Five ways the government is failing NHS patients

In its damning report last month, the King’s Fund health think tank criticised the government’s NHS reforms as “damaging and distracting” for introducing even more markets to the NHS, for making it too complex to govern properly and lacking effective leadership.

The man behind these reforms, former health secretary Andrew Lansley, dismissed the report, saying that the King’s Fund should have focused on “whether patient care has been improved”.

We agree: quality of patient care is the most important measure of the success of government health policy. So let’s examine the evidence.

1. A & E waiting times – WORSE

The government has a set a target of no more than 5% of patients waiting over 4 hours in A & E for treatment, referral or discharge.Yet in the period October – December 2014, 414,000 patients waited more than 4 hours for – an increase of 47% on the previous quarter and the worst performance in over a decade. 42,000 patients waited on trolleys for more than 4 hours, a 134% increase on the previous year. And the number of Foundation Trust hospitals missing the 4 hour target has doubled to 66 since the summer of last year.

Below: % of patients waiting longer than 4 hours in A&E

2. Treatment waiting times – WORSE

The total number of patients on the waiting list for treatment has increased from around 2.5m in May 2010 to over 3.2m at the end of last year. Below: % of patients waiting longer than 18 weeks for treatment

The number of patients waiting longer than 18 weeks for treatment at Foundation Trusts has increased by 30 per cent in just over a year. That’s an increase from 87,000 in September 2013 to 113,000 in December 2014.

In fact, 12.5% of all patients have to wait more than 18 weeks– the highest level since the target was introduced in 2008

3. Cancer care waiting times – WORSE

The government has a target of 85% of patients receiving treatment within 62 days of referral from their GP.

Below: % of patients receiving cancer care within 62 days

The proportion of cancer patients receiving treatment within the 62 day target has fallen from 86.7 per cent in April 2010 to 83.5 per cent in October 2014, with the target missed now for three consecutive quarters. The number of Foundation Trusts missing the target has almost doubled to 31 since the summer of last year.

4. Delayed transfers of care – WORSE

Delayed transfers of care are where patients still occupy a hospital bed, but are ready to return home or transfer to another form of care. This clogs up the entire medical service, and means that patients might not get the kind of care they need.

Below: Average number of patients delayed in hospital per day each month

The number of delayed discharges from hospital increased sharply to more than 5,000 per day in November 2014, an increase of almost 20% since the previous January. This reflects a longer-term increase dating back to April 2011

5. Adult social care – WORSE

Following cuts over around 12% to care budgets across local authorities in England, there has been a 25% reduction in the numbers of people receiving care through community services, nursing or residential homes, leaving more old people reliant on NHS services.

Below: The number of people receiving state-funded care

The government failing patients

These are five key ways that patient care is on the decline. But there are others too. The number of cancelled operations is up by a third between November and January, compared to the same time in the previous year. Ambulance response times are rapidly deteriorating with all three national standards for response times missed in quarter 3 2014/15, largely because of increased handover times at over-stretched A&E departments.

What is causing this failure of patient care?

Clearly the toxic mix of restructuring, complexity, confusion and lack of system leadership referred to by the King’s Fund report is taking its toll. The view from the front line is that services are deteriorating. Over a third of NHS trust finance directors feel that care in their local area has worsened over the past year, a view shared by a similar proportion of CCGs. But the fundamental problem is the massive financial squeeze by the government, at a time of rising demand.We have discussed previously how the finances are in parlous state due to flat-lining government spending on the NHS. More recent evidence shows that 60 out of the 83 acute Foundation Trusts are currently in deficit, over three-quarters of NHS Trust Finance Directors are not confident of achieving financial balance in 2015/16 and over a quarter of CCGs are not confident that they can stick to budget without compromising care quality or access over the next 12 months.

Below: Percentage of NHS Trusts and Foundation Trusts in year-end deficit (2014/15 – predicted)

This is leading to staff shortages and capacity constraints, particularly a lack of beds. Monitor, the English NHS regulator, reports that “constrained bed capacity” is contributing to increased A&E waiting times, that 45 per cent of Foundation Trusts cite “inadequate capacity” as a factor behind missed cancer treatment targets and that with staff vacancies for qualified ambulance staff ranging between 10% and 24% has had a “significant impact on performance”.

There is a very clear message coming through. No matter what David Cameron might argue, the NHS has been starved of investment with a direct impact on patient care.

Below: Real growth in public expenditure on healthcare

John Appleby, Chief Economist at the King’s Fund sums it up thus:

“Services are stretched to the limit. With financial problems also endemic among hospitals, and staff morale a significant cause for concern. The situation is now critical”