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Care deteriorating as projected NHS deficit reaches £2.3bn


Quality of care has worsened in the past year according to a survey of NHS trust finance directors, which revealed forecasts of a £2.3bn deficit across the health service by April.

The regular survey, carried out by the King’s Fund think-tank, showed that for the first time since it began in 2011, more than half (53%) of finance directors in England said the quality of care in their local area had deteriorated in the past 12 months.

web survey

In addition, 48% of clinical commissioning group finance leads agreed.

Concerns over the recently introduced caps on agency worker spending were also revealed, with more than half of trusts saying they may not be able to stay within the limits that were set by regulators Monitor and the NHS Trust Development Authority in the autumn.

Almost a quarter (22%) said the caps would impact on their ability to recruit the staff they needed to provide safe care. 

A further 35% were unsure of the impact on safe staffing levels, which the think-tank said indicated an increasing uncertainty about the effect of the controls.

“This is shaping up to be a make or break year for the NHS”

John Appleby

It comes against a backdrop of escalating NHS deficit, which the King’s Fund estimated would reach £2.3bn at end of this financial year in April.

From its survey of 83 trusts, 67% expected to end the 2015-16 year with a deficit. Almost 90% of acute hospitals were forecasted to be in the red.

The warning comes as NHS national bodies have called for extra measures from trusts to curb spending and reduce the total deficit to £1.8bn by the end of the financial year.

King's Fund chief economist on health policy John Appleby

King’s Fund chief economist on health policy John Appleby

John Appleby

John Appleby, chief economist at the King’s Fund, said: “These findings are further evidence that the NHS is facing a huge financial challenge.

“Even with the additional funding recently provided by the Treasury and a big switch from capital to revenue spending, it is touch and go whether the Department of Health will be able to balance its budget at the end of the year,” he said.

“At the same time, performance is deteriorating with key targets being missed with increasing regularity and increasing concerns being raised about the quality of patient care,” he added.

“This is shaping up to be a make or break year for the NHS,” he warned.

“Senior midwives are telling us that they have had to cut services due to budget restrictions”

Cathy Warwick

Royal College of Midwives chief executive Cathy Warwick described the King’s Fund results as “a real concern”. She said: “Senior midwives are telling us that they have had to cut services due to budget restrictions and cutting staff or holding posts vacant ensures poorer outcomes for women and their babies.” 

She added: “This report must generate a discussion about the government’s pursuit of savings over safe staffing it seems, at the expense of patient care and about the underfunding of the NHS as a whole.”

Siva Anandaciva, head of analysis at NHS Providers, which represents trusts, said the think-tank’s report demonstrated the “precarious position of NHS finances”.

“The report rightly notes the impact on productivity and, crucially, on quality of patient care as the financial crisis deepens,” he said. ”The many pressures on providers including unplanned growth in hospital demand, a significant increase in the use of agency staff and addressing systemic issues such as delayed transfers of care are issues of overriding concern.”


Readers' comments (8)

  • This is less then 2% of the overall NI Contributions. I would consider this as a great success when the world economy is based on the debt.

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  • I work as an RMN in liason psychiatry. I always ask patients how they feel on the ward and what their experience has been like. The compliments for the nursing staff has been great. Caring for people isn't exactly the easiest thing to do and we are humans not robots.

    Sure we have to ensure that we look after our patients and provide safety and comfort for those in our care. But I find that all too often NT and a few other media outlega enjoy making Nursing staff feel rubbish about their jobs by posting articles like these.

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  • Media outlets*

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  • There seems to be a general consensus on unmet targets reflected by available paperwork evidence being one and the same with the actual level of care provided. Are we, perhaps, not measuring care provided correctly and accurately? Paperwork and paperwork audits have increased. More data is accumulating every day and increasing demands are placed on staff to record this data accurately. More targets have been set based on the increased markers available from the increased data. But there are several problems with drawing such a conclusion on the quality of care from this data. Firstly, the information systems available cannot cope with processing amounts of information this large. Most of care markers are not even recorded electronically but on paper. This prevents the flow of information and generates immense amounts of duplicated data. Secondly, keeping up with filing increasing amounts of paperwork has become increasingly challenging for front line nursing and medical staff. This means either that paperwork is incomplete because of prioritising patient care ahead of paperwork, either patient care suffers because increasing amounts of time are used to fill in paperwork. This is a loose-loose situation, highly demoralising for all involved and only deemed to get worse. It the follows that low morals lead to poorer care.
    However, I believe that the answer relies in further investment in the NHS, particularly in information technology (IT) and software. I belive that once data begins to flow more efficiently, following the patient on their journey across multiple departments and healthcare settings, this will lead to less duplicated data and more time saved from not having to generate duplicate records. By upgrading the NHS IT data can than be collected automatically by networking medical devices. From a bed side blood pressure monitor to doctors bleeps, and from doctors electronic portable notes to nurses portable electronic notes, updates can flow, to do lists can autogenerate and auto "tick off" as tasks are communicated and completed. Clerking and care plans will mostly full in themselves with preexisting data, only requiring updating with simple touches on a touch screen patient monitor. Etc.
    Once recording becomes automatic and performed by computers, with minimal human input, then front line staff can focus on spending real time caring for patients.
    I belive that this is indeed the make it or break it point for the NHS. But this massive one time investment could make the difference.

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  • I wish I had the faith of Radu (10.00am) but have seen too much waste in the NHS on IT solutions to believe in the internet of things coming to our rescue. While I would like anything which gives nurses more time with patients, reducing care plans to prefill forms and a few added "simple touches" misses a lot of the point about individualised care, and I wonder whether this would also become a means of central control where numbers determine nursing care rather than the individual attention to need and that nursing becomes closer to the "meat robot" expectation of Amazon staff. That said, make or break is certainly where we are - if only there wasn't quite so much stacked up on the side of break...

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  • Doesn't anyone out there grasp it?

    No-one cannot predict how just many people will need the services of the NHS, or specify how much money is required just for the technology used by the workforce.

    Therefore, the NHS, unlike other 'businesses' who may well be able to invest their profits to raise more capital, and or, buy more equipment and employ more staff, rely on money raised through taxes.

    As you all know, our present government leaders, particularly, Cameron, Osbourne and Hunt, are determined to create an atmosphere of anxiety, stress, and guilt within all departments of the NHS, insinuating it is the staffs' fault for any so called, ' overspending' of their pitiful budgets.

    So, how can the daft MPs believe they can calculate how much is needed to run an ever demanding service in any year, is beyond me.

    Qualified Doctors, midwives, Nurses, frustrated with the multitude of regulations, standards, and objective set upon them by the department of health, accept they cannot meet all these demand and feel they have no option but to leave the service altogether. Thus creating the old familiar 'staff shortages' we keep on hearing about from the idiot MPs.

    The sooner the government realises the NHS is not a business and should be managed by specialist medically and trained doctors and nursing staff and not ex- businessman, the better.

    Cameron, and his like, bankers and business partners. Simply get away with all sorts of failures in their work. Do they get penalised? Not likely, in fact if they are proven to be utterly useless, they are more likely end up with a massive golden handshake, bonus pay offs and a rediculousy boosted pension upon leaving/ getting the sack.

    Doctors and nurses only receive criticism for their efforts trying to protect the NHS, and, their livelihoods which has been limited to a 1% or less pay rise, with the burden of having to do more work iand a change in their working hours. It a disgraceful state if affairs.

    Immigrants and asylum seekers, and their extende families as well, in some cases, can get more benefits out of the U.K. whether they need it or not.This fact has been exposed and reported on televised documentary programs, which, you never hear Cameron commenting on, do you? I don't suppose , because his head is stuck up his backside, he takes any notice off.
    Ironically, in spite of all that, he reckons he's got a deal sorted to persude us to vote, in the referendum, to stay within the European Community.
    Cameron is just a figurehead who is only out to look after himself and buddies. He has demonstrate an utter lack of support in any of the public services, whilst enjoying the benefits it a tax cut in his wages: a massive pay rise: paid expenses. God only knows why we tax payers put up with!

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  • Dear Anonymous from 18 February, 2016 6:11 pm

    I know nurses are amazing and totally brilliant

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  • There should be no such thing as bad care anywhere. It simply should not exist. there are no excuses for damaging patients. Is this jargonistic 'never events' merely a myth?

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