Difficult decisions for NHS leaders when push comes to shove

This is a time of great possibilities for the NHS. With the 10-Year Health Plan just weeks away from being published, hopes are high. After a wide-ranging programme of conversations and events with patients, staff and the public, the expectation is that the NHS will get a clear plan for the future. A route-map with clear directions to a better health service: convenient, local, prevention-focused and digitally advanced.

On all these ambitions we see examples of progress being delivered by trusts and their partners every day. Trusts are making headway too on key targets: whittling down waiting lists for routine planned care, expanding diagnostic activity and improving productivity

Trust leaders want to go further, faster, but a survey by NHS Providers, published today, shows they are being pulled in different directions, fuelling fears that financial imperatives are forcing painful cuts affecting patient care.

This is not just a warning of what might happen. We are seeing it now. 

Trust leaders face immediate competing priorities. They are under huge pressure to balance the books at the same time as being tasked with improving services for patients and boosting performance. The question trust leaders are asking themselves is this: when push comes to shove, what matters most?

These findings will understandably make for difficult reading at a time when we should be laying the groundwork for the transformation of the NHS. Almost half of trust leaders (47%) told us that they would have to scale back services in the coming year to deliver their financial plans, and a further 43% said this was under consideration. Examples included virtual wards to treat more people at home, diabetes services for young people and talking therapies.

When asked which aspects of patient care were most at risk, one of the main concerns was access to timely care, alongside patient experience and work to address health inequalities. Reassuringly, the survey showed that patient safety would be protected to the last.

However, they were clear about the likely impact of cuts to staff in both clinical and non-clinical roles on patient care, innovation, productivity and staff wellbeing. More than a third (37%) said they were cutting substantive clinical posts, with another 40% saying this was under consideration. Ask any trust leader working to deliver a better NHS and they’ll tell you, “We need to look after our people”. They have serious concerns that headcount reductions could have a significant detrimental effect on staff morale and meeting performance targets.

The focus of the survey was the current financial year, but the findings contain important messages for the NHS’ longer-term ambitions. They underline concerns about capital investment to deliver a positive environment for staff and patients, to improve productivity and deliver the shift from analogue to digital. They also highlight worries about having sufficient funding to invest in prevention and to help manage future demand for care.

This survey is a reality check.

Trust leaders are committed to the government’s ambitions for a better NHS this year and for the coming decade. Working with frontline staff they are showing what can be done with the resources available to them to deliver progress. But they face the daily reality of hugely difficult dilemmas posed by financial constraints that are affecting staff and patients.

Cuts have consequences. Given that, what trust leaders need is clarity of direction on what gives when operational targets cannot be reconciled with financial imperatives, to ensure every pound that goes on the NHS is spent well and wisely, in support of the ambitions we all share to develop and improve the health service.

This article was first published in Public Finance