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NHS in England ‘buckling’ under spending controls, think tank warns

The NHS in England is ‘buckling’, a think tank has warned, with levels of funding failing to meet soaring demand. 

The NHS in England is ‘buckling’, a think tank has warned, with levels of funding failing to meet soaring demand 


Emergency department attendances have increased. Picture: Neil O'Connor

The King’s Fund said the number of admissions to hospital were rising steeply and were outstripping increases in the health service budget. Since 2003-4, hospital admissions have increased 3.6% per year. Emergency department attendances, referrals to outpatient services and diagnostic tests have also increased, it added.

But since 2010, this increased activity has coincided with a prolonged funding squeeze, a new report by the think tank states.

Between 2010-11 and 2014-15, funding increases slowed significantly, averaging 1.2% each year, compared with average increases of 4.8% a year between 2003-04 and 2010-11, the authors said.

Challenges ahead 

As a result of this mismatch between funding and activity, plans for the health service in the coming years could be jeopardised, the report warns.

The NHS Five Year Forward View sets out a plan for meeting the projected gap between funding and demand. But the King’s Fund report said: ‘Failure to moderate the rise in demand for hospital care highlights the challenges in delivering the Forward View.’

It also warned that the squeeze on spending is set to tighten further over the coming years, with 1.1% growth in 2017-18, no growth in real terms funding in 2018-19 and only 0.4% in 2019-20.

‘King's Fund chief executive Chris Ham said: ‘Our analysis provides more evidence that the health system is buckling under the strain of trying to meet rising demand, and maintaining standards of care within constrained resources.

Gap to grow 

‘With the gap between funding and hospital activity set to grow over the next few years, the NHS needs to do everything it can to moderate demand for hospital care.

‘This means increasing investment in community services to provide more care closer to people’s homes and focusing on prevention to reduce the need for treatment in the first place.’

RCN professional lead for primary, community and Integrated care Kathryn Yates said patients were currently ‘trapped in a revolving door’ between acute and community care, and that boosting numbers of community nurses would reduce avoidable hospital admissions and financial pressures.

‘Sadly with many of those admitted being older people, being in hospital can mean a loss of independence, which they may struggle to get back,’ she said.

Hospitals ‘overwhelmed’

‘Many people are seeing their condition decline to such a point that they do have to be admitted, because there wasn’t the nursing workforce available in the community to manage common conditions at home. The hospitals then get overwhelmed and demand just keeps on rising.

‘This situation is unsustainable, and investment is needed into community services, which can keep people well at home, as well as hospital care for those who really need it.’

A Department of Health spokesperson said the government had invested £10 billion to transform services and reduce pressure on hospitals by ensuring rising demand was dealt with in the most appropriate place.

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