Mission impossible: the NHS can't deliver in 2017/18

The NHS is a can-do organisation. Day in, day out, NHS staff go the extra mile for patients. NHS hospital, ambulance, community and mental health trusts have shown that, given the right resources, they can make huge gains in cutting waiting times, reducing infections and finding new ways of working to improve care and save money.

So when those trusts say that, without more support, they can’t deliver what’s being asked for next year, it is time to sit up and listen.

NHS Providers has analysed what NHS trusts have to deliver from 1 April 2017 and compared it to the available funding. The result is an unbridgeable gap, with worrying implications for patients and staff.

Let’s start with the money. Despite some protection for health, we’re in the middle of the longest and deepest financial squeeze in NHS history. Post Budget, we know that next year’s NHS frontline funding increases will be much lower – a 1.3% real terms increase compared to this year’s 3.6%.

It's mission impossible. The numbers don't add up.

The Budget brought some welcome news with £1bn extra for social care next year. Depending on how it’s spent, this could help ensure more older people are not kept in hospital when they’re ready to leave. But this won’t be enough. Overall demand for NHS trust services is forecast to rise by more than 3%. Add in a 2% rise in costs, including pay, drugs and equipment and that’s at least 5% more funding needed to just stand still.

Trusts will work more efficiently and continue to reduce unwarranted variation in what they do. But even if they manage an ambitious 2% efficiency gain there will still be a yawning gap just to keep services ticking over as they are.

However, NHS trusts have been told to plan to do much more than that.

They’ve been asked to recover performance targets such as the four hour waits in A&E and 18 weeks for routine operations. Trusts are already pulling out all the stops to meet these standards, treating more patients than ever before, with performance good by international standards. But, in the face of spiralling demand, the targets are slipping out of reach with increasing speed. Turning this round in a single year would mean investing more than £2.5bn - money the NHS simply doesn’t have.

That’s before you factor in plans to improve care for cancer and mental health. Ambitions we support, but they cost an extra £200-£300m.

Trusts have also been told to balance next year’s books. This year they are on course to end up more than £800m in the red. So that’s a further pressure the system has to absorb, even though it’s a big improvement on last year’s £2.5bn deficit.

Take all this together and it’s mission impossible. The numbers don’t add up.

The NHS is a can-do organisation. Day in, day out, NHS staff go the extra mile for patients.
So when trusts say that, without more support, they can’t deliver what’s being asked for next year, it is time to sit up and listen.

Chris Hopson    Chief executive

The impact of long A&E delays are well documented as patients wait in overcrowded waiting rooms, their conditions deteriorating as staff struggle to cope. We estimate that, on current trajectory, 1.8 million A&E patients next year will fall outside the target to deal with 95% of patients in four hours: half a million more than this year and an increase of nearly 40%.

Delays for operations mean patients have to live longer with the consequences of debilitating conditions including restricted movement, pain and mental ill health. Here too, there is the risk of conditions deteriorating to the point where they may become untreatable. We estimate that, next year, on average, 100,000 people waiting for routine operations will be in breach of the 92% 18 week target, 150% more than this year’s figure of 40,000.

Trying to meet performance targets with inadequate funding also places an unsustainable burden on NHS staff. Despite positive news on staff engagement, only 30% in the recently published NHS staff survey felt there were enough staff where they worked to enable them to do their job properly.

NHS trust leaders want to meet NHS standards, achieve financial balance and improve their performance. But you get what you pay for. Trusts can only deliver if they get the appropriate funding and support. Without these, difficult choices are required.

If we are to maximise the use of NHS resources, plan properly, treat staff fairly and be straight with the public, NHS leaders have to be realistic about what can be delivered next year. Trusts won’t be able to recover the A&E and elective surgery targets across the whole year – the best we can hope for is turning the current performance decline into an improvement. Given that demand and cost increases will easily outstrip funding and efficiency increases, just reproducing this year’s financial performance is a stretching target.

NHS trusts will strain every sinew to deliver the commitments made for the health service. But we now have a body of evidence showing that, with the resources available, the NHS can no longer deliver what the NHS constitution requires of it.

See the full report: Mission impossible? The task for NHS providers in 2017/18

This opinion piece was originally published by the Sunday Times on 19 March.

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