increase on that found in previous surveys, highlights the growing pressures on hospitals as the NHS continues to manage the biggest financial squeeze in its history, says The King’s Fund.

The survey suggests the NHS will struggle to meet its target of delivering £20 billion in efficiency savings by 2015, with less than half (47%) of finance directors expecting to meet their productivity targets for the current financial year.

And it shows that staff morale now tops the list of concerns identified by hospital finance directors.

The online survey was carried out online between 22 November and 6 December 2013. Altogether 235 NHS trust finance directors (79 responses); 195 CCG finance leads (58 responses); and 152 directors of adult social services (47 responses) were contacted.

NHS commissioners are more optimistic about the outlook, with 61% of CCG finance leads confident of meeting their productivity targets. However, 1 in 8 (13%) still expect their CCG to be in the red at the end of the year.

Severe cuts to local authority budgets mean the financial squeeze is biting even harder in social care, with more than a third (36%) of directors of adult social services forecasting deficits.

Despite the increasing financial pressures faced by the NHS, analysis of key performance data shows that performance is holding up well.

During the final quarter of 2013, the proportion of patients waiting more than four hours in A&E was within the government’s target range of 5%, although this masks considerable variation in performance.

One in four hospitals (26%) breached the target over the period, but most hospitals have managed to cope with winter pressures so far, the figures suggest.

Waiting times for hospital treatment are also within the target range, although the proportion of outpatients waiting more than 18 weeks for treatment has reached its highest level since 2008, which is another sign that pressures on hospitals are increasing, says The King’s Fund.

The main findings from the analysis of performance data show that:

  • 230,517 patients (4.4%) spent four or more hours in A&E over the quarter to the end of December 2013.
  • healthcare-acquired infections remain at historically low levels with 420 cases of C difficile and 40 cases of MRSA reported in November 2013
  • 8.9% of inpatients and 3.6% of outpatients waited longer than 18 weeks for treatment in October 2013.
  • delayed transfers of care remained stable, with 4190 patients recorded as delayed on the last Thursday of November 2013, but delayed discharges was once again identified as a significant concern by trust finance directors in the survey.

Professor John Appleby, chief economist at The King’s Fund, said: “Despite warnings about a potential crisis in A&E, most hospitals are coping with winter pressures so far – a tribute to the hard work of staff in A&E departments.”

But he added: “The growing number of hospitals set to overspend their budgets shows that for some, it is no longer possible both to maintain the quality of services and balance their books. The emerging concerns about staff morale in hospitals are very worrying as there is a proven relationship between staff satisfaction and the quality of care provided to patients.”

Unite, which has over 100,000 members who work in health, said that the state of NHS funding demanded urgent scrutiny by MPs, and that it planned to write to the Public Accounts Committee.

Unite head of health Rachael Maskell said: “With the NHS being put at serious financial risk, Unite believes that it has now become urgent that the current state of NHS funding comes under public scrutiny by the Public Accounts Committee so that the real picture of the NHS financial model can be understood.”

The King’s Fund’s report: How is the health and social care system performing?

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