As over-stretched hospitals struggle to cope with the worst flu season in seven years, A National Audit Office (NAO) report on the NHS published today, 19 January, concluded that “repeated short-term finding boosts could turn into the new normal.” The additional Sustainability and Transformation funding of £1.8bn the NHS had received this year, was intended to give the financially struggling health service stability that would help it weather the challenges of significantly less funding increases from this year onwards.

The money was also expected to help the NHS achieve a sustainable health system, improve services and staff performance. Since the funds were instead used to cope with existing financial pressures,  the NOA’s assessment finds that the taxpayer spending would be put to better use, by not injecting these short-term funding boosts. The head of the NAO, Amyas Morse, said that the best solution for the NHS requires a commitment “to a long-term funding settlement that provides a stable platform for sustained improvements.”

Improved deficit, still struggling

There is some good news in the report regarding the NHS’s deficit, which stood at £1,848m in the period between 2015 and 2016. In the following year, there was a surplus of £111m. The combined trust deficit fell from £245m down to £791m, over the same time period. There was an improved underspend of £154m clinical commissioning groups, however the groups cumulative deficit reports nearly doubled, rising from 32 to 62.

Tightening purse strings meant that money could not be spent on the longer term transformation, which is crucial to meeting demand and improving services. To keep funding day-to-day NHS work, the Department had used £1.2bn of their capital projects budget of £5.8bn. The NOA found that many trusts are counting on large levels of cash loans from the Department, which are increasing with the ultimate effect of worsening rather than improving their financial performance. This extra cash support rose from £2.4bn to £3.1bn compared to the previous year.

The pattern emerges of increasingly relying on one-off measures to save money, not making wholesale changes that would deliver savings every year. This practice will compromise the NHS’s future financial sustainability. The NOA recommends the NHS rapidly move further towards aligning nationwide processes, and reassess “how to best allocate the sustainability and transformation funding.”

Overcrowding causes

It’s logical that the best course of action for the NHS is to use the financial resources to improve facilities, but it also takes time to plan these kinds of sustainable improvements for existing NHS hospitals. One improvement that must clearly be made, is to increase the speed of care and add more beds across many A&E facilities. This winter, up to 100,000 patients have had to wait for at least 30 minutes in the backs of ambulances because of A&E overcrowding. So far this winter, 104,987 patients who were rushed to hospital remained in ambulances or hospital corridors, waiting at least a half hour for care.

Some of the problem has been caused by a shortage of available hospital beds. However, much of the overcrowding has been caused by an outbreak of the flu, which is at the highest levels seen in eight years. Nearly three times more people have died of the flu this year than succumbed last year. Saffron Cordery, director of policy and strategy at NHS Providers, the which represents hospitals said that, although there was “a very slight easing of pressures last week, NHS trusts are still working at or beyond full stretch, resulting –at times-in care for patients that falls short of what trusts and their staff want t provide.” Ominously, she added:” The worst of winter may be yet to come.” 

Planning for an ageing population with less funding

The NHS planning also has to take into account the increase in the numbers of people over 65 that use the health service. In 1971, just 13 % of the population was over 65; today, that figure is 18%, which accounts for around one in five people, and it will steadily rise. This is due to the fact that over 30% of the UK is aged 40 to 64

It’s hard to imagine a world before the NHS. Many people who use the National Health Service weren’t yet born on 5 July 1948, the day when health secretary Aneurin “Nye” Bevan launched the NHS at the hospital now known a Trafford General Hospital in Manchester. The facility was then called Park Hospital, which the NHS describes as being opened as “the climax as a highly ambitious plan to bring good healthcare to all,” regardless of wealth. Over 70 years on, the service has retained its founding principles of being funded by general taxation and free at the point of use.

The NHS is facing a serious financial crisis, at a time when the government plans to cut public health funding by £170m, or around 5% over the next two years. Local authorities will lose £85m in funding in 2018-19 and another £85m in the following year. This is a result of the Chancellor’s 2015 autumn budget, which cut public health budgets by 9.6% over the five years ending in 2021. These cuts were criticised by Dr. Dominique Thompson, a Bristol GP, who said: “Public health is by definition preventative medicine, so cutting it makes as much sense as reducing seat belt use.”

Other physicians noted that taking money away from services, like smoking cessation and weight management, will only increase the need for more costly treatment later, so they will only aggravate the burden on the NHS in the years to come. The NHS is described as facing a “watershed moment”, by NHS Providers, requiring billions of Pounds in additional long-term funding. In a letter written on 11 January, to Health and Social Care secretary Jeremy Hunt, the trade body which represents NHS services requested the boost saying “the government must accept that the service can no longer deliver what is required of it within current funding.”

Since they are forced to dip into capital budgets to keep pace with current demands—and they must leave seriously ill people waiting for over a half hour—the NHS urgently needs the long-term funding the NAO and NHS Providers recommends.