Only 27% of NHS trust leaders are confident they have the right staff numbers, quality and skill mix to deliver high quality healthcare for patients and service users.
Fewer still, 22%, are confident about having the right staffing levels in six months’ time, reveals the largest ever survey of trust chairs and chief executives.
“NHS trusts tell us they are facing the biggest challenge in a generation”
The findings show that, for many trust leaders, worries over staffing are becoming even greater and more urgent than those over funding.
The survey was completed by 172 chairs and chief executives from 136 acute, mental health, community and ambulance trusts – well over half of all England’s 238 NHS trusts.
It revealed that trusts were struggling to meet a series of workforce challenges, including shortages in key specialties and rising pressure on staff.
More than half (55%) of chairs and chief executives were “worried” or “very worried” about whether their trust had the right numbers, quality and mix of staff to deliver high quality healthcare. Most expect this to deteriorate over the next six months.
The survey forms the centrepiece of a comprehensive assessment by the organisation NHS Providers into the challenges trusts are facing and how they are responding to them.
“Anecdotally, Brexit is making the problem worse”
The State of the Provider Sector report, published at the start of the NHS Providers annual conference in Birmingham, highlights where trusts are improving care quality and productivity – despite operating at full stretch due to financial pressures and growing demand.
For example, trusts coped with 5% more emergency admissions and 8% more accident and emergency attendances this September than last September. NHS Providers also claimed trusts were “on track” to cut agency spending by a quarter.
In addition, it said they were addressing staff shortages by increasing overseas recruitment, piloting new roles like the nursing associate, and using technology to roster staff more effectively and meet staff requests to work more flexibly.
However, the survey also acknowledged a range of growing concerns over how services for patients and service users could be sustained at current levels.
Despite their efforts, trusts were missing nearly all of their key performance targets and just 30% of chairs and chief executives expect performance to improve over the next six months.
“Today we have new evidence of the scale of the staffing challenge”
Only 10% were “confident” or “very confident” they could maintain the level and quality of services over the next six months within the resources available, but 49% thought their trust’s financial position would deteriorate in the next six months.
Chris Hopson, chief executive of NHS Providers, said: “NHS trusts tell us they are facing the biggest challenge in a generation.
“Thanks to hard work at the frontline a huge amount is being delivered. Record numbers of patients are being treated,” he said. “But we need to listen carefully to frontline leaders when they say that the NHS is now running a much higher level of risk.
“We need greater honesty and realism about what can be delivered for the funding and staff capacity that is available,” he said.
“We need a smaller set of key priorities, more support for staff, and a better relationship between trusts, the government and its arms’ length bodies to develop solutions to these challenges,” said Mr Hopson.
He added: “Above all, we need a clear plan on how to close the gap between what the NHS is being asked to deliver and the funding available.”
Nigel Edwards, chief executive of the Nuffield Trust think-tank, said: “It is very worrying that almost three-quarters of NHS trust leaders don’t think they have enough or the right type of staff to give their patients high quality care.”
Mr Edwards noted he had previously warned that staffing issues were rapidly becoming as big a problem for the NHS as its financial woes.
“In particular, the current combined pressures of increasing patient demand and strained finances are making it very difficult to recruit into areas such as general practice and A&E departments in some parts of the country,” he said. “Anecdotally, Brexit is making the problem worse.”
Dr Mark Porter, chair of the British Medical Association, said: “It is no secret that the NHS has been under enormous pressure for some time, but this report shows that things are getting worse – financial pressures, staff shortages, and a lack of long-term planning have hit access to NHS services and the quality of patient care.
“Rota gaps and staff shortages across the NHS mean our patients are waiting longer for the appointments and treatment they need,” he said. “We desperately need a plan to put the NHS on a sustainable, long-term footing.”
Labour shadow health secretary Jonathan Ashworth said: “This is yet another important warning about the funding gap that confronts the National Health Service.
“We know the NHS is going through the largest financial squeeze in its history, that demands from an ageing population are increasing and today we have new evidence of the scale of the staffing challenge the service also now faces,” he said.