Analysis by the health sector regulator found foundation trusts treated a record breaking 10.7 million emergency in-patients between April 2014 and March 2015, a 574,000 increase on the previous year. In addition, there was also a significant increase in non-emergency patients.
However, this increase in demand for care, combined with an over-reliance on expensive agency staff and the need to make cost savings, is putting trusts under sustained and exceptional pressure.
Overall, the 152 foundation trusts (the majority of NHS trusts) missed a number of national waiting times targets for A&E, routine operations and some cancer treatments for the entire year. The sector also ended 2014/15 in deficit (-£349 million) for the first time, in a further sign of the increased pressures upon services.
Foundation trusts have indicated to Monitor that 2015/16 is likely to be even tougher.
Dr David Bennett, Chief Executive at Monitor, said:
The last financial year was exceptionally challenging for the foundation trust sector, and it is clear the current one is following the same pattern. The sector can no longer afford to operate on a business as usual basis, and we all need to redouble our efforts to deliver substantial efficiency gains in order to ensure patients get the services they need.
This will no doubt involve some significant changes to the way people work at some institutions, but as the regulator we believe there is scope for more to be done at a number of levels without compromising patient care. Monitor is therefore stepping up its efforts to provide practical help and support to foundation trusts that are struggling both financially and operationally.
Foundation trusts are providing more treatment, to more patients with more complex care needs. Therefore, it is right that, in these difficult circumstances, agency staff are used to ensure patients always get quality care. However, trusts should act to reduce their over-reliance on agency staff in the longer-term by improving their planning and building up their reserve staffing resources, so they can protect their finances.
A report to Monitor’s board on the performance of the foundation trust sector for the year ended 31 March 2015 found that overall, the sector reported a deficit of £349 million compared to £10 million planned:
- 77 foundation trusts (51%) ended 2014/15 in deficit of whom 70% were acute trusts
- trusts spent £1.8 billion on contract and agency staff which is more than double the amount they had planned (£766 million)
- trusts made £1.17 billion worth of cost savings compared to £1.23 billion in 2013/14
- the foundation trust sector as a whole has missed the A&E waiting time target of seeing 95% patients within 4 hours since autumn 2013/14
- the size of the waiting list for routine operations reached 1.76 million, an 8.3% increase on 2013/14
- between January and March 2015, 55,400 people waited on a trolley for more than 4 hours between the decision to admit them to A&E and their arrival on a ward due to reduced bed availability
- foundation trust ambulance services meet the national waiting time for responding to the most critical and life threating incidents between January and March 2015
- Monitor intervened or agreed regulatory action at 32 trusts (21% of the sector) because of operational or financial concerns