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NHS faces accelerating decline as election approaches

Coalition leaves health service ‘under significant strain’ says King’s Fund report

Louise Prime

Thursday, 26 March 2015

Whichever new Government that takes office in May will inherit an NHS that has run out of money and is operating at its absolute limits, the King’s Fund warned this morning. Its latest report into the fortunes of the NHS under the coalition, launched this morning, highlighted huge pressure on general practice, concerns over vulnerable patients’ access to mental health services, £800m of overspends, and a serious risk of deteriorating patient care as service and financial pressures overwhelm the NHS.

The King’s Fund said in the second part of The NHS under the coalition government that the strain is being felt right across all areas of the NHS. It found:

  • Target waiting times for A&E, hospital treatment and cancer treatment have all been missed towards the end of the parliament.
  • Hospital bed occupancy has increased to very high levels, and delayed discharges have risen significantly over the past 12 months.
  • NHS staff are under significant pressure, and morale is an increasing cause for concern.

It urged the next government to commit to additional resources while avoiding grand reforming gestures and warned that without the estimated £8bn funding that the NHS requires, as a very minimum, there is a real prospect of accelerating decline in NHS performance. It cautioned: “This could mean staffing cuts that affect patient safety and quality of care … together with longer waiting times for patients to access services.”

It suggested that one way to help avoid this was for the NHS to successfully renew its commitment to productivity improvement. It said smarter procurement, better use of the estate and changes in clinical care, would all help – but that “a particularly promising” route would be to more closely integrate hospitals, community services and social care to reduce waste during transitions of care (for example delayed transfers from hospital). It also called for a transformation fund to pump-prime investment in new models of care, and for greater priority to be given to reforming the NHS ‘from within’ – including developing leadership (especially clinical leadership) and nurturing cultures focused on safe and high-quality care.

There was some respite from the bad news – the report found that the numbers of doctors and nurses have increased, while management costs have been significantly reduced; patient experience remains positive and public satisfaction with the NHS is at its second highest level ever, with “consistently high levels of patient satisfaction with GP services”; and the number of health-care acquired infections has fallen, with cases of MRSA and Clostridium difficile at historically low levels.

The BMA said that after years of underfunding, “the cracks are beginning to show” with longer waits for treatment, services stretched close to breaking point and unsustainable pressure on staff. Council chair Dr Mark Porter said: “The NHS is the best health care system in the world, and the most efficient – there is no fat left to cut without patient care being hit. The report makes clear that further cuts to front-line staff pay are not a solution to the funding crisis in the NHS.”

He warned: “The NHS needs a long-term, fully funded plan to protect patient care, support front-line staff and ensure it can rise to the enormous challenges facing it.”

Dr Maureen Baker, chair of the Royal College of GPs, added: “Whichever party comes into power after the General Election in May, they need to commit to increasing the NHS budget by at least £8bn a year by the end of the next parliament. The NHS will be a key issue for many voters in the upcoming election – and general practice is its foundation.”

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