News / Warnings issued over recovery and finances

06 March 2023 Steve Brown

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The Institute for Government and accountancy body CIPFA’s latest performance tracker said that ‘by any reasonable measure, hospitals are in crisis’. It highlighted record levels of people waiting longer than four hours in accident and emergency departments last year and a waiting list of more than seven million.Meg.Hillier L

It said the crisis had been driven by ‘more than a decade of relative under-investment’, which had led to ‘too few, burnt-out staff working with too little, faulty or out-of-date equipment in buildings that are often unsuitable for a modern health service’. It rejected arguments that the critical state of the service was due to the pandemic or striking staff, although these had exacerbated underlying problems.

The report also singled out difficulties with discharging patients as a contributor to high bed occupancy and capacity issues. Some funding had been provided to address this, but its ‘short term and haphazard nature makes it very difficult for the service to effectively plan and spend the money’.

The tracker looked across nine public services, also including social care, schools, police and prisons. It concluded: ‘Performance in some services has got substantially worse over the last three years and reversing that will require considerable effort.

‘As such, performance in these services is unlikely to return to pre-pandemic levels before the next election.’

The Institute for Fiscal Studies came to a similar gloomy conclusion that waiting lists were most likely going to ‘flatline’ this year. The research body’s analysis suggested that the government target for a 30% increase in elective activity by 2024/25, compared with pre-pandemic levels, would require ‘unprecedented double-digit growth’ in treatment volumes over the next two years.

The 10.3% annual growth requirement compared with average annual growth of 2.9% in the five years prior to the pandemic. ‘That would be more than three times the growth rate in the five years prior to Covid, and looks increasingly unreachable,’ said Max Warner, IFS research economist and author of the report published to coincide with the one-year anniversary of the government’s backlog recovery plan. ‘As a result, it is likely that the waiting list will flatline rather than fall over the coming year.’

At the end of February, the Commons Public Accounts Committee also gave a negative assessment of progress to reduce waiting lists. It said the three-year recovery programme was already falling short.

Cancer waiting times were at their worst recorded level and the NHS would not be able to meet its first 62-day cancer recovery target.

Dame Meg Hillier (pictured), the committee’s chair, said the NHS was in ‘full blown crisis’, with ‘all the metrics going in the wrong direction’.

‘We do not expect the NHS to achieve the significant and ambitious targets of its current recovery plan, but it must now step up and show leadership for a realistic way forward, with targets that have patients seeing the real improvements,’ she said.

The concerns are not confined to England. Audit Scotland has also called for full transparency on NHS recovery. The Scottish government’s recovery plan was a ‘high-level, top-down document’ that did not contain the detailed actions that would allow progress to be accurately measured. And the financial watchdog said that growing financial pressures could limit investment in recovery and reform.

Outside Scotland, strikes over pay have exacerbated recovery efforts. The government in England has now offered to reopen discussions with all unions after previously rejecting claims for a higher pay increase in 2022/23. As Healthcare Finance went to press, there was no news of any revised pay offers.

Speaking ahead of the March Budget, the NHS Confederation’s chief executive, Matthew Taylor, said the NHS was going through ‘an extremely tough period’.

‘It is in the government’s hands to set out details of its long overdue workforce plan,
to reach level ground with the trade unions, and ensure that its spring statement delivers – for the NHS and the communities it serves,’ he added.Lee.Bond L

The HFMA also issued a statement in February on the current challenges facing the health service, which included ‘significant financial pressures’. Integrated care systems are now expected to end the year with a £500m deficit, according to a paper at the NHS England February board meeting. And the HFMA said the current challenges were set to continue into the new financial year.

The association called for more flexibility for systems to deliver local solutions, with as much money as possible allocated to systems without being tied to specific uses. ‘If we are clear on “what” the national priorities are, we need to allow local systems to develop the “how”,’ it said.

HFMA president Lee Bond  (pictured) said that NHS systems would need to realise significant levels of cash-releasing efficiencies to balance plans in 2023/24.

‘That would be hard enough on its own, but we need to do it while wrestling with major workforce challenges and creating headroom to transform services and pathways,’ he said.