Ministers and NHS bosses are being urged to stop asking the health service to “deliver the impossible” of higher standards of care when it is being denied the money it needs to do its job properly.
The plea from the organisation that represents NHS trusts in England was accompanied by a blunt warning that care for patients is already deteriorating and that even a flu outbreak could “destabilise” some hospitals this winter.
NHS Providers, whose member trusts receive £65bn of the NHS’s £100bn annual budget, says the health secretary, Jeremy Hunt, and the NHS England chief executive, Simon Stevens, are making unrealistic demands of the service.
“The government has said there will be no more money. The government and our system leaders have said that the NHS still has to deliver everything that is currently being asked for,” Chris Hopson, the chief executive of NHS Providers, will say on Tuesday.
He will dismiss the idea that the NHS could hit its tough financial targets this year while also transforming how it delivers care, giving every patient high-quality care, meeting a host of waiting time targets, implementing the government’s “seven-day NHS” pledge and also improving patient safety.
Ministers and NHS bosses should scale back their expectations of what the NHS can do in all those areas given its parlous finances and the government’s refusal to boost its budget, Hopson argues.
Three-quarters (73%) of NHS trust bosses believe they do not have enough staff to function properly, according to a new NHS Providers report on the state of the NHS in England. More than half (55%) say they are worried or very worried by their organisation’s lack of staff. Many trust chairs and chief executives now say the difficulty in recruiting personnel is as onerous as balancing their books.
In a survey of 172 bosses from 136 of England’s 238 trusts, one said: “There are simply not enough high-quality clinical staff in the country to cover some specialities.” Another said: “Brexit has caused drying up of recruitment from the rest of Europe.” Widespread worry about the NHS’s workforce “concerns me more than the money”, said a third boss.
Just 10% are confident or very confident that they can maintain the level and quality of services they currently provide over the next six months because money is so tight. Nearly half (49%) expect their financial position to worsen over that time.
Hopson will tell his organisation’s annual conference that the government’s decision not to put more money into a cash-strapped NHS raises “four main risks. The first is that the service the NHS provides is now starting to deteriorate”, and that the deterioration will accelerate because of the “crisis” in social care services.
The NHS is also becoming less resilient, he will add. “When you run a system under as much pressure for as long as we have been running the NHS, it becomes much less able to absorb the shocks that any health system has to absorb – the winter flu outbreak [or] closure of a couple of care homes [or] a few experienced GPs retiring and being replaced by more risk-averse locums”.
In addition, Hopson will say, “pressure on staff and leaders becomes intolerable, which erodes morale”. Hopson is also worried that pressures are so great that “the invisible bond of mutual trust and faith between the government and NHS system leaders, on one hand, and frontline leaders, on the other, is starting to fray”.
NHS Providers’ warnings on staffing come as an audit of NHS stroke services in England, Wales and Northern Ireland found that patients who have suffered a stroke do not always receive optimum care because many units have too few nurses and doctors, especially at weekends.
Nearly half (49%) of stroke units do not have the recognised minimum number of nurses needed to ensure good care, according to the Sentinel Stroke National Audit Programme. At weekends as many as 80% of units do not have the three nurses per 10 beds that is recommended. In addition, 40% of units have at least one vacancy for a consultant and 28% do not provide consultant-led ward rounds every day of the week.
Staff shortages were a concern, the experts behind the audit said. A lack of nurses in stroke units has been shown to increase the risk of patients dying.
The Department of Health welcomed NHS Providers’ acknowledgement that trusts were treating record numbers of patients and also making good progress at reducing its collective deficit, which hit a record £2.45bn in 2015-16.
Stop asking us to deliver the impossible, NHS trusts urge ministers
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