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NHS Providers comment on 'Mission Impossible'

A detailed analysis by NHS Providers shows that what is currently being asked of NHS Trusts in the coming financial year is well beyond reach.

The report sets out how greater realism, flexibility and support are needed if Trusts are to deliver in 2017/18.

The report, Mission impossible? The task for NHS providers in 2017/18, presents a detailed assessment of the demands that are being placed on NHS Trusts through the NHS planning guidance. These are compared against next year’s significantly lower funding increases, revealing a currently unbridgeable gap.

The report sets out, in detail, the challenges facing the NHS in 2017/18. These include:

  • Absorbing a projected 3.1% increase in overall demand from patients and 2.1% increase in costs including pay, buildings and laboratories
  • Recovering key performance targets, such as for A & E and routine operations - the estimated extra cost of delivering these targets across the year is £2.4 - £3.1 billion
  • Delivering new commitments on cancer and mental health with an estimated cost of £150 - £200 million
  • Trusts to collectively balance their books with an estimated financial performance improvement of £800 - 900 million required
  • All of this is set against sharply reduced NHS England funding, with funding increases dropping from 3.6% this year to 1.3% in 2017/18.


The report sets out three ways that could make the 2017/18 NHS Trust task more deliverable:

  • NHS leaders setting more realistic performance trajectories against the key targets, as they have already started to do
  • Building on work already started, review whether more of the £5 billion currently spent on commissioning and the Department of Health and its arms length bodies can be redirected to front line care
  • Providing more support to NHS Trusts to enable them to improve performance and eliminate unwarranted variation more rapidly.

The report points out the patient impact in 2017/18 of continuing on the current performance trajectory:

  • 1.8 million people in A & E will fall outside the target to deal with 95% of patients in four hours - that is half a million more than this year, and an increase of nearly 40%
  • On average 100,000 more patients than expected will wait longer than 18 weeks for routine surgery, 150% more than this year’s figure of 40,000.

The report points to the increasing patient safety risk over the winter period with record levels of demand leading to potentially unsafe bed occupancy levels and rising numbers of long ambulance handover times and 12 hour trolley waits. It also highlights the increasing burden on NHS staff of trying to deliver impossible targets without adequate funding.

Commenting on the findings, the chief executive of NHS Providers, Chris Hopson, says: "The NHS is a can-do organisation which achieves extraordinary results for patients every day. NHS Trusts are treating more patients than ever before and performance remains good by international standards. So when those trusts say that they can’t deliver what’s currently being asked for next year, it is time to sit up and listen.

"It is unprecedented for us to warn the NHS will not be able to deliver on its commitments before the financial year has even started. But Trusts are currently being asked to absorb a 5% plus cost and demand increase, recover the four A&E wait and 18 week surgery targets, improve care for cancer and mental health and balance next year’s books financially. All on a 1.3% funding NHS England funding increase, down from this year’s 3.6% increase. Taken together, this is mission impossible. The numbers don’t add up.

"NHS Trusts want to deliver NHS standards, achieve financial balance and improve performance. The standards on A&E and surgery were set for a good reason – they are a good proxy for the quality and access to care the NHS should provide. But Trusts can only deliver if funding keeps pace with rapidly rising demand. In the absence of those funding increases, we need greater realism, flexibility and support from those leading the service.

"Trusts won’t be able to recover the A&E and elective surgery targets across the whole year. Just stabilising the rapidly increasing performance decline would be an achievement in itself. Given that demand and cost increases will easily outstrip funding and efficiency increases, just reproducing this year’s financial performance is a stretching target.
"We also need to redirect money to front line care and provide more support to help providers reduce unwarranted variation and improve performance as quickly as possible.

"There is also a very clear and simple warning in our analysis. We have now reached the point where, on the resources available, NHS Trusts can no longer deliver what the NHS constitution requires."