NHS at breaking point despite deficit reduction, say trusts

A combination of growing demand, staff shortages and future slowdowns in funding increases mean the NHS is at breaking point despite a reduction in deficit compared with the same period last year, trusts have said.

The deficit in the first quarter of the financial year (April to June) was £461m, less than half the amount in the same period last year (£930m), but without emergency injections of cash it probably would have been little changed.

As well as a spending increase of 3.7% in real terms this year, trusts have been helped by the £1.8bn sustainability and transformation fund (STF), which contributed £450m to the results published on Thursday.

The funding increase is set to fall to 1.3% next year and 0.4% in 2018/19, and while demand is increasing at a rate of around 3% for many services.

Chris Hopson, the chief executive of NHS Providers, which represents trusts, said: “Our guys are saying to us we’re really struggling to make this work at the moment and we can’t see – we have only half made it work in a year of plenty – how can we do it in a year of 1.3% and 0.4% increases?

“Effectively they are coming under more and more pressure to deal with these demand increases without the money to employ staff, without the staff being available … We are now at breaking point.”

This month St Helens Clinical Commissioning Group (CCG) in Merseyside proposed a temporary ban on non-vital operations in an attempt to tackle funding problems. Hopson said more would follow.

The regulator NHS Improvement has asked hospitals to identify “marginal services”, often those led by one consultant, such as dermatology and rheumatology, which could be axed. But these cuts are unlikely to be enough and may just transfer demand – and cost – elsewhere.

Hopson said that unless funding was boosted, decisions would have to be made akin to those already made in other government departments: either cut workforce, change eligibility or stop providing certain services.

“Either put more money in or … we’ve got to make a conscious decision of what we’re going to deliver as a result,” he said. “We simply can’t go on doing everything we’re being asked to do.”

Polling by the King’s Fund, a health charity, released to coincide with the figures found that 38% of trusts were not confident of meeting the financial targets set by regulators for the end of the financial year. A third were unsure and the final third were “fairly confident”.

The charity’s director of policy, Richard Murray, said: “This is the year when the money still flowed. The growth in funding for the NHS in the next couple for years slows very sharply. What you want to do is finish this year in a good position; that’s not [what appears to be] happening here.”

There was also a suggestion that finance managers at trusts would have pulled out all the stops in the first quarter, using all available legal means to gain access to the STF.

Nuffield Trust’s senior policy analyst Sally Gainsbury said: “Access to the special £1.8bn fund which trusts desperately need to keep paying staff wages is tied to them reporting the ‘right’ figures at the end of each quarter. So although today’s results reflect a lot of hard work from managers and professionals, we should be ready for the possibility of a nasty surprise towards the end of the year.”

NHS at breaking point despite deficit reduction, say trusts