More than half of NHS leaders believe patients’ access to services is likely to worsen over the next year, an NHS Confederation survey has shown.

Responses from the survey, carried out by the Picker Institute in May and June, came from 287 chief executives and chairs at 243 organisations – half of the confederation’s membership base.

Generally, 58 per cent felt clinical outcomes would improve over the next year while 11 per cent felt they would decrease.

But 53 per cent felt patient access was likely to decrease, while 21 per cent thought it would improve. A quarter said it would stay the same.

Confederation deputy chief executive David Stout told HSJ the findings on access “largely” related to waiting times, although treatment restrictions would also play a part. It was more likely that waits would lengthen within the 18 weeks standard, rather than lead to breaches, he added.

Many – 42 per cent – said the financial situation facing their organisation was the worst they had ever experienced and 47 per cent said it was “very serious”. More than two thirds - 70 per cent - of respondents said financial pressures would get worse over the next year, although 13 per cent felt they would stay the same and 15 per cent said they would decrease.

A clear majority – 82 per cent – did not expect to overspend on 2011-12 budgets and 76 per cent felt confident they would meet planned Quality, Innovation, Productivity and Prevention targets.

Leaders in the West Midlands were most pessimistic, with 46 per cent saying QIPP objectives would not be met. The most optimistic region was the North East, where 44 per cent of leaders were “very confident” QIPP targets would be hit.

Three quarters of respondents said cuts to local authority spending would impact upon their organisation’s services in the nest year, increasing demand for community services, primary care services and mental health services.

Confederation chief executive Mike Farrar said: “People will overlook these worrying results at their peril.  It is getting harder to maintain the great progress we have made on the quality of care, and there is now real concern about the speed of access to services.”

Asked what would help most to overcome external barriers and difficulties, the biggest proportion – 68 per cent – named certainty over NHS reforms, 53 per cent said stronger partnerships with local government and 32 per cent said strong political support at a local level.

Nearly all – 91 per cent – of respondents said they were redesigning or reconfiguring services over the next year to make them more efficient and productive. More than half – 53 per cent – were reducing general staffing costs and 30 per cent were reducing demand, access and capacity.

Only 15 per cent named increasing clinical involvement in leadership and management as one of the top actions they were taking to safeguard and improve the quality of services. 

Comments made by chairs and chief executives as part of the survey revealed some were more optimistic than others. One respondent said: “I see the current financial crisis as an opportunity to push through significant cultural change which can lead to improved quality”.

But another warned: “Generally there will be an increasing postcode lottery and the fragmentation of the NHS will incur. The underlying issues around value for money will not be addressed.”

Another predicted: “Longer waiting times, higher thresholds for putting people on waiting lists, rationing”.