Mental health
There is a welcome commitment at the very top of government and among NHS system leaders to address long-standing inequalities in care for people with mental health needs. The accompanying increased funding is starting to enable better service provision in the targeted areas. But there is an increasing divergence between this new commitment and the deteriorating state of core mental health services. Rapidly rising demand is overwhelming those core services; extra funding is not reaching the NHS trust frontline; trusts are facing major workforce shortages; and mental health does not feature strongly enough in sustainability and transformation partnership (STP) plans and thinking.
Access and quality
Trusts are experiencing record demand, and many are running at capacity levels that are starting to risk patient safety. As we saw last winter, local services are becoming less resilient and some are increasingly unable to cope with surges in demand. Despite the best efforts of staff last year, for the first time, the NHS missed all four key ambulance, A&E, elective surgery and cancer 62-day targets. The evidence on quality is mixed: while patient satisfaction remains high and some trusts are improving, the NHS faces serious challenges in maintaining standards of care.
Finances
Thanks to a clear plan, financial support and a lot of hard work at the frontline, NHS trusts made significant progress in reducing the provider sector deficit in 2016/17. But the underlying financial position is unsustainable and trusts remain heavily dependent on one-off and non-recurrent savings. The NHS still needs a credible medium-term, plan to match what is required of the NHS to the funding available.
Workforce
Workforce challenges are now the top concern for trusts. There are not enough staff to meet the rising demand for services. Staff shortages are increasing as Brexit uncertainties persist and more staff leave due to seven years of pay restraint and their jobs becoming more pressured, stressful and difficult. The NHS needs a realistic, long-term workforce strategy that ensures the NHS has the right number of people, with the right skills, in the right place, within the funding available. This needs to include a clear plan to end pay restraint.
Transformation
Trusts recognise the need to transform to deliver the vision set out in the NHS Five year forward view. While we need to be realistic about how quickly such a wide-ranging and complex set of changes will take to deliver, the required transformation is taking too long. Trusts need more leadership capacity, more support and less regulation from NHS arm's length bodies, appropriate investment and clarity on the future of STPs.