Analysis

Lack of funding leaves NHS with ‘impossible’ task

The prime minister’s promise of a long-term funding settlement will not solve the crisis those working on the front line are experiencing now

The prime minister’s promise of a long-term funding settlement will not solve the crisis for those working on the front line


Picture: John Houlihan

In a headline-grabbing appearance before MPs on the House of Common’s liaison committee, prime minister Theresa May promised a long-term funding settlement for the NHS in the near future.

This was widely interpreted as an indication there will be a ten-year plan set out later this year. But for managers and leaders on the front line the here and now is more pressing.

As the new financial year gets under way, NHS Providers warns that the task for 2018-19 looks impossible.

Unrealistic targets

The organisation has published a report setting out how the health service is too short of staff, beds and money to achieve everything it is being asked to do.

On staffing, it points to figures from NHS Improvement showing that one in 12 jobs, including more than 35,000 nursing posts, are vacant.

On bed capacity, it says hospitals are between 10%-15% below what they need.

£1.6 billion 

Extra money announced for 2018-19 

(Department of Health and Social Care)

The consequences of this will be felt in planned and emergency work, NHS Providers warns, with waiting lists rising and limited progress in improving performance in emergency care against the four-hour operational standard.

NHS Providers also states that the requirements being asked of it financially are unrealistic. The target for the provider sector is to break even, despite an estimated deficit of £930 million having been racked up last year, according to interim figures.

Indeed, in a sign of how bad things are, a survey of leaders at NHS trusts has found that just over half will be hitting their individual financial targets.

'No immediate difference'

NHS Providers chief executive Chris Hopson says: ‘The NHS is a can-do organisation. It has shown great resilience in treating more patients than ever before while working to protect standards of care. 

‘It has also improved productivity at nine times the rate of the wider economy and delivered greater efficiency savings than other western healthcare systems.

10%-15% 

Shortfall in the number of beds 

(NHS Providers)

‘But our analysis shows the levels of performance expected and the savings demanded for next year are beyond reach. While we strongly welcome the prime minister’s commitment to increase long-term funding, it makes no immediate difference to the tough task facing trusts now.’

So, what does this mean for nurse leaders in the year ahead? NHS Providers says there is a challenge for management as it is clear that nurses, and other staff groups for that matter, are experiencing a worrying decline in engagement and morale.

Increasingly difficult

Workload pressures are taking their toll with the latest staff survey showing that more than half work additional unpaid hours and one third feel unwell due to work-related stress.

RCN emergency care association chair Janet Youd says this is unsurprising for those in the emergency care system, given what is being asked of the service.

She says that demands, in terms of improving performance in emergency departments, are simply ‘not realistic’ and that staff are constantly under pressure to ‘turn around patients quickly’ and get them discharged. 

'It is often nurses who have to manage and explain delays to patients'

Mark Foulkes

Ms Youd says: ‘It is going to be a difficult year and will require all parts of the health and care sectors to work closely.’

In cancer care too, the relentless slog is having an impact, says UK Oncology Nursing Society board member Mark Foulkes. He says that, while it has been publicised less than the pressures on emergency care providers, the 62-day cancer target is ‘becoming increasingly difficult’ to achieve.

Mr Foulkes says: ‘There is a real bottleneck in the patient pathway for diagnostics and it is often nurses who have to manage and explain these delays to patients.’

He says staffing shortages have hit chemotherapy nursing particularly badly.

‘You cannot easily fill these positions with agency staff, and that is why we are seeing news items such as the leaked Oxford [Churchill Hospital] memo [which raised the prospect of delays starting chemotherapy and fewer cycles being offered]. A lot of places are facing similar issues,’ he says.

He adds that cancer nursing teams ‘are getting stretched by undertaking roles previously provided by other professional colleagues and dragged into other tasks, even filling staffing gaps on wards’. 

Battle conditions

The government maintains that the goals set out for this year are realistic.

A Department of Health and Social Care (DH) spokesperson has acknowledged there is pressure, saying ‘staff have never worked harder’.

But, the DH says, the £2.8 billion of extra money announced in the autumn budget, £1.6 billion of which was for this year, and the pay award agreed with unions in March will make a difference.

'Managers have little wiggle room to help their staff'

Sally Bassett

The pay deal is still to be ratified by front-line staff, with the results of the consultation by unions expected in the summer.

But even if it is agreed, says RCN nurses in management and leadership forum chair Sally Bassett, it will not be the ‘silver bullet’ the government is suggesting.

1 in 12 

Proportion of posts that are vacant 

(NHS Improvement)

She says: ‘The pay deal was hard won, deserved and can only help. But, when it comes to being a good employer, things like supervision, support, coaching and giving staff the time to recover are more important.

‘The problem for managers is that they have little wiggle room to help their staff with these things.’

As a result, she believes nurse leaders and managers face a difficult 12 months, wrestling with rotas, vacancies and trying to keep services afloat with over-worked staff.

‘The received wisdom is that the NHS has some of the brightest, most capable clinical, managerial and leadership talent anywhere in the world,' says Ms Bassett. ‘If they are saying it’s not possible then it’s not. It’s madness to expect otherwise.

‘As committed clinicians, managers and leaders, we’ll do our best to influence, juggle, motivate, make ends meet and support each other to keep coming to work each day. We do that so that we can do what we believe in, which is to serve our patients. But it feels like almost battle conditions.’

To-do list for 2018-19

  • Achieve an aggregate financial break-even position
  • Majority of trusts to hit the 95% four-hour emergency department operational standard by March 2019
  • Reduce delayed transfers of care to 4,000 a day; it stands at almost 5,000
  • No increase in hospital waiting lists for planned treatment
  • Halve the number of patients waiting more than 52 weeks for planned treatment
  • Achieve the 62-day cancer waiting time target
  • Continued progress on cancer strategy, including introduction of a new bowel screening test and starting to work towards the new 28-day diagnosis target
  • Work towards the 2020 target of reducing birth brain injuries, maternal and neonatal deaths and stillbirths by 20% from the 2010 baseline
  • Seven-day working standards rolled out to half the country
  • Integrated care systems and new models of care rolled out to one fifth of the country

Sources: Department of Health and Social Care, NHS England and NHS Improvement



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