By Andrew Holt
Pessimism is growing in the NHS and social care as local leaders respond to mounting financial pressures, according to the latest quarterly monitoring report on service performance published by The King’s Fund.
For the first time, the report includes a survey of directors of adult social services in English local authorities alongside its usual survey of NHS finance directors.
Both surveys suggest that the financial squeeze is beginning to have an impact on quality and access to services in some parts of the country.
A third of NHS finance directors report that the quality of patient care has worsened during the last year and more than a third of social services directors expect to have to cut social care services over the next year.
While most NHS organisations are on track to meet financial targets, it is clear that pressures are growing towards the end of the second year of the so-called Nicholson Challenge to find £20 billion in productivity improvements by 2015.
The main findings from our survey of NHS finance directors are:
A third report that the quality of patient care in their area has worsened during the past year; this compares with only about 1 in 6 who said the same thing in our last survey
More than three-quarters expect to end the financial year in surplus, with only 3 anticipating a deficit; 34 are confident of achieving their cost improvement programme targets for 2012/13, with 9 expressing concern
In contrast, when asked how they felt in general about the financial state of their local health economy – not just their own organisation – over the next 12 months, around two-thirds were pessimistic.
With local authorities grappling with the second year of a budget squeeze that will see an overall cut of 27 per cent in central government funding by 2015, directors of adult social services are pessimistic about the financial outlook:
Nearly a third predict an overspend on their budgets, with a similar number expecting an underspend and 23 expecting to break even
The financial pressures are set to have a significant impact on access to services, with more than a third of directors anticipating having to reduce services and nearly a fifth expecting to increase charges over the next year
Nearly three-quarters said that they are pessimistic about the overall state of the local health and care economy over the next 12 months, with only 3 reporting any optimism.
The report also includes a dashboard of key NHS performance indicators.
While these are mostly stable, the proportion of patients waiting more than four hours in A&E is at its highest level for this quarter since 2003/4.
This remains within the government’s target range, with the increase to some extent accounted for by the relaxation in the target and seasonal factors.
However, with more than a quarter of trusts, reporting breaches of the target, it is clear that many hospitals are struggling to maintain performance in emergency care.
The main findings from the analysis of performance measures are:
4.3 per cent of patients spent longer than four hours in A&E in the third quarter of the current financial year
Waiting times for hospital treatment are stable, with the proportion of patients waiting longer than the operational standards having increased slightly for outpatients and reduced for all other waiting lists
Impressive reductions in health care-acquired infection rates continue, with a 13.5 per cent drop in C difficile and a drop of nearly 12 per cent in MRSA year-on-year counts to November 2012.
According to the official statistics, delays in transferring patients out of hospital remain stable, despite more than 60 per cent of NHS finance directors reporting that delayed transfers of care have worsened over the last year.
With other feedback also suggesting delayed transfers have got worse, the report calls for further investigation into this issue.
Professor John Appleby, chief economist at The King’s Fund said: "The NHS faces unprecedented financial pressures, and there are growing worries that patient care will suffer.
"For social care, it will be increasingly difficult for councils to make further savings without directly cutting services or affecting quality. Health and care services have coped well until now, but it is clear that many organisations expect things to become much more difficult over the coming year."
Trustees came under the spotlight last year because of their reluctance to defend
the salaries of their chief executives. The sector has since offered trustees opportunities to learn from the experience. It is an opportunity they must take, argues Andrew Holt
Tris Lumley takes the reader on an in-depth journey analysing impact
leadership, arguing that impact starts with leadership
Andrew Holt searches through the maze that is the Big Society for meaning