BMJ 2015;350:h1683 doi: 10.1136/bmj.h1683 (Published 26 March 2015)

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NEWS Patient care is at risk as NHS faces substantial deficit, says think tank Gareth Iacobucci The BMJ

The performance of the NHS in England has rapidly deteriorated under the coalition government in the past two years, a major report from a leading healthcare think tank has said.1 In its assessment of the NHS’s performance since the coalition was formed in 2010, the King’s Fund said that although performance held up well for the first three years of the parliament, the service was now under huge strain, with a real risk that care of patients will suffer as the NHS heads towards a substantial deficit. It said that waiting times were at their highest levels for several years and warned that the current funding gap could lead to “an accelerating decline in NHS performance” if it is not tackled in the next parliament. The report is the second in a two part assessment of the coalition’s record on the NHS in the run up to May’s general election, the first of which concluded that the upheaval caused by the government’s healthcare reorganisation was “damaging and distracting.”2

In its follow-up report the fund said that the coalition had met its pledge to increase the NHS budget in real terms since 2010, with funding increasing by an average of 0.8% a year in real terms. At the same time the government increased numbers of doctors and nurses while substantially reducing management costs and oversaw a fall in the number of healthcare acquired infections. Patients’ experience of the NHS has also remained broadly positive.

However, it said that the NHS was likely to record a substantial deficit at the end of 2014-15, with hospitals and other care providers set to post a combined overspend of more than £800m (€1.1bn; $1.2bn). The King’s Fund said that deficits were partly attributable to providers responding to concerns about patient safety and the quality of care highlighted in the Francis report on Stafford Hospital by recruiting extra clinical staff, often on an expensive locum basis.

Waiting targets being missed

It said that the government should take some credit for prioritising patient safety and quality of care despite the increased debt among NHS providers. But it said that these financial problems were placing strain on NHS services across the board, with general practice also under huge pressure and concern being raised about access of vulnerable patients to mental health services. Alongside this, waiting time targets for emergency department care, hospital treatment, and cancer treatment were all missed For personal use only: See rights and reprints http://www.bmj.com/permissions

towards the end of the parliament, while hospital bed occupancy had risen to very high levels and delayed discharges from hospital rose substantially over the past 12 months. The fund said that this pressure was also being felt by NHS staff, with morale suffering as a result.

Although the NHS had made some progress in delivering efficiency savings, the fund said that the methods for achieving these so far—such as pay restraint, reducing the prices paid to hospitals for treatment, and cutting management—had almost been exhausted. And, although further efficiencies could be found, it said that the additional funding of £8bn a year by 2020 identified by NHS England’s chief executive, Simon Stevens, was “the minimum requirement for the NHS to continue to meet patient needs and maintain standards of care.”

“No fat left to cut” John Appleby, chief economist at the King’s Fund and the report’s lead author, said, “The next government will inherit a health service that has run out of money and is operating at the very edge of its limits. While the NHS has performed well in the face of huge challenges, there is now a real risk that patient care will deteriorate as service and financial pressures become overwhelming.

“More optimistically, with the economy recovering, there could soon be an opportunity to think about public spending choices and the kind of health services we want in a fresh light. Future debate about the NHS should focus not on how parsimonious we need to be but on how generous we want to be.”

Mark Porter, the BMA’s chair of council, said, “Staff have done as much as they can to protect and improve patient care but, as this report lays bare, after years of underfunding the cracks are beginning to show. The NHS is the best healthcare system in the world and the most efficient—there is no fat left to cut without patient care being hit.” Rob Webster, chief executive of the NHS Confederation, said, “An open public debate must happen now on NHS finances and service change. We’ve been calling for it for a long time, and politicians from all parties cannot duck it any more: the public simply won’t allow them.” 1 2

Appleby J, Baird B, Thompson J, Jabbal J. The NHS under the coalition government. Part two: NHS performance. www.kingsfund.org.uk/coalition-NHS-performance. Kmietowicz Z. Coalition’s changes to NHS were damaging and distracting, says new review. BMJ 2015;350:h633.

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BMJ 2015;350:h1683 doi: 10.1136/bmj.h1683 (Published 26 March 2015)

Page 2 of 2

NEWS

Cite this as: BMJ 2015;350:h1683

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Patient care is at risk as NHS faces substantial deficit, says think tank.

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