Over one third (39%) of NHS finance directors expect the quality of services in the NHS to improve over the next few years and over half (53%) expect quality to hold steady in the same time period, despite increasing financial pressures on NHS organisations. This optimism about quality comes at the same time as the number of NHS organisations overspending or reporting a deficit has increased.
The NHS Financial Temperature Check report, released today by the HFMA (Healthcare Financial Management Association), outlines the views of 41% (188) finance directors across England on the financial challenges facing the NHS. The research shows the number of organisations overspending or reporting a deficit has increased since the 2012/13 financial year and more organisations are reporting an actual deficit than planned to at the beginning of this financial year. In the last financial year, clinical commissioning groups (CCGs) and provider trusts delivered planned financial savings of 2.3% and 4.5% respectively, but this was not the case across the board and fell short of the overall planned savings (2.5% and 4.8% respectively).
Looking ahead at the financial position for 2014/15, 36% of provider trust finance directors were quite or very confident of achieving their financial targets, yet 20% were not very or not confident at all, and 44% said it was too early to say. CCG finance directors were more positive, with 54% being quite or very confident, 21% were either not very or not at all, and 25% said it was too early to say. More worryingly, looking ahead to 2015/16, just 12% of provider trusts and 25% of CCGs feel quite or very confident that their financial targets will be achieved. Cost pressures cited by both groups include an increasing demand for services, increasing the number of nursing staff and emergency care.
The report also sets out finance directors' opinions about the action that should be taken to reduce the financial pressures in their health economy. Most called for the pace on service transformation to be picked up to help with high quality, safe care delivered in an efficient manner and in the most appropriate settings. Finance directors are also keen for there to be an honest debate with the general public and politicians about the need for change in the NHS to make it fit for the future.
Paul Briddock, Director of Policy at the HFMA, said:
"Resources are being stretched and although many NHS organisations have just got by, we have seen an increasing number of them report a deficit last year. We are seeing financial problems materialise in organisations that have previously been financially stable. If all things stay equal, the financial outlook looks increasingly challenging, but despite this, it is encouraging to see that finance directors do not see quality deteriorating – in fact, many think quality will improve.
"However, it is clear that the future success of the NHS depends on the clinically led transformation of services, with support from managers and finance staff. Finance directors are clear that this transformation needs to happen faster than at present and we all need to work together to make this happen effectively."
Additionally, there was some concern about the impact of the implementation of the Better Care Fund, which comes into operation from 1 April 2015. While supporting the move to integrate services, only 2% of provider trust finance directors and 11% of CCG chief finance officers think that the Fund will help improve their organisation's services for patients and users in the first year. This rose to 25% and 62% respectively after the first three years.
The HFMA is calling for a focus on five areas over the coming months to ensure that NHS organisations remain clinically, financially and operationally sustainable:
• Making faster progress on large transformation schemes
• Having an open and honest debate with the public and government, about the financial challenges facing the NHS
• Utilising the expertise and skills of NHS financial staff to support much needed change
• Creating solid foundations for the Better Care Fund so that it achieves its aims
• Focusing on obtaining the maximum value for every pound spent in the NHS