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NHS overspend on staffing nudges £1.5 billion

Increased demand, sickness absence and high vacancy rates put pressure on staffing budgets

Increased demand, sickness absence and high vacancy rates put pressure on staffing budgets


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The RCN said patients are paying a heavy price for a lack of health service investment, as figures reveal massive financial deficits and staffing overspend in NHS England.

Staffing budgets were overspent by almost £1.5 billion and there was an additional £960 million deficit in 2017-18, largely seen across the acute sector, according to NHS Improvement.

There were 35,794 nursing vacancies and 9,982 doctor vacancies at the end of the financial year, of which 95% and 98% respectively were filled by temporary workers. This meant NHS providers spent £976 million more on temporary staff than had been planned.

Contrast between planned savings and reality

The report states: 'At the start of the year, providers ambitiously planned for a real-terms reduction in the pay bill – their single biggest area of expenditure – driven by a planned reduction in temporary staffing and workforce productivity measures. The overspend of £1,485 million (2.9%) in this area reflects the significant pressure caused by increased demand, vacancies and staff sickness absence.'

‘Whether the chancellor announces extra funding in time for the NHS anniversary this summer or waits until the autumn budget, it must be both substantial and genuinely new money’

Janet Davies, RCN

RCN chief executive Janet Davies said: 'These figures reveal both sides of the same coin – a cash-starved NHS forced to run without enough staff to treat people safely. For as long as hospitals remain £1 billion in the red, patients will pay a heavy price.

'The number of nurses missing from England’s NHS remains stubbornly high – hospitals cannot afford to recruit and inadequate numbers are being trained too.'

Ms Davies added that prime minister Theresa May and chancellor Philip Hammond could not allow what she described as 'a financial knife-edge' to continue.

'Whether the chancellor announces the extra funding in time for the NHS anniversary this summer or waits until the autumn budget, it must be both substantial and genuinely new money.

'It would not be enough just to wipe these deficits – health and care budgets must be boosted to reflect genuine demand. Anything less exposes patients to unacceptable risks and leaves care increasingly unsafe.'

A warning about care standards

The King's Fund think tank's chief analyst Siva Anandaciva agreed the overspending was 'another clear warning' that the NHS can no longer deliver the standard of care expected of it within the current funding settlement.

Mr Anandaciva said: 'The cost of the pressures on frontline services is not just financial but is seen in patients having their operations cancelled or facing longer waits for urgent and planned care.

‘The fact that staffing budgets were overspent by nearly £1.5 billion during a year when pay was held down and spending on agency staff was cut, underlines the huge pressures on overstretched staff who are delivering more care than ever before despite staff vacancies now reaching 100,000.’

The system is fundamentally broken

‘It is now an open secret that the system for managing NHS finances is fundamentally broken. Many NHS organisations are being set annual financial targets they have no hope of achieving, while providers of community, mental health and ambulance services are effectively underwriting substantial overspends in acute hospitals.'

NHS Improvement chief executive Ian Dalton pointed out that two-thirds of NHS providers had ended the year on budget or better than planned. 

'Hundreds of thousands more patients have been to A&E this year, but the NHS did not buckle under the pressure.

'Despite epic challenges, NHS staff up and down the country displayed incredible resilience and saw more patients than ever before within four hours.'


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