News story

NHS foundation trusts under pressure from rising demand

NHS foundation trusts are providing more treatment, to more patients with more complex care needs in tough financial times.

Doctor talking to a patient in a hospital bed
NHS foundation trusts treated almost 100,000 extra emergency patients between April and June 2014

Analysis by Monitor, the health sector regulator, shows NHS foundation trusts treated almost 100,000 extra emergency patients between April and June 2014, in addition to significant increases in non-emergency patients.

However, this increased activity, when combined with the continuing need to make cost savings and an over-reliance on expensive agency staff, is putting trusts under unprecedented pressure.

Among other indications of this pressure, the 147 NHS foundation trusts (which make up two-thirds of all NHS trusts) failed overall to meet a number of national waiting times targets, and the sector as a whole posted a deficit for the first time. Despite missing the targets for A&E, routine surgery and cancer services, NHS foundation trusts still treated more patients in each area than they did a year ago.

Dr David Bennett, Chief Executive at Monitor, said:

NHS foundation trusts are striving to overcome the challenges they face while still meeting patients expectations for quality care. However, we believe trusts can make further progress by improving their planning, aggressively implementing best operational practices and working more effectively across local systems.

In particular, getting a greater grip on their staffing costs, especially for agency staff, will help trusts increase their financial resilience. But many trusts also need strong support from their staff to identify and urgently deliver cost savings, with ideas for redesigning operations being implemented at maximum pace.

Key findings from Monitor’s report

A report to Monitor’s board on the performance of the foundation trust sector over the three months ended 30 June 2014 found:

  • the sector reported a deficit of £167 million compared with a planned deficit of £80 million
  • 86 foundation trusts reported a deficit of which 80% were acute trusts
  • the combined deficit of the 86 foundation trusts was £227million, offset by 61 foundation trusts making a surplus of £60 million
  • foundation trusts spent £391 million on contract and agency staff, double the £189 million they had planned
  • foundation trusts made £223 million worth of cost savings which is £58 million less than planned
  • 2.7 million patients received emergency care and 500,000 non-emergency inpatient treatment
  • 18,200 patients received cancer treatment, but the sector failed to treat 15% of them within 62 days of referral by a GP
  • the sector as a whole breached the target to treat 90% of admitted patients within 18 weeks of referral
  • the sector as a whole failed the A&E waiting time target of seeing 95% patients within four hours
  • 28 trusts (19% of the sector) were subject to enforcement action by Monitor because of governance and performance concerns
Published 19 September 2014