QMR 24 | November 2017

Patient care deteriorating as NHS heads into winter on a knife edge

Performance against a number of key indicators is worse than at this time last year, and finances remain precarious despite an emergency funding injection.

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In this issue . . .

  • Performance against a number of key indicators has worsened


    of A&E patients were seen within four hours during September 2017, missing the standard of 95%.

    4.1 million

    patients were on the waiting list for elective treatment at the end of August 2017.


    increase in emergency admissions in 2017/18, compared to 2016/17.

  • The NHS is likely to miss targets for reducing delayed transfers of care, the next performance milestone for improving A&E performance, and financial targets for reducing deficits in the provider sector.

    Underfunding and increasing demand

    “Without additional funding for the NHS, waiting times for hospital treatment will get longer and the deterioration in patient care is set to continue. This should be a warning for the Chancellor as he prepares the Budget.”

    Siva Anandaciva, Chief Analyst

    We have not arrived at this situation because of a lack of effort or because of poor management within individual NHS organisations. As frontline staff try their best to improve quality of care and access for patients, it is increasingly apparent that we are setting them an unachievable task.


    fewer nurses and health visitors (full-time equivalents) employed in the NHS than in July last year, with concern around staff morale and pay restraint.

  • The impact of funding constraints in the wider health and care system may be even more dramatic than those facing NHS commissioners.

    “Social care cuts are frightening, and councils face nightmarish decisions. Health visiting and school nursing as we know it will no longer exist.”

    NHS trust finance director

    A precarious position as we head into winter


    of NHS trust finance directors think patient care in their area has got worse over the past year, as do 59% of clinical commissioning group finance leads.

    Once again, we wait to see if winter sends provider income and performance plans off track, and we start the long run-in to March wondering if CCGs can land their savings plans or if NHS England can find a large enough underspend to cover any remaining deficits.