Original post from The Health Foundation
Published: April 2015
The NHS in England faces the huge challenge of meeting rising demand in a period of sustained financial pressure. The service is projected to overspend its budget by £626m in 2014/15, despite £250m additional Treasury funding and an extra £650m from transferred planned capital investment.
In this report we examine the financial performance of NHS providers, focusing on hospitals. We identify areas of cost pressure using their financial accounts up to 2013/14 and quarterly reporting data up to December 2014 (Q3 2014/15). We also examine trends in efficiency and productivity from 2009/10 to 2013/14.
Watch an audio slideshow of the key findings
- The financial performance of NHS providers in England has deteriorated sharply since 2013, from a net surplus of £582m in 2012/13 to a net deficit of £789m at the end of Q3 of 2014/15.
- Despite an expected under-spend from commissioners of £197m, the NHS is projected to overspend by £626m by the end of 2014/15.
- Staff costs are the biggest driver of rising operating costs. Spending on temporary staff grew by £1bn (27.8%) in 2013/14 and continues to rise. Acute hospitals are hardest-hit: 76% were in deficit at the end of Q3 of 2014/15, up from 19% in 2012/13. Hospitals’ crude productivity fell by almost 1% in both 2012/13 and 2013/14.
- NHS hospitals have only improved efficiency at an average rate of 0.4% a year over this parliament. This is substantially below previous estimates and the 2-3% set out in the NHS Five year forward view.
Original post from The King’s Fund
‘………..From hospitals to health systems
A core part of the vision in the NHS five year forward view is a fundamentally different role for acute hospitals. Hospitals in England and elsewhere face significant challenges as a result of rising demand and the changing needs of the population, and they will not be able to meet these challenges by continuing to work alone. Instead, acute trust leaders need to embrace a system-wide perspective and work increasingly closely with primary care, community services, social care and others.
In some areas of the country this change is already well under way, with hospital leaders taking a shared responsibility for leadership of a local system. This report describes lessons from five case studies where acute hospitals are working collaboratively with local partners to build integrated models of care – three of these sites have since been chosen as vanguards by NHS England. The report assesses the achievements made so far, distils the lessons learnt for other local health economies, and makes recommendations for national policy-makers.
- The successes seen in the case study sites have only been achieved after several years of sustained effort, with a particular emphasis on building the necessary relationships and trust.
- Whole-system governance structures involving acute hospital providers and other local partners can support the development and rapid implementation of integrated models of care, drawing on resources and expertise from across the local health system.
- A major challenge identified was engaging primary care within these shared governance structures. In cases where progress had been made, acute hospital leaders had invested considerable time and energy in building relationships with general practice.
- There was some evidence that integration of acute and community services within a single organisation can facilitate the implementation of integrated care models, but many of the same benefits can also be achieved through successful partnership working.
- Hospital leaders in the study believed that integrated service models would help to manage growing demand within existing bed capacity, rather than achieving any significant reduction in bed numbers.
- Acute sector leaders should be encouraged and supported to take a leadership role in their local health systems, working with local partners to develop more integrated models of care, and taking greater responsibility for prevention and public health.
- Supporting actions at various levels are needed: including a regulatory model with greater emphasis on whole-system performance; a nuanced approach to competition that does not create barriers to constructive dialogue and partnership working between commissioners and providers; and more flexible contracting models for general practice.
- There is a need for realism regarding the pace of implementation of new models of care. Even in local health economies where integrated working is well advanced, the current situation is a long way from the vision described in the NHS five year forward view.
Print copy: £10.00 | Buy
No. of pages: 92
ISBN: 978 1 909029 47 7…………’