New research has linked waiting times and safety incidents to the financial performance of NHS trusts, and identified 32 “risk zones” where people are more likely to die of preventable causes.
The areas highlighted by the Centre for Progressive Policy have low life expectancy, as well as an NHS trust which is in financial trouble.
The thinktank, which was supported by an advisory group, including Dame Julie Moore, Professor Mike Bewick, and Sir Ian Gilmore, said age standardised mortality rates, for causes considered avoidable, amenable and preventable, were 29 per cent higher in these areas than in others.
Almost half of the risk zones are in the north of England (see list of areas below).
The report, shared exclusively with HSJ, said: “People in these risk zones are hit first by a social environment which is conducive to illness and then by a healthcare system that struggles to respond under the scale of financial pressure.”
The researchers found a “strong tendency” for a trust’s performance in the three core standards – for accident and emergency, elective and cancer care – to weaken as financial position worsens.
They said the result held after controlling for varying levels of A&E admissions by trust, which are correlated with patient safety incidents, and after controlling for varying levels of safety reporting openness by trust, which are correlated with the reporting of patient safety incidents.
They also found a “strong link” between underfunding and the number of safety incidents reported, with deficit trusts reporting an average of 32.2 incidents per 1,000 bed days, as opposed to 27.7 at trusts in surplus. They used financial data from 2015-16.
Dr Sarah Wollaston, chair of the parliamentary health and social care select committee, said: “This analysis from the CPP sets out in stark detail the urgent need to plan not just for the scale of future need but to address the impact of current deficits on care.”
North: Middlesbrough; Cheshire West and Chester; Carlisle; Manchester; Tameside; Wigan; Knowsley; Liverpool; Sefton; Kingston upon Hull; Barnsley; Bradford; and Kirklees.
Midlands and East: Leicester; Nottingham; Lincoln; Stoke-on-Trent; Birmingham; Worcester; Southend-on-Sea; Stevenage; and Ipswich.
London: Islington; Lambeth; and Southwark
South: Medway; Reading; Dartford; Bournemouth; Cornwall; Torbay; and Gloucester.
These are local authority areas where male life expectancy at birth is below the English average (2012-14) and where local NHS trusts ran a financial deficit as a percentage of their turnover (2015-16). The CPP found age-standardised mortality rates for causes considered avoidable, amenable and preventable were 29 per cent higher in these areas than in others.
The Centre for Progressive Policy is funded by Labour peer Lord David Sainsbury, and describes itself as a “new think tank committed to making inclusive economic growth a reality”.
The report also highlighted 13 social care “crunch zones”, which were defined as areas with “an elderly population weighing on an underfunded care sector, in turn compounding financial pressures on NHS trusts”. Almost half of these are also in the north.
For more details on the methodology used, see the footnotes in the full report.
The report added that the Five Year Forward View underestimated the scale of funding shortfall and cost of reform, the time it would take for reforms to take effect, the pace of increase in demand, and the level of productivity savings that could be achieved.
It estimates there could be a £241bn health and social care funding gap by 2048-49 without “root and branch” reform, which would require “unseen rises in existing taxes”.
The CPP said it has launched a 12 month programme of “data led research and deliberative public and professional engagement” to produce recommendations for a “truly sustainable, high quality system of health and social care”.
The Department of Health and Social Care said in a statement: “The prime minister and Jeremy Hunt have committed to a long term plan with a sustainable multi-year settlement for the NHS to help it manage growing patient demand, which will be agreed with NHS leaders, clinicians, and health experts.
It said the best performing trusts have been able to “balance finance with excellent quality care” and it expects all providers to deliver on both.
Social care ‘crunch zones’
North: Cheshire East; Cheshire West and Chester; Carlisle; Sefton; South Lakeland; and Stockport.
Midlands and East: Broadland; South Norfolk; and Shropshire.
South: Wiltshire; Canterbury; Torbay; and Cornwall
These are local authority areas where the 65+ population share is above the English average (2016) and where local NHS trusts ran a financial deficit as a percentage of their turnover (2015-16).
5 June, 2018