An NHS in crisis – King’s fund report

Missed targets in calmer month indicate ‘impossible task’ facing NHS

The NHS faces an “impossible task” in trying to deliver services within its funding constraints, the chief executive of the King’s Fund said as the latest monthly figures show the service continues to miss key performance targets.

In August 2016, A&E attendances reached 1.93 million, 3.6% more than the same time last year. Of these patients, 91% were admitted, transferred or discharged within four hours. This is a small increase from 90.3% the previous month, but falls below the 95% target.

Chris Ham, chief executive of the think tank, said: “The fact that the NHS failed to meet so many performance of its targets during August, a month when pressures usually ease, underlines once again the impossible task of continuing to meet rising demand for services and maintain standards of care within current funding constraints.

“We have moved from an era where performance dipped in the winter to key targets being routinely missed all year round.”

For ambulance calls, 70% of Red 1 calls were answered within eight minutes, marking 15 months in a row since the 75% standard was met. The target for Red 2 calls has not been met in 32 months.

For Category A calls, for which 95% of are meant to be met within 19 minutes, 91.5% were responded to, marking 15 months since the target has been met.

Delayed transfers of care continue to reach record levels. There were 188,340 delayed days and 6,448 patients delayed at midnight on the last Thursday in the month, both the highest since the measures were introduced in August 2010.

Nigel Edwards, chief executive of the Nuffield Trust, said that the health service should “look at the underlying causes” of these problems, such as difficulties managing bed capacity, on which the trust published a report this week.

The target for referring patients to a consultant after diagnostic care has also not been met since November 2013, with 1.7% of patients waiting six weeks or longer against a 1% target.

Furthermore, 90.9% of patients on the waiting list for consultant-led care had been waiting for 12 weeks or long against a 92% target.

The 85% standard for 62 day cancer waiting times was not met, with just 82.8% of patients beginning a first definitive treatment within 62 days from an urgent GP referral for suspected cancer.

NHS England and NHS Improvement have said that national performance measures have gone unmet for so long that they should be replaced by targets for individual trusts.

Sir Amyas Morse, the head of the National Audit Office, who appeared before the Health Select Committee this month, indicated that he supported the idea.

“If you’re trying to run something effectively, you want a few indicators that you look at closely,” he said. “Any more and it’s impossible. It becomes an industry.”

Also speaking to the Health Select Committee this month, Chris Hopson, the chief executive of NHS Providers, argued that providers can no longer continue “squaring the circle” of meeting increased demand with decreasing funding.

Matthew Swindells, NHS England’s national director for operations and communication, said that the figures, and the CQC’s new report into the state of health and social care, showed that reforms to care delivery such as the new STPs are “essential”.