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.
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”
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
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”
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.”