News / Increased demand raises alarm over financial sustainability
The King’s Fund said ‘relentless demand’ was pushing up waiting times and exacerbating financial pressures. And NHS Providers chief executive Chris Hopson said trusts were finding it impossible to provide quality services and meet performance targets with available funding.
The King’s Fund quarterly monitoring report said more than 1 million patients were admitted to hospital from A&E in the first quarter of 2016/17, while A&E attendances rose to nearly 6 million. This was more than the same time last year by 14,000 and 54,000, respectively. Increased activity was affecting waiting times, with 3.8 million patients on waiting lists in June – the highest level since December 2007.
The fund’s survey of finance directors showed an improving financial position, in line with NHS Improvement’s first quarter report.
However, finance directors said the position was fragile, with 47% of trusts forecasting a year-end deficit and a third confident they would meet the control totals agreed with NHS Improvement.
Commissioner chief finance officers’ confidence had declined, with twice as many (23%) forecasting a year-end deficit than at the same point last year. In addition, 40% of trust finance directors and 61% of clinical commissioning group CFOs were concerned about meeting cost improvement or QIPP productivity targets.
King’s Fund policy director Richard Murray said: ‘Winter usually brings a dip in NHS performance, but what is striking now is that key targets are being missed all year round. This reflects the impossible task of continuing to meet rising demand for services and maintain standards of care within current funding constraints.’
While investment and action to curb spending was helping, it would be a mistake to believe financial pressures had eased. ‘Unless more is done to tackle rising demand, the ideas emerging from sustainability and transformation plans about cutting beds and reconfiguring hospitals will look even more unrealistic.’
Writing in The Observer, NHS Providers chief executive Chris Hopson said without extra funding the NHS had to make ‘quick, clear choices’ on the services it could afford to provide.
‘We face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate,’ he said. ‘Trusts will, of course, do all they can to deliver efficiency savings and productivity improvements. But they are now saying it is impossible to provide the right quality of service and meet performance targets on the funding available.’
• See Fixing the NHS
RCP paints stark NHS picture
Funding earmarked to transform patient
services could be ‘sucked into a financial black hole’, according to the Royal College of Physicians. 
Underfunded, underdoctored, overstretched said demand was increasing by 4% a year, real-terms funding would rise by an average of 0.2% a year to 2020. It insisted the UK does not train enough doctors.
Staff were under significant stress and felt ‘like collateral damage in the battle between rising demand and squeezed budgets’.
Nuffield Trust policy director Candace Imison said: ‘The NHS needs a sustainable funding settlement. Under current plans, trusts are being asked to make savings over the next two years at a rate never before achieved – at a time when they are already visibly struggling after delivering efficiencies through years of financial pressure.
We cannot carry on like this.'
Related content
The Institute’s annual costing conference provides the NHS with the latest developments and guidance in NHS costing.
The value masterclass shares examples of organisations and systems that have pursued a value-driven approach and the results they have achieved.