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NHS will struggle to meet £20bn productivity challenge, shows survey

The NHS is struggling to meet the so-called ‘Nicholson Challenge’, with one in ten trusts and CCGs predicting they will be in deficit by the end of the financial year, according to a new survey.

The King’s Fund’s latest Quarterly Monitoring Report says only one in ten NHS finance directors believe their chances of meeting the target as better than 50/50.

Most - 56% - identified a high or very high risk that the target will not be met.

The survey - which for the first time includes finance leads from CCGs as well as trust finance directors - shows that 72% of CCG finance leads expect to meet their organisation’s targets  for 2013/14.

In contrast, only 33% of trusts expect to meet their cost improvement targets this year - a sharp fall on the same quarter last year when nearly three-quarters were confident of meeting their targets.

The survey also found:

* the vast majority of trusts and CCGs - 89% - expect their organisation to be in surplus or to break even in 2013/14, with 11% expecting to be in deficit

* nearly a third - 31% - said patient care in their area had got worse over the past year, compared with 14% who said it had improved and 55% who said it had stayed the same

* nearly three-quarters - 72% - were pessimistic about the prospects for their local health economy over the next 12 months and only 10% were optimistic

Analysis of NHS performance data for the first quarter of 2013/14 contained in the report shows A&E waiting times remain comparatively high. A total of 61 hospitals breached the Government’s four hour waiting target. Over the quarter, 4.3% of patients - 241,000 - spent four hours or more in A&E which - although within target range overall - is the highest level for this quarter since 2004.

Other key findings from the analysis of NHS performance data include:

* the number of health care-acquired infections continues to fall, with 398 cases of C difficile and 24 counts of MRSA recorded in June 2013

* waiting times for hospital treatment remain stable, although the median waiting time for outpatients has crept up to more than five weeks, its highest level since January 2008

* the proportion of patients waiting more than four hours to be admitted from A&E to hospital (‘trolley waits’) fell back to 4.5% in the last quarter but remains high by recent historical standards

Professor John Appleby, chief economist at The King’s Fund said: ‘The findings from our survey of finance directors have become significantly more pessimistic over the past 12 months, reflecting the growing pressures on the NHS.

’Now just over half way through the so-called Nicholson Challenge, it is clear the NHS will struggle to meet its £20 billion productivity target, with potentially serious consequences for patient care.

‘The reality for many hospitals is that they face an uncomfortable choice between whether to prioritise the quality of services for patients or allow performance in some areas to slip in order to balance the books.’