More than 50 hospitals in England have been given the green light to miss key waiting time targets this year to help ease their cash crises. The move is part of a package of measures taken by NHS bosses after hospitals exceeded their budgets by a record amount last year.
Fines for missing targets in A&E, cancer and routine operations the 62-day target to get cancer treatment and the 18-week goal for routine operations, such as hip and knee replacements – have been scrapped altogether. Instead, they will have to simply improve on their current performance to get their slice of the extra money being invested in the NHS this year.
A new failure regime is being set up for the worst-performing trusts which will see regulators parachute senior managers into the hospitals to help devise plans to get them out of trouble.
Five trusts – Barts Health in London, Croydon Health Services, Maidstone and Tunbridge Wells, Norfolk and Norwich Hospitals and North Bristol – have been placed into the new regime immediately, with another 13 to follow shortly.
Patients Association chief executive Katherine Murphy said: “This is the slippery slope back to the bad old days of never-ending waiting times and uncertainty – with patients left endlessly on A&E trolleys and waiting for life-changing operations. Where is it all going to end?”
Health bosses believe the measures will help the NHS get the deficit down to £250m this year after an overspend of £2.45bn was posted in 2015-16, the highest ever recorded and triple what it was the previous year. That figure also covered the budgets for mental health units and ambulances, but it was the hospital sector that ran into the most difficulties with nearly nine in 10 ending the year in the red.
NHS England chief executive Simon Stevens said: “Precisely because the pressures across the NHS are real and growing, we need to use this year both to stabilise finances and kickstart the wider changes everyone can see are needed.”
Meanwhile, it has emerged the financial problems in hospitals almost meant the Department of Health failed to balance its budget overall, which could have meant sanctions from the Treasury.
The department managed to cover the overspend by trusts by drawing on surpluses elsewhere in the health service, which meant it finished £210m in surplus on a budget of nearly £115bn.
But this came only after it raided the capital budget, which is set aside for buildings and maintenance, by £950m, and identified £417m of extra income from national insurance receipts which it had failed to declare initially – something officials blamed on an “administrative error”.
Auditors said the steps taken this year to balance the books were not sustainable and should be considered a one-off.
Meanwhile, the Committee of Public Accounts challenged the Government to address the scale and cost of delays in discharging older patients from hospital, concluding: “Patients and the NHS have a right to expect better.”
The PAC demanded new measures to tackle discharge delays, finding “a poor understanding” of the scale of problems, with official data substantially under-estimating the range of delays and the number of older patients affected.
There is “unacceptable variation” in local performance on discharging such patients, and poor sharing of patient information is a significant barrier to improving performance, while “the fragility of the adult social care provider market” exacerbates discharge difficulties.
Evidence given by NHS England that pressure on local authority funding “would see a widening gap between the availability of, and the demand for, adult social care over the next few years” and that this would “prevent significant progress being made in reducing delays over the next five years”.
The PAC report concluded: “NHS England shows a striking poverty of ambition in believing that holding delays to the current inflated level would be a satisfactory achievement.”
PAC chair Meg Hillier said: “Studies indicate older people can lose five per cent of muscle strength per day of treatment in a hospital bed. Delayed discharge is damaging the health of patients and that of the public purse. While there have been improvements, the Department of Health and NHS bodies are still failing to properly address the root causes of this problem.
“Blaming local circumstances for poor performance short-changes patients and is an unacceptable cop-out when the Government has clear indicators of what works and the power to drive change.
“Best practice can be as simple as planning a patient’s discharge early in their hospital stay, or conducting shared patient assessments between health and social care providers. NHS Improvement should move faster to ensure such approaches are widely adopted.
“Evidence also shows that discharge performance is best where local health and social care organisations work together effectively, sometimes in fully integrated systems. The Government must learn from this and push the pace of integration where evidence supports doing so.”