Trusts may have to close services to make savings, say NHS leaders

Saffron Cordery, who took on the interim CEO role at NHSP following Chris Hopson’s move to NHS England, described the efficiency rates facing some trusts in 2022-23 as “eye-watering”, and said this could also lead to increased thresholds for treatment.

Survey results published by NHSP, which represents trust leaders, today suggest trusts face an average efficiency target of 4 per cent this year, despite three quarters believing 2.5 per cent would be the maximum of what would be realistic.

Ms Cordery told HSJ: “I don’t want to cause undue alarm but I think trusts are starting to get really concerned about the levels of patient care, versus what they have the capacity to deliver because of what they’re being asked to achieve [in financial savings]…

“We might see services that were previously offered in a number of locations possibly being streamlined and offered in one place.

“In some areas, [the savings ask] is going to have an impact on the thresholds that people need to meet in order to be treated.

“We see, particularly in mental health services – notwithstanding huge efforts to get as many people as possible seen and into treatment – the knock-on impact of both the financial efficiencies and also huge workforce challenges mean that access to services can be constrained, and so the thresholds for treatment may become higher”.

Systems face a real-terms core funding cut in the current financial year as more generous arrangements introduced during the pandemic come to an end and rising inflation adds further pressure. They have been told they are required to break even at the same time as meeting targets to boost elective activity and diagnostics past pre-pandemic levels.

Ms Cordery warned ambulance trusts and emergency departments are “really at the edge of what they can possibly manage right now” and further social care reform was “desperately overdue”.

“That’s needed in its own right, not just to support the NHS but to provide people with the services they need in their home. We know the domiciliary care market is basically broken and that’s a key factor in the challenges the NHS faces in terms of efficiency and recovery.”

The survey results raised further questions about NHSE’s requirement for systems to break even this year, with nearly nine in 10 respondents saying they did not believe this would happen. Systems received extra funding last month to cover spiralling inflation, but HSJ analysis found most areas still face large financial gaps.

Ms Cordery said: “These efficiency levels are incredibly high – eye-watering, really – for many trusts. Thinking about how they’re going to tackle that whilst maintaining the appropriate level of service and the appropriate quality, and about how they’re going to then push to working in systems, is really challenging.”