Confidence that trusts have the capacity to meet demand for services over the next 12 months
- Almost four in five trust leaders (79%) were very worried (26%) or worried (53%) about whether their trust has capacity to meet demand for services over the next 12 months, which was nearly the same as last year (78%). These levels are significantly higher than before the pandemic (61% in 2019).
- Several trust leaders noted severe issues with bed capacity and recruitment in certain services, with growing wait lists compounding high demand. Respondents highlighted the need for longer term planning.
“We won’t be able to meet the demand in many services.”
“Given bed capacity, workforce availability and general financial objectives, all UEC, elective and Cancer targets will not be met”.
Quality of healthcare provided by your local area now and in the future
- Just over a third of trust leaders (35%) rated the current quality of healthcare provided by their local area as very high (5%) or high (30%). 41% rated it as average, 12% as low quality, and 4% as very low. This figure has dropped from 41% last year and 48% in 2022. This figure also remains lower than before the pandemic when nearly half (47%) of trust leaders rated the quality of healthcare as high or very high.
- Only 32% of trust leaders predicted that the quality of healthcare provided by their local area in the coming year would be very high (1%) or high (31%). Almost half (48%) said the quality would be average, 12% said low, and 2% said very low.
- Two fifths of leaders (41%) predicted that the quality of healthcare provided by their local area in the coming two years would be very high (3%) or high (38%). 49% rated it as likely to be average, 9% as low, and 1% very low.
Improving financial position
- The majority of respondents (96%) said it is very likely (45%) or likely (51%) that their trust will have to review responsibilities within non-clinical roles, with a view to optimisation in order to help manage or improve their trusts’ financial position.
- Almost nine in 10 trust leaders (87%) said it is very likely (32%) or likely (55%) that their trust will have to review responsibilities within clinical roles, with a view to optimisation.
- 85% of respondents said it is very likely (34%) or likely (51%) that their trust will have to reconfigure services to help manage or improve their trusts’ financial position.
- Relative to the other responses, fewer trust leaders (42%) said it is very likely (13%) or likely (29%) that they will have to close some services to help manage or improve their trusts’ financial position.
What is your biggest concern in relation to the trust’s finances over the next 12 months?
- Capital: Trust leaders noted capital as their biggest concern, managing the estate and high maintenance costs, the constraining impact of CDEL on availability of capital, and lack of capital for vital infrastructure projects. Respondents flagged that the ability to innovate is being hindered, limiting the extent of transformational change.
- Impact on staffing: Respondents frequently raised the issue of headcount reduction, delivering the financial position and its impact on staff wellbeing and patient care, and continued agency spend.
- Reliance on non-recurrent savings: Trust leaders noted the reliance on non-recurrent savings to deliver efficiency targets and raised concerns at being able to achieve a breakeven position in a sustainable way.
- Lack of autonomy: They raised concerns around the lack of autonomy in decision-making and the impact this has on ensuring service provision is reflective of population needs and setting realistic financial plans.
“Financial pressure taking priority over quality and operational performance.”
“Bank and agency costs to support gaps in recruitment in hard to fill specialties.”
“Lack of meaningful joint planning across system to deliver long term solutions.”
“Consequence on patient care of remaining in budget.”
“Exodus of talent due to lowered morale and less opportunity for development and career progression.”
“Managing an ageing estate, the high cost of maintaining services.”
Actions trusts and/or ICBs have taken or are considering to help manage or improve their financial positions.
- Trust leaders responded with a range of actions their trust or ICB has taken or is considering to help manage or improve their financial position. A common theme was action related to staffing and recruitment, including recruitment freezes across non-clinical roles, eliminating bank and agency spend and scaling back spending on training and personal development.
Confidence that trusts have the right numbers, quality and mix of (clinical and non-clinical) staff in place to deliver high quality healthcare to patients and service users now and in the future
- Almost a third of trust leaders (29%) said they were very confident (3%) or confident (26%) about their trust having the right numbers, quality and mix of staff currently in place to deliver high quality healthcare to patients and service users. 14% were neither confident nor worried. Over half of respondents (54%) said they were very worried (20%) or worried (34%). The proportion of worried trust leaders has fallen from 60% last year and is now slightly lower than the levels seen before the pandemic in 2019 (59%).
- A quarter (25%) said they were very confident (2%) or confident (23%) about their trust having the right numbers, quality and mix of staff to deliver high quality healthcare in the coming year. 23% were neither confident nor worried. The remaining half (50%) said they were very worried (11%) or worried (39%).
- Lastly, two fifths (41%) felt very confident (3%) or confident (38%) about their trust having the right numbers, quality and mix of staff to deliver high quality healthcare in the coming two years. 18% were neither confident nor worried. 42% of trust leaders said they were very worried (6%) or worried (36%).
Workforce concerns
- Three quarters of trust leaders (75%) were extremely (32%) or moderately (43%) concerned about the current level of burnout across their workforce. This year, fewer trust leaders are extremely concerned compared to last year (42%) but the proportion of those moderately concerned is similar (42%).
- Regarding morale, over three quarters of trust leaders (78%) were extremely (28%) or moderately (43%) concerned about their workforce. The proportion of those extremely and moderately concerned is down from 83% last year (40% were extremely concerned and 43% were moderately concerned last year).
“Morale amongst staff is broadly good, but the risk of burnout as the demand for services is a worry.”
“Covid followed by industrial action has also adversely impacted on the resilience of our staff who no longer will go that extra mile.”
“Burnout is inevitable for staff working in a number of our clinical services if current conditions continue.”