Unprecedented demand sees NHS providers overspend

A high level of demand on the service and 'a combination of other pressures' led to an overspend in the NHS provider sector in 2017-18, with the sector as a whole having a deficit of £960 million at the end of 2017-18.

NHS Improvement, which released the data in its report, Quarterly performance of the NHS provider sector: quarter 4 2017/18, said this was ‘£464 m above what was anticipated by trusts at the start of the year and £30 m above what the sector anticipated at the end of December’. More than two thirds of providers (156 out of 234 Trusts), however, finished the year ‘at or better than planned financially’, while the provider sector deficit for the past financial year was £1.5 billion down on the 2015-16 figure of £2.45 bn.

The data, released on 31 May, also revealed the scale of recent pressures on Accident & Emergency Departments – with more than 5.87 m people attending A&E in January, February, and March this year – over 220,000 more than the same period last year. In the same three month-period, 1.1 m people attending A&E needed to be admitted for treatment – 70,000 more than the same period in 2017.

The NHSI said that ‘despite these enormous pressures, staff had worked extremely hard and cared for more people in A&E within the expected four hours than the year before’. A total of 277,150 more patients were seen within four hours at A&Es in 2017-18 than in 2016-17. However, performance against this standard slipped nationally – 88.4% of patients were seen within four hours in A&E, compared with 89.1% the year before, against a national target of 95%.

The report also revealed that ‘higher than planned levels of A&E activity meant hospitals had to cancel operations and hire temporary staff to cover vacancies and sickness’. At the end of March 2018, 2647 patients were waiting over a year for elective treatment, compared with 1513 in March 2017. Equally, ‘the rise in A&E activity at the expense of more profitable elective work’ led to ‘a significant shortfall’ of £505 m in elective and outpatient income against providers’ plans over the year.

At the end of the 2017-2018 financial year, the sector was faced with 92,694 staff vacancies –an 8% vacancy rate – including 35,794 nursing and 9,982 doctor vacancies.

NHSI said acute hospitals had been largely responsible for the sector’s deficit, mainly due to the increase in demand within A&E, with all other providers – including ambulance, mental health, and community healthcare Trusts – ‘collectively underspending’ during 2017-18. It said: “We are providing intensive support to 12 of the most financially challenged providers through our special measures programme, all of which are in the acute sector. In 2017/18 three Trusts joined the programme, and one Trust made significant financial improvements and left.” The number of NHS Trusts in deficit fell to 102 in 2017-18, down from 157 in 2015-16 and 105 the year before (2016-17).

NHSI cautioned that as NHS Trusts continued to plan for 2018-19, the sector would ‘need to rely less on one-off non-recurrent savings, such as by selling off hospital-owned land and buildings’. It said: “We are helping the sector do this by demonstrating how similar Trusts save money through procuring medicines, planning operations better, and utilising technology.”

NHSI CEO, Ian Dalton, said: “Hundreds of thousands more patients have been to A&Es 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. More than two-thirds of providers ended the year on budget or better than planned. Given rising demand and record vacancies, this is an important achievement."


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