The King’s Fund reflects on the performance of the NHS, finding that the service is facing a broadly challenging environment

policy digest

29 / 01 / 2019

How is the NHS performing? December 2018 Quarterly Monitoring Report

King’s Fund, December 2018


The King’s Fund has regularly published its Quarterly Monitoring Report since April 2011 as part of the organisation’s work to “track analyse and comment on the changes and challenges the health and care system is facing”.

The December 2018 issue reports on how well the NHS performed throughout the final quarter of 2018 and considers the possible future impact of the recently announced increase in funding for the NHS.

In the December QMT, finance directors at the King’s Fund break down their assessment of the NHS’s effectiveness into the three areas of “Finance”, “Performance”, and “Mental Health”.

The King’s Fund’s finance directors claim that “red is the new black” within the NHS, as they identify the significant budgetary struggles of NHS providers and Clinical Commissioning Groups. The QMT’s research finds that 48 percent of NHS trusts are forecasting to end the year in deficit and 11 of the 195 CCGs are expecting to overspend their allotted budgets.

Research from the King’s Fund’s own survey of 84 NHS trust finance directors and 43 CCG finance presented worrying findings

47 per cent of CCGs responding to this survey reported that they were expecting to delay or cancel planned spending to remain within their budgets this year. Many CCG finance leads report that the financial situation has necessitated: longer waiting lists for surgery; halting funding towards treatments with limited clinical effectiveness; and increasing the use of eligibility criteria to determine access to care.

As for NHS provider trusts, the provider sector overall is forecasting a deficit of £558 million, with some trusts individually responsible for deficits of over £100 million.

The QMR rounds off its evaluation of the NHS’s finances by pointing out that despite deficits at the local level, NHS England, by contrast, is forecast to underspend its overall commissioning budget by £450 million.

In the section on NHS “Performance”, the QMR focuses on various national targets on the failure of the NHS to reach multiple targets on waiting times and clinical outcomes.

This section reports that in November 2018, the NHS broke the record for the highest number of emergency admissions to hospital in a single month, due to the 6.3 percent increase in emergency activity compared to November 2017. This section also reports that the NHS fell just short of targets concerning: A&E waiting times; elective surgery waiting lists; and the number of people waiting more than 52 weeks for consultant-led treatment.

A key paragraph in the December QMR asserts,

The proposed average annual funding increases of 3.4 percent a year for the NHS are welcome but hardly a bonanza. The calls on the funding are legion. The NHS remains in the grip of a workforce crisis that is unlikely to end any time soon. And against this backdrop the demands on services from a growing and ageing population continue to push staff and services to their limit.

With regards to mental health, the QMR describes the financial performance of mental health providers to be in “rude health”. The QMR notes that while NHS mental health trusts are expecting to end the year £133 million in surplus (with only 19 percent of these trusts in deficit), it is also the case that mental health services are being asked to expand access to their services despite incommensurate increases in funding. 56 percent of finance directors from trusts providing mental health services were concerned about making their efficiency savings in the 2018/19 financial year.

As for performance targets, the report notes that while performance against two particular national targets (on timely access to psychological therapies and early intervention for people experiencing psychosis) remains strong, these targets to not reflect mental health trusts’ overall performance given the breadth of services these trusts provide.

The QMR reports from its survey of finance directors that mental health trusts’ quality of care has deteriorated over the past two years, and points to the fact that their survey’s finding correlates with research findings from the CQC’s 2018 Community Mental Health Survey and a report by Rethink Mental Illness.

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