A new study
published today by The King's Fund uncovers the tough decisions
NHS leaders are making to balance their books and protect patient
care. Researchers from The King's Fund health and care charity
spoke in detail to NHS leaders in England to understand the
decisions being driven by tight finances.
In addition to initiatives to drive efficiency and boost
productivity, the researchers found examples of local NHS leaders
cutting services like patient transport, holding down workforce
costs by freezing recruitment and reducing agency staffing, and
reducing investments in public health services like health
visiting and school nurses.
The authors call for realism about the trade-offs needed to
deliver essential NHS reforms in the context of tight public
finances and pressure to rapidly improve existing services.
Despite sustained real terms increases in the NHS budget, rising
demand for care and treatment driven by a sicker population have
left the health service struggling to live within its means. An
additional £22.6 billion NHS funding was announced in the 2024
Autumn Budget, yet the first iteration of financial plans for
2025/26 showed ‘a very significant
financial deficit' of £6.6 billion for NHS systems.
Meanwhile, the maintenance backlog to return NHS buildings and
equipment to an acceptable standard has been growing,
and currently stands at £13.8 billion.
The financial strains are complex, with some newer pressures,
like mitigating the impact of recent industrial action and
cyber-security risks, while others, like inflation, have been
longstanding. Now, leaders interviewed for this research warn
that some services are becoming financially unsustainable to
run.
With the NHS unlikely to get a major funding boost in the current
economic context, the report authors conclude that it will not be
possible for the health service to do everything that might be
asked or expected of it. The researchers argue that the
government and public will need to be realistic about the extent
to which current services can be improved in the short term while
also delivering fundamental reforms that would make for a
sustainable health service in the long term.
The authors also recommend NHS Trusts are set multi-year budgets
instead of the current annual approach. They argue that greater
funding certainty would help NHS leaders mitigate the risk that
in-year financial pressures adversely impact patient care.
Commenting on the findings, Siva Anandaciva, Director of
Policy at The King's Fund, said:
“It is absolutely right that the NHS is asked to be as
productive as possible and deliver value-for-money for patients
and taxpayers. By adopting new technology and improving existing
processes, health services around the globe are trying to improve
patient care and reduce pressures on public finances. But it is
also right that the health service is set realistic goals.
“Our research shows how challenging it is to keep running
high-quality services when budgets can't keep pace with demand.
It underlines just how difficult it will be to deliver
much-needed reforms while also expecting rapid improvements to
current services.
“NHS budgets have risen in real terms while some other public
services have seen funding cuts, but financial pressures
persist and they are having an impact on the quality of
care. Patients are experiencing long waits for care, are treated
in dilapidated buildings, and report worsening experience. The
impact is shown in the findings of the latest British Social
Attitudes survey which found that public satisfaction with the
NHS is at its lowest level since the survey began over 40 years
ago.
“The government's ambition to deliver major reform for the NHS
has never been more needed. To achieve that goal, ministers have
previously said they will need to make tough trade-offs. Now is
the time for realism about what can be achieved in the current
financial envelope, and clarity about how the NHS should
prioritise funding to deliver reforms versus maintaining the
services people are currently using every day.”
ENDS.
Notes to editors
- This research was a BBC exclusive,
with a programme on BBC Radio 4 on 1:30pm Sunday 18 May which
explores the research findings
