Quarterly monitoring report by the King's Fund shows continued pressure

policy digest

28 / 03 / 2017

Quarterly monitoring report
King’s Fund, March 2017

The quarterly monitoring report by the Kings Fund, published in March 2017, surveyed trust finance directors (31 per cent response rate) and CCG finance leads (27 per cent response rate). The survey was carried out in late January 2017. 

NHS providers forecast a full year net provider deficit of £873 million for 2016/17. NHS England reported that CCGs are aiming to reduce the £437.2 million overspend to £370.4 million by the end of the year. This will allow NHS England to underspend its own budget and retain ‘up-to’ £800 million of its reserve (all commissioner budgets together). 

Key points regarding NHS performance from the report:

  • Main concerns highlighted by the trusts surveyed included delayed transfer of care, staff morale and high bed occupancy rates. For CCGs they included the four hour A&E waiting time, the 18-week referral-to-treatment, delayed transfers of care and the cancer treatment waiting times. 
  • Despite pre-emptive measures taken by 70 per cent of trusts (increasing the number of staff), 50 per cent suspended some elective care and paid higher rates to agency staff. Bed occupancy rose to a record high of 90.5 per cent for quarter 3, a 1.4 per cent increase compared to quarter 3 in 2015/16. 
  • Eighty per cent of those surveyed suggested that the rising number of patients with complex conditions or more acute illness was the cause of difficulties in A&E, above staff shortages or access to GPs. 
  • Three out of four directors surveyed are concerned that they will not rescue the A&E and 18-week referral-to-treatment standards by April. 

The main points on financial prospects for 2016/17 are: 

  • Quarter 3 results show that trusts now forecast a net deficit of £873 million. 
  • It is highly unlikely that surplus will be achieved in Q4 as 31 per cent of those surveyed suggested they will miss their control total and another 17 per cent suggested they are fairly or very concerned that they may ultimately fail their control total. CCGs are also very unlikely to be able to improve their financial performance in Q4. 
  • This has increased the risk that the department will break its constitutional spending limits. 

Looking beyond 2016/17:

  • Fifty-three per cent of trusts and 63 per cent of CCGs are fairly or very pessimistic about reaching financial balance in 2017/18.
  • Seventy-four per cent of trusts and 86 per cent of CCGs surveyed have stated there is a high or very high risk of failure to achieve the efficiency gains set in NHS Five year forward view. 
  • From the surveyed finance directors, 29 per cent stated they plan to reduce permanent clinical headcount and 74 per cent plan to reduce the number of agency staff they use. According to the report it will be hard to see any reductions in the numbers of clinical staffing with the current high levels of bed occupancy and increasing demand.  
  • There is an increased risk that the NHS may miss both finance and performance standards. Although the STP plans may provide some relief, very few of those surveyed think it will be quick enough for any optimism in the near future. 

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