Trust leaders are bracing themselves for another tough winter with concerns mounting over whether the health service can meet key performance targets, a new NHS Providers survey has found.

They warn patient care is being put at risk because of delays in being able to discharge thousands of people from hospitals and mental health services when they could be cared for closer to home.

The findings show how years of squeezed funding, major workforce challenges and rising demand on hospitals and ambulance services have taken their toll, with overstretched community and mental health teams also coming under increasing strain.

These are huge challenges. Yet, NHS Providers’ survey shows a keen determination by health leaders to keep improving patient care, and clear backing for the government’s plans to shift care out of hospitals to community-based services. There are also signs that concerns about staff burnout and morale, although still a major worry for trust leaders, are starting to come down from very high levels recorded in recent years.
Survey findings include:

• Over 9 in 10 trust leaders (96%) raised concerns about the impact of seasonal pressures over winter on their trust and local area.
• Delayed discharge (57%), social care capacity (49%) and acute bed capacity (43%) were identified as the top three greatest risks to the provision of high-quality patient care over winter.
• Nearly three quarters of trust leaders (71%) and 100% of acute specialist trust and ambulance trust respondents thought it unlikely the NHS can meet the constitutional standards over the next five years.
• Most (79%) trust leaders were very worried or worried about whether their trusts have capacity to meet demand for services over the next 12 months.
• 98% of trust leaders expressed support for the national policy agenda to shift more care from acute services to community and move care closer to home for patients.
• When considering how patient care could be improved, the top three areas trust leaders would like the new government to prioritise are capital investment in estates (54%), capital investment in digital (48%) and social care (41%).

Saffron Cordery, deputy chief executive of NHS Providers, said:

"The NHS has had its busiest ever summer and won’t get a moment’s respite as it heads into another gruelling winter.

"Despite this, trust leaders know the health service needs to work differently to improve care for patients.

"And, with a significant - and welcome - boost for the NHS in the Budget, they are fully aware the health service needs to provide more bang for the buck, too. They are working flat out to improve services, reduce waiting lists, and see patients as quickly as possible.

"But after years of underinvestment and severe staff shortages, there needs to be realism about how quickly this will happen. It’s worrying so many trust leaders are sceptical about the prospects for meeting performance standards set out in the NHS constitution – such as the four-hour target for A & E or the eighteen-week standard for planned hospital treatment – over the next five years.

"However, these survey findings also show health leaders back Lord Darzi’s prescription for reforming the health service. They are ready and willing to work with the government on the 10-year plan to tackle head on the challenges facing the health and care system.

"They wholeheartedly agree that digitising the NHS, focusing on prevention and public health, delivering care closer to home and investing in the NHS’ bricks and mortar are vital steps to tackling demand and improving productivity, which are fundamental to get the health service back on track.

"This must be backed up with long-term sustainable funding and investment- including in social care, which has been overlooked for far too long."