Workforce, social care capacity and finance top trusts’ worry list

NHS Providers’ State of the provider sector survey found 84% of respondents did not expect to end the year in a better financial position than at the end of 2021/22 and 66% had experienced issues in accessing operational and national capital funding.

The survey – launched on the eve of the NHS Providers’ conference – had 183 respondents, representing leaders in 57% of provider organisations. Thirteen per cent of them were finance directors.

They were asked to name the three biggest challenges facing their integrated care systems with 39% mentioning insufficient revenue funding and 23 per cent insufficient capital – with only workforce shortages and social care capacity being seen as bigger issues.  

Asked about their biggest concerns around trust finances in the next 12 months, many respondents mentioned the impact of inflation on running costs. Agency spend and meeting efficiency/cost improvement programme targets also featured.

But funding for social care stood out as a universal concern with 94% worried about the level of national funding for social care in their local area.

Some respondents pointed to an even more difficult year in 2023/24. One ambulance trust leader said it was unlikely that all recurrent efficiency targets for 2022/23 would be identified and delivered, putting additional pressure into next financial year. ‘This coupled with further reduction in non-recurrent Covid-19 allocations will mean 2023/24 will be even tougher than this year,’ they said, pointing out that some recurrent pressures in 2022/23, such as the pay award, were not fully funded.

The survey also showed concerns about winter pressures on trusts. Nearly nine out of 10 – 89% – of trust leaders said they were ‘extremely concerned’ about the impact of seasonal pressures and nearly as many (86%) were worried about their trusts having the capacity to meet demands for services over the coming year.

Linked to this were concerns about burnout for staff, with 93% being extremely or moderately concerned about this, and 77% feeling worried about having the right numbers, quality and mix of staff to delivery high quality healthcare currently.

But there were some bright spots. Statutory integrated care systems were seen as enabling better collaboration and joint working between trusts by just over three quarters of respondents and nearly two thirds said they had improved working between their trust and the integrated care board.  

Saffron Cordery (pictured), interim chief executive of NHS Providers, said: ‘With the fiscal statement looming large, leaders will closely scrutinise announcements from the Treasury amid fears trusts will be asked to implement unrealistic efficiency measures at a time when there really is no more give. Our survey shows in stark detail that mounting pressure on tight NHS budgets is a major concern for trust leaders with a £7bn shortfall in next year’s budget mostly caused by soaring inflation. They simply cannot squeeze out any more savings without negatively impacting patients.’

She added that ‘alarm bells should be ringing across Whitehall’ as less than half of trust leaders expected to meet the end of year elective recovery and cancer targets.

‘It’s clear trust leaders are doing all they can, but there’s only so much they can do at a local level,’ she added. ‘We have to boost the resilience of the NHS to make it sustainable for the long-term.’