State of the sector

Confidence that trusts have the capacity to meet demand for services over the next 12 months

• 78% of trust leaders were very worried (26%) or worried (52%) about whether their trusts have capacity to meet demand for services over the next 12 months. 14% were neither confident nor worried, 8% were confident, and 1% did not know. Fewer trust leaders are worried this year compared to last year, when this figure was 86% (39% were very worried and 47% were worried), however this year's proportion is higher than before the pandemic in 2019 (61%).
  
  

Quality of healthcare provided by your local area now and in the future

• A little over two fifths of trust leaders (41%) rated the current quality of healthcare provided by their local area as very high (1%) or high (40%). 49% rated it as average, 5% as low quality, and 4% did not know. This figure dropped from 48% last year, and is lower than before the pandemic, when nearly half (47%) of trust leaders rated the quality of healthcare as high or very high.
• Over a quarter of trust leaders (27%) predicted that the quality of healthcare provided by their local area in the coming year would be high. 57% said it would be average, 10% low quality, and 6% did not know.
• 3 in 10 trust leaders (30%) predicted that the quality of healthcare provided by their local area in the coming two years would be very high (1%) or high (29%). 43% rated it as average, 12% as low, and 11% did not know.

 

Confidence that trusts will have access to sufficient capital funding to meet requirements, over the next three years

• Under two thirds (63%) of trust leaders strongly disagreed (33%) or disagreed (30%) that their trust will have access to sufficient capital funding to transform and continue the journey to digital maturity. 16% neither agreed nor disagreed, whereas 19% agreed and 1% strongly agreed.
• When it came to investment in business critical ICT infrastructure or systems, three in five trust leaders (60%) strongly disagreed (34%) or disagreed (26%) that their trust will have access to sufficient capital funding, whereas 21% neither agreed nor disagreed, 17% agreed and 1% strongly agreed.
• Lastly, when asked about whether their trust will have access to sufficient capital funding to address the maintenance backlog (high or significant risk issues only), 7 in 10 leaders (70%) strongly disagreed (44%) or disagreed (26%). 11% neither agreed or disagreed, whereas 17% agreed and 1% strongly agreed.
  
  

Measures put in place to help trusts manage the current or anticipated level of risk

• To manage the risks around not having enough staff, respondents mentioned investing more in recruitment including using overseas recruitment, incentivised pay and conditions and investing in bank and agency staff. Respondents also mentioned having incentives to retain staff such as improving staff well-being, putting more focus into staff culture and staying true to trust values.
• To manage the risks around funding, respondents mentioned increased financial controls, establishing a financial strategy working group and developing a finance recovery plan.
• A few respondents highlighted the importance of creating plans to help their trust manage the current or anticipated level of operational risk. For example, respondents mentioned having a Urgent and Emergency Care (UEC) recovery plan to help with waiting lists and winter plans and to anticipate the winter pressures.
• Many respondents also highlighted that collaborative working in systems has helped their trust to manage current or anticipated risk. This includes cross-ICB system planning, a system financial recovery programme and improvement schemes.

 

How have trusts scaled back service provision or staffing levels to live within their 2023/24 financial envelopes?

 

• Inability to fund additional bed capacity: Trust leaders are concerned about the affordability of unfunded escalation capacity. While trusts initially absorbed the financial risk of additional surge capacity, current financial pressures mean they have had to revisit the feasibility of expanding bed numbers, and other service capacity, ahead of winter.
• Phased reduction of escalation beds: Some trusts have flagged they are working on a phased reduction of additional capacity. One trust said they have closed approximately 50 unfunded beds in 2023/24, which has led to a deterioration in their type 1 performance in A&E. Others noted they have reduced their elective capacity and scaled back service developments that require additional staff.
• Limiting off-framework spend and reducing temporary staffing expenditure: Trusts are adhering to the financial controls established by NHS England. They are attempting to live within national agency spending limits, and better utilise bank staff to limit off-framework expenditure.
• Limiting expansion in clinical workforce: Trusts noted that they have had to limit the expansion of the community and mental health workforce despite their original ambitions. Other trusts have reduced medical cover for new wards.
• Consolidating back-office and non-clinical role spending: Trusts are consolidating back-office spending in order to protect funding for substantive front line staff. For example, this includes time-limited vacancy freezes for non-clinical roles, corporate restructures, back-office headcount reductions.

Currently only non-clinical services have scaled back, however further options are now being considered given the current forecast. This may include closing unfunded beds.

   Acute trust, South West.

Whilst the trust has continued to prioritise quality and safety, all corporate recruitment has been paused which will inevitably start to have a deleterious impact on the delivery of trust services.

   Acute specialist trust, North West.

Confidence that sufficient investment is being made in social care

• When asked about direct investment by the system and its partners in social care, a large proportion (71%) were very worried (26%) or worried (45%) about sufficient investment being made. 14% were neither worried nor confident, 4% were confident, 1% were very confident, and 10% did not know.
• However, when thinking about direct investment by the trust in supporting social care, a smaller proportion (43%) were very worried (10%) or worried (33%), 34% were neither worried nor confident, 7% were confident, 1% were very confident and 14% did not know.
• Most (89%) leaders were very worried (51%) or worried (38%) about whether sufficient national investment is being made in social care via local government.

Even if investment levels were higher the workforce issues remain. Care remains an undervalued skill and remains underpaid (…),

   Acute trust, East of England

Social care is in a very difficult place and the demands being placed on them as providers are very difficult to manage and ‘spilling over’ to us as statutory providers.

   Combined Mental Health / Learning Disability and Community trust, North West