The NHS is now planning to delay or cancel spending in half of local areas this year to meet financial targets, according to The King’s Fund’s latest quarterly monitoring report.
The report finds that 50 per cent of clinical commissioning group (CCG) finance leads say that achieving this year’s financial forecast is likely to depend on delaying or cancelling spending. More than 40 per cent say they plan to review or reduce the level of planned treatment they commission following the recent downgrading of the 18-week referral-to-treatment target. Just under half of CCGs were also uncertain or concerned about their ability to increase funding for mental health services in line with the national commitments.
The survey of NHS trust finance directors suggests that NHS finances improved over the last quarter of 2016/17, with more than half of finance directors (54 per cent) expecting to have ended the year in surplus, significantly more than were forecasting this three months ago. But while progress has been made in reducing spending on agency staff, the report suggests that the underlying financial position remains gloomy, with many trusts having relied on one-off actions such as land sales and payments from the Sustainability and Transformation Fund (additional central funding that is conditional on targets being met) to improve their position.
The 2017/18 financial year promises to be another difficult one for the NHS. While trust finance directors are more optimistic than at this time last year, 43 per cent of them expect to overspend their budget and a similar proportion (46 per cent) are concerned about meeting financial targets. This lack of confidence extends to the commissioning sector, with only one in five CCG finance leads confident they can achieve financial balance this year.
The final quarter of 2016/17 saw a sharp improvement in A&E performance, with 90 per cent of patients admitted, transferred or discharged within four hours. Despite this, fewer than 1 in 10 (9 per cent) trust finance directors are confident that the NHS will meet the commitment that 90 per cent of patients will spend no longer than four hours in A&E by September 2017. Across 2016/17 as a whole, NHS performance deteriorated in a number of key areas:
- 2.5 million patients (11 per cent) spent longer than four hours in A&E, an increase of more 685,000 on the previous year
- more than 362,000 patients (9 per cent) waited longer than 18 weeks for hospital treatment in March 2017, an increase of almost 64,000 on March 2016
- 26,283 patients waited longer than 62 days for cancer treatment having been urgently referred by their GP, an increase of 8 per cent on the year before
- almost 2.25 million bed days were lost as a result of delayed discharges from hospital, an increase of nearly a quarter (24 per cent) on the previous year.
Richard Murray, Director of Policy for The King’s Fund, said: ‘Given the enormous pressures experienced in January, the improvement in A&E performance in February and March is a tribute to successful planning and the hard work of NHS staff during a difficult winter.
‘While the financial picture improved at the end of the last financial year, much of this is down to one-off actions such as selling land. The high levels of concern about the year ahead suggest that NHS providers are again likely to run up a significant deficit in 2017/18, a year when the sector is supposed to be in balance.
‘With many CCGs planning to delay or cancel spending, local NHS leaders will be forced to make tough decisions about priorities and this is likely to have a direct impact on what care patients can access and how long they have to wait for it. This reinforces the underlying reality that demand for services is continuing to outstrip the rate at which the NHS budget is growing.’
The King’s Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.