Key points
- NHS trusts must be set a deliverable task with realistic expectations about demand, performance and financial improvements that can be made given the capacity available.
- In 2017/18 we published Mission impossible? predicting that the task set for providers was impossible to deliver. Over the last year, trusts have treated more emergency patients than ever before. They are delivering 1.8% efficiency gains, nine times the UK whole economy average. They are on course to realise more than £3bn in savings.
- Sadly, this will not be enough. The forecast provider sector deficit is at least £930m, over £750m more than planned, taking account of the Budget’s extra winter funding. Far from recovering, A&E performance has dropped to the worst levels ever recorded, and waits for routine surgery have significantly increased. There are similar pressures in the community, mental health and ambulance sectors.
- This report analyses the size of the provider task for 2018/19, using survey data from trust leaders and an analysis of current data. This year the task is just as tough, if not tougher.
- We conclude that, next year, patients’ experience of care is likely to continue to fall below the standards trusts and the NHS constitution consider acceptable. Based on projected levels of demand and performance, around 3.6 million emergency patients will not be treated within four hours and 560,000 patients needing elective care will not be seen within 18 weeks. The size of the task will add a significant extra burden onto an already hard pressed workforce.
- The report shows that the task set for trusts for 2018/19 once again looks impossible.
- On A&E performance, our survey shows only 5% of trusts are confident their area can meet the four-hour A&E target next year. The report shows that the number of trusts needing to improve and the scale of improvement needed to hit the required performance target is extremely ambitious.
- On elective surgery waiting lists, our survey shows that 55% of trusts are worried they will not be able to contain the size of their list next year. Given that elective volumes have fallen this year due to winter pressures, workforce and capacity constraints, the assumed increases in outpatient appointments (5%) and elective admissions (3.5%) are too optimistic.
- On finances, trusts tell us they would need to deliver more than £4bn worth of savings next year – 20% higher than this year – to deliver the required collective breakeven position. Only 54% indicated they would sign up to their allocated financial target (control total) and, of these, only 35% believed they could meet this target.
- Looking ahead, we need to reset the NHS national planning framework from 2019/2020 onwards. NHS frontline organisations must be a key part of the national level planning process alongside national bodies. National frameworks must be based on realistic projections and assumptions about demand and speed of change. Funding must match the task in hand recognising that, on current resources, we can no longer deliver or recover the NHS constitutional standards. A fully funded, effective, short- and longer-term plan is also needed to address current workforce shortages, which are significantly affecting trusts’ capacity to deliver.