By Andrew Holt

The performance of the NHS is continuing to hold up well, but there is concern that quality of care may suffer as financial pressures bite from next year, according to the latest quarterly monitoring report published by The King’s Fund.

A survey of 45 NHS finance directors undertaken for the report found that a majority are confident of delivering average cost improvement targets for this year of just under 5 per cent.

However, 2013 is seen as a potential turning point, with savings becoming more difficult to deliver and most directors sceptical that the NHS will be able to meet its target of finding £20 billion in productivity improvements by 2015.

Significantly, 40 per cent of the finance directors expect the quality of care to worsen over the next few years.

The main findings from the survey were:

35 of the panellists expect to end this financial year in surplus, with only 3 anticipating a deficit

33 are confident of achieving their cost improvement programme targets for 2012/13, while only 5 expressed concern

27 panel members believe there is now a very high or high risk that the NHS will not meet its target to deliver £20 billion in productivity improvements by 2015; just 4 judged there to be little risk of failure

19 of the panel said that they expect patient care to worsen over the next few years, with only eight anticipating improvement; this compares with 14 who felt care had improved in the last 12 months, and just 7 who believed care had got worse.

The report shows that the NHS also continues to perform well against a number of key performance measures.

Having peaked in early 2011, waiting times for hospital treatment have now fallen back to the same levels as June 2010 when the coalition government stopped central performance management of targets.

The number of hospital-acquired infections has also fallen to historically low levels.

However, analysis of A&E waiting times for the first quarter of the current financial year highlights growing pressure in emergency care – although the proportion of patients spending more than four hours in A&E fell compared with the two previous quarters (as expected at this time of year), it is at its highest level for this quarter since 2004/5.

The national figures also mask variation in local performance with 35 hospitals breaching the government’s target that no more than 5 per cent of patients should spend longer than 4 hours in A&E.

The main findings from our analysis of key performance indicators are:

7 per cent of inpatients waited more than 18 weeks for hospital treatment in July, compared with a peak of more than 10 per cent in March 2011

0.93 per cent of patients waited more than six weeks for diagnostic tests in July, a fall from 1.26 per cent in June, bringing it back within its 1 per cent target range

3.4 per cent of patients spent longer than four hours in A&E in the first quarter of the current financial year compared to 4.2 per cent in the last quarter of 2011/12; this is within the government’s target range that no more than 5 per cent of patients should spend more than four hours in A&E

The number of patients waiting between 4 and 12 hours for admission to hospital from A&E – so-called ‘trolley waits’ – also appears to be increasing, although this is at least in part explained by the relaxation of the A&E target in June 2010

Year-on-year reductions in health care-acquired infection rates continue, with a 35 per cent drop in C difficile and a 22 per cent drop in MRSA monthly counts.

The report also highlights a reduction of 27,000 full time NHS posts since March 2010. This includes a reduction of nearly 4,800 nurses, midwives and health visitors and around 8,000 managers (a drop of around 18 per cent). In contrast, the number of consultants has risen by 8 per cent during the same period.

Professor John Appleby, chief economist at The King’s Fund said: "The NHS continues to perform well in the second year of the productivity challenge.

"But there are signs that future years will be harder. The end of the public sector pay freeze next April may add to financial pressures and increase the strain on services. The difficulty for local providers will be finding ways to absorb these costs without compromising the quality of care for patients."

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