NHS Improvement has published performance data for quarter 3 (2017/18). The data included NHS vacancy figures for the first time alongside financial data.

The report shows:

• that 5.6 million people visited A&E over the three month period, a quarter of a million more than the same period last year. Performance against the four-hour A&E standard was 89.5% at the end of December;
• the provider sector reported a year-to-date deficit of £1,281m, this is £365m above the target for this point in the year. Providers are now predicting a end of year deficit of £931m;
• there are 100,000 whole time equivalent vacancies across the NHS.

Commenting on today’s NHS quarter 3 performance and financial results, Saffron Cordery, NHS Providers director of policy and strategy and deputy chief executive said:

“These figures show how the NHS has been pushed to the limit. Despite working at full stretch with around 100,000 vacancies and a real risk of staff burnout, and despite treating six per cent more emergency patients year on year in December, trusts can not close the gap between what they are being asked to deliver and the funding available.

“The figures confirm, once again, three key problems the whole NHS provider sector is facing - increases in demand for treatment continue to significantly outstrip increases in NHS funding; trust savings targets remain too ambitious; and there are serious ongoing workforce shortages.

The NHS has shown extraordinary resilience in sustaining performance in the midst of an unprecedented financial squeeze.

“There is an increasing feeling amongst frontline trust leaders of ‘we cannot carry on like this’. The NHS has shown extraordinary resilience in sustaining performance in the midst of an unprecedented financial squeeze. We have managed to keep the show on the road. But the warning signs are now clear and in plain sight. The time to act is now.

Demand increasing much faster than funding

“Today’s figures show that demand is rising much faster than funding. Trusts are not only having to treat larger numbers of patients but more of those patients have serious, complex, illnesses. As a result, trusts have faced a financial triple whammy – less than full funding for many emergency admissions, higher costs than planned to meet the extra demand, and lost income from cancelled planned operations.

“We should therefore commend the way trusts have held performance against the four hour A&E target but, equally, shouldn’t be surprised that, despite best efforts, their finances have taken a significant hit. Demand is also outstripping funding in the mental health, community service and ambulance sectors as well.  As the figures clearly show, these issues are affecting all types of trusts in different ways.

Overambitious savings targets

“Today’s figures show that NHS trusts continue to generate significant productivity gains – 1.8 per cent so far this year, which is nine times more than the UK whole economy and nearly twice the NHS’ historical average. In the first nine months of the year NHS trusts have realised more than £2.1 billion of savings – which is 3.3 per cent of total spend and around £100 million more than last year. But plans required them to save four per cent. If trusts are asked to deliver the impossible, it’s not surprising there’s slippage against plan during the year.

If trusts are asked to deliver the impossible, it’s not surprising there’s slippage against plan during the year.

Workforce shortages

“Today’s consolidated vacancy figures shine a spotlight on the size of workforce shortage NHS trusts are having to cope with. Trust leaders tell us that having one in eleven posts vacant makes it much more difficult to provide high quality care. It also means the continued progress trusts are making in reducing the amount of money they are spending on agency staff looks even more impressive.”

What next

Trust leaders have said they need five things, all of which NHS Providers has highlighted over the last few months:

• a review of Winter performance, with full trust involvement, that honestly assesses the size of the current gap in NHS staff and treatment capacity and seeks to fill that gap before next Winter;
• ensuring that the 2018/19 NHS financial plan reflects the true end of year position, given that this position will clearly now be significantly worse than planned with results from a difficult fourth quarter still to come;
• acknowledgement that, as set out in the recent Kirkup report, overambitious cost improvement targets of above four per cent harm the quality of care and trusts therefore need a realistic and sensible dialogue with NHS Improvement on what they can deliver in their 2018/19 control totals;
• follow through on the recent workforce strategy, with a particular focus on what immediate and short term support trusts need to address current staffing shortages;
• a clear statement of intent and a plan to address – without delay - the long term funding of health and social care.