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HEALTHCARE DELIVERY


works for everyone, and they now need to match this with action.” Anita Charlesworth, director of research and economics at the Health Foundation, said: “On too many occasions over the last few years the approach to funding for the NHS and care system has been to rob Peter to pay Paul: social care cut to protect the NHS, budgets to train new doctors and nurses reduced to fund care now, capital budgets raided to meet day-to-day costs. It is absolutely clear that this is not sustainable and has undermined the drive to improve efficiency. While the pressures on the health service are very real, the case to prioritise social care funding is compelling.” John Appleby, director of research and chief economist at the Nuffield Trust, said: “After years of austerity, by the middle of this parliament we will start to see the amount of NHS money per person actually fall in real terms. In this context, providing high quality healthcare that meets the needs of a growing and ageing population will put the NHS under enormous pressure. We are likely to see this expressed through an explosion in waiting lists, patients being denied new drugs, or hospitals going even further into the red. These would neither be desirable for patients nor for the Government and action is needed.”


References


1 CQC, State of Care, October 2016, http://www.cqc.org.uk/content/state-of-care


2 Health Select Committee, Winter pressure in accident and emergency departments, 3 November 2016. www.parliament.uk


3 Press release, Nuffield Trust, ‘Health charities warn of £1.9bn social care funding gap’, November 2016, accessed at: http://www.nuffieldtrust.org.uk/ media-centre/press-releases/health-charities- warn-%C2%A319bn-social-care-funding-gap


NHS financial performance worsens CSJ


The financial performance of NHS bodies worsened considerably in 2015-16 and this trend is not sustainable, according to the National Audit Office (NAO). In 2015-16, NHS commissioners, NHS Trusts and NHS Foundation Trusts reported a combined deficit of £1.85 billion, a greater than three-fold increase in the deficit position of £574 million reported in 2014-15. Provider Trusts’ overall deficit grew by 185% to £2.45 billion, up from £859 million in 2014-15, against total income of £75.97 billion. In addition, two-thirds of NHS Trusts (65%) and NHS Foundation Trusts (66%) reported deficits in 2015-16, up from 44% of NHS Trusts and 51% of NHS Foundation Trusts in the previous financial year. The number of clinical commissioning groups reporting cumulative deficits was 32 in 2015-16, up from 19 in both 2014-15 and 2013-14. There are indications that financial stress is having an impact on access to services and quality of care. Trusts’ performance against important NHS access targets has worsened, and the NAO found an association between Trusts’ financial performance and their overall Care Quality Commission rating, with those that achieved lower quality ratings also reporting poorer average financial performance. The 14 Trusts rated ‘inadequate’ had a net deficit equal to 10.4% of their total income in 2015-16. Trusts’ spending on agency and contract staff has slowed but is still significant at £3.7 billion in 2015-16, compared with


£3.3 billion in 2014-15. According to the NAO, it may take years to resolve workforce issues that affect the successful recruitment and retention of permanent staff, and reduce the need for agency staff. Together, the Department, NHS England and NHS Improvement estimate that they can make £6.7 billion of efficiencies by capping public sector pay, renegotiating contracts implementing income generating activities, and reducing running costs. They estimate that Trusts and commissioners can make a further £14.9 billion by moderating the growth in demand for healthcare services and achieving 2% productivity and efficiency improvements. “With more than two-thirds of Trusts in deficit in 2015-16 and an increasing number of clinical commissioning groups unable to keep their spending within budget, we repeat our view that financial problems are endemic and this is not sustainable. It is fair to say aggressive efficiency targets have helped to swell the ranks of Trusts in deficit over the last few years. The Department, NHS England and NHS Improvement have put considerable effort and funding toward stabilising the system, but have a way to go to demonstrate that they have balanced resources and achieved stability as a result of this effort. Therefore, value for money from these collective actions has not yet been demonstrated,” said Amyas Morse, head of the National Audit Office.


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MARCH 2017


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