More trusts failed the four hour accident and emergency target in the first quarter of 2012-13 than in any first quarter since 2004-05, a King’s Fund analysis has found.

Between April and June 2012, 35 trusts breached the target for 95 per cent of patients to be admitted or treated and discharged within four hours.  In total 188,594 patients waited more than four hours in A&E in quarter 1 of 2012-13. This is a decrease of 17 per cent over the previous quarter in line with seasonal trends but a 16 per cent increase over quarter 1 2011-12.

The King’s Fund Quarterly Monitoring Report also notes the “emergence” of a possible upwards trend in patients waiting more than four hours for a bed once a decision to admit has been taken. The proportion of patients waiting has increased from 1.5 per cent in 2009-10 to just under 3 per cent in the latest quarter. Again this is the highest figure for seven years.

However, the report also notes continuing success in keeping waiting times broadly steady and reducing delayed transfers of care and hospital acquired infections.

King’s Fund chief economist John Appleby said the figures did not indicate any “particular crisis” at the moment but highlighted concerns expressed by finance directors surveyed for the report about the NHS’s ability to realise necessary savings in the medium term.

Overall finance directors were confident of making their own savings targets this year but less certain of the ability of the NHS as a whole to realise £20bn efficiency savings required by the Nicholson challenge. More than 40 per cent said they expected patient care to worsen over the next few years.

Dr Appleby added: “The pay freeze stops next year and there will be the difficulty of it being the third year of finding savings when some of the biggest savings have already been made.”

Meeting the four hours target was the top concern of 13 per cent of the 45 NHS finance directors surveyed.

Just under a fifth [19 per cent] highlighted meeting the 18 week referral to treatment targets as their biggest concern, 17 per cent healthcare acquired infections and a further 17 per cent emergency admissions.

Quality of care could suffer


Quality of care for patients could suffer as the NHS struggles to make £20 billion in efficiency savings, health experts have said.

Two-fifths of NHS finance directors expect patient care to worsen over the coming years, according to the King’s Fund survey.

Almost two-thirds think that the NHS as a whole will struggle to achieve the £20 billion “productivity challenge” by 2015.

Financial directors are confident they will end this year in surplus or break even, but monetary pressures will start to bite next year, the research suggests, as the two year public sector pay freeze comes to an end in April.

The report stated that an average staff pay increase of 1 per cent would add around £400m-£500m to NHS expenditure.

Dr Appleby said: “The NHS continues to perform well in the second year of the productivity challenge.

“But there are signs that future years will be harder.

“The end of the public sector pay freeze next April may add to financial pressures and increase the strain on services.

“The difficulty for local providers will be finding ways to absorb these costs without compromising the quality of care for patients.”

The survey of 45 NHS finance directors, who work across the sector, also indicated that there is growing pressure on emergency care.

The number of patients who are waiting for more than four hours in accident and emergency is at its highest level in the three month period from April to July since 2004-05, the researchers found.

They also noted an upward trend in the number of patients forced to wait more than four hours before they are admitted to hospital after presenting at accident and emergency.

The number of staff was also affected.

There has been a reduction of 27,000 full-time jobs since March 2010, according to preliminary staff figures.

There are 4,800 fewer nurses and 18 per cent of managers have lost their jobs, the data suggests, while the number of consultants has risen by 10 per cent since 2009.

Health minister Lord Howe said: “The NHS is on track to achieve its up-to-£20 billion savings target. The NHS made good progress delivering £5.8bn of savings in 2011-12 while improving care for patients - waiting times have been kept low, infections have been reduced, there are more doctors, more diagnostic tests and more planned operations.

“Latest figures show that on average patients waited only 51 minutes for treatment in A&E. Patients are spending longer in A&E, but they are not left untreated during this time.”