- Financial pressures on the NHS are severe and show no sign of easing. However, we know relatively little about their impact on patient care.
- This study sought to investigate the impact of financial pressures in four very different areas of the health service: genito-urinary medicine (GUM), district nursing, elective hip replacement and neonatal services. Our research used data analysis and interviews to explore different experiences across the system.
- We found that GUM and district nursing services were under particular strain. Both access to services and quality of patient care have been affected in ways that are difficult to detect with currently available metrics.
- Within elective hip replacement services, activity has increased in recent years and patients remain happy with the outcome of their operations, but the latest data shows that average waiting times for treatment are starting to rise. Neonatal services appear to have largely maintained quality and access despite a number of longstanding pressures, although there is variation between units.
- Our findings create a challenge to the direction of travel set out in the NHS five year forward view of strengthening community-based services and focusing on prevention.
The NHS is under growing financial pressure. Between 2010/11 and 2014/15, health spending increased by an average of 1.2 per cent a year in real terms and increases are set to continue at a similar rate until the end of this parliament. This is far below the annual growth rate of 3.7 per cent in previous years, and is not sufficient to cover growing demand. As budgets tighten, NHS organisations have been struggling to live within their means – acute trusts ended 2015/16 with a deficit of £2.6 billion.
It is difficult to ascertain the impact these financial pressures are having on patient care. For one thing, national data on NHS performance mainly covers acute hospital services, with little known about community-based services. For another, while attention tends to focus on explicit restrictions to patients’ access to care – such as longer waiting times or restrictions on access to treatments like in vitro fertilisation (IVF) – changes to the quality of care patients receive are less visible, but just as important.
Lack of funding is by no means the only challenge facing the health system. A number of other factors affect the availability and quality of patient care; the impact of these factors may be intensified by the financial challenges.