The ambitions of the NHS Long Term Plan will be jeopardised unless the incoming prime minister delivers on capital investment, training and education budgets, and public health, and unless we “finally get a long-term settlement for social care”, the NHS Confederation has warned. It issued the warning after The King’s Fund’s revelation that the NHS is still facing substantial financial pressure and missing key targets – despite the additional funding available from April this year.
The King’s Fund said its Quarterly Monitoring Report (QMR) for July suggests that patients face a long wait before they will see improvements in care as a result of the government’s £20 billion NHS funding boost. The QMR is based on its analysis of NHS performance data as well as a survey of 59 NHS trust finance directors (26% response rate) carried out in May and June 2019.
It said its survey of financial directors revealed that money intended for investment in service improvement might instead be needed to cover deficits that had not be planned for, potentially risking ambitions to improve patient care set out in the Long Term Plan. It also uncovered concerns that under-investment in budgets that fall outside the funding deal – including staff training, capital investment, social care and public health - will undermine commitments to improve financial and operational performance in the NHS. Finance directors told The King’s Fund that:
- 27% expect their trust to be in deficit at the end of the current financial year.
- 81% expect the NHS provider sector to miss the target set in the NHS Long Term Plan for it to be in balance in 2020/21.
- 79% expect the NHS to miss the target in the Long Term Plan that deficits in all NHS organisations will be eliminated by 2023/24.
The QMR’s analysis of NHS performance data for 2018/19 not only backs up previously reported deterioration in performance against key waiting times targets, it also shows that the NHS struggled to meet less well-known interim targets that NHS leaders had set to get performance back on track.
- The number of people waiting for planned treatment in hospital reached more than 4.3 million in March 2019, the highest on record and a 5% increase since March 2018 (despite a target that the waiting list should not increase over the year).
- Performance against the A&E standard continues to be poor, with only 86.6% of patients treated within four hours in May (against the 95% target that NHS leaders pledged to get back to meeting during 2019).
- However, hospitals met a target to halve the number of patients waiting more than 12 months for planned treatment, with the number waiting longer than a year falling from 2,756 in March 2018 to 1,154 a year later; the aim remains for no patients to be waiting longer than a year for planned care.
The think tank pointed out that its analysis of data for April and May this year suggests little sign of improvement – only seven of 119 trusts with major A&E departments met the target for treating 95% of patients within four hours in May, and the proportion of patients waiting longer than 18 weeks for elective care in hospital continued to rise in April.
Lead author of the report, The King’s Fund’s chief analyst Siva Anandaciva, commented: “Our latest quarterly monitoring report provides a reality check as the NHS enters the first year of its new five-year funding deal. Despite the funding boost, unrelenting financial and operational pressures suggest that patients are not going to see improvements in care for some time yet.
“Thanks to the hard work of staff, the NHS is treating more patients than ever before. But without a concerted effort to address staff shortages and more investment, ambitions to improve patient care will remain more aspirational than realistic.”
The NHS Confederation welcomed the “considerable achievements”, in light of funding and staffing constraints, that the NHS is treating more patients than ever before and staff have made real progress in reducing waiting times for patients waiting more than a year. Chief executive Niall Dickson said: “After a decade of austerity in the NHS we cannot expect to recover performance on waiting times and eradicate deficits overnight. This sobering report shows how far we need to go to get back to the performance levels the NHS was delivering five years ago…
“We know the scale of the challenge ahead is significant. We have the right vision for the future of the NHS but we need investment in key areas that fall outside of the £20 billion funding settlement. Unless the incoming prime minister delivers on capital investment, training and education budgets, public health and unless we finally get a long-term settlement for social care, then the ambitions of the NHS Long Term Plan will be jeopardised.”