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Access to services likely to decline due to financial squeeze, warn NHS managers

Patient access to services is highly likely to decline due to the financial pressures facing the health service, senior NHS managers have warned.

An extensive survey of almost 300 senior managers by the NHS Confederation has laid bare the scale of the challenge facing the service, and uncovered widespread fears that access to treatment and waiting times will suffer.

But the Confederation's chief executive Mike Farrar is expected to tell 1,500 delegates at the organisation's annual conference today that the results should act as ‘a wake up-call rather than a counsel of despair', and will call on ministers to put an end to ‘unwarranted attacks' on NHS managers.

The survey gathered responses 287 chairs and chief executives from 243 organisations, including PCTs, acute trusts, ambulance trusts, mental health trusts and independent sector NHS providers.

NHS managers said they were fighting to improve services despite the need to make an unprecedented £20bn worth of savings over the next four years, but said the pressures would inevitably lead to restrictions on some treatments and pressures on waiting times.

Overall, 53% felt access to services would worsen, while only 21% thought it would improve.

In addition, 32% of managers warned that patient experience would suffer, while one in ten also warned that patient safety could be compromised by the financial squeeze.

Managers were more positive on quality of care, with 51% forecasting that the quality of services delivered or commissioned would improve over the next three years. But one in five felt quality would dip in the next twelve months, while almost a third thought it would worsen over the next three years.

Some 42% of respondents described the current financial situation as ‘the worst they have ever experienced', with more than two-thirds predicting this pressure would increase in the next three years, and 13% expecting to overspend in the next 12 months.

But three quarters of respondents were confident of meeting their quality and efficiency targets over the next 12 months, although one in four were not.

Four out of five ranked delivering the NHS reform agenda alongside the savings drive as one of their three biggest obstacles to achieving QIPP targets, while 70% said lack of certainty over the reforms, and 51% said cuts to local authority services.

Almost three quarters - 71% - of senior managers felt cuts to local authorities would increase demand for primary care services.

Mike Farrar, chief executive of the NHS Confederation, said: ‘People will overlook these worrying results at their peril. The picture they paint is of pressure on money now and of pressure on money mounting down the line. It is getting harder to maintain the great progress we have made on the quality of care, and there is real concern now about the speed of access to services.'

David Stout, head of the Confederation's PCT network, said the dual concerns about restricting access to services reflected the fact that both commissioners and providers responded to the survey: ‘The commissioning action might be around threshold management, so restricting and being more targeted on who accesses what's services. The provider response may well be on extending waiting times.'

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