Performance Watch: Honesty needed ahead of another tough winter

The NHS is facing a winter which is likely to be just as tough, or tougher still, than the last one. Even if new money is pumped into the service this year, there is a danger the die is already cast.

This grim prediction, made by a number of senior provider sources this week, could sound surprising – churlish even – to the lay ear, so soon after the NHS was handed a funding settlement beyond the wildest dreams of other public services.

But anyone working within or close to the health service knows it is merely a logical conclusion based on the empirical evidence.

And unless ministers and system leaders are honest about the scale of the challenge facing the service – and actively convey this message to patients – a dangerous mismatch could open up between public expectations about what can be achieved with the new funding.

Senior figures have expressed sincere gratitude for the extra funding, albeit while pointing out that 3.4 per cent real term increases fall below both the 3.7 per cent historic average growth, and the 4 per cent health think-tanks say is needed to deliver genuine transformative change.

But several trust chief executives told HSJ this winter they expected the elective waiting list to grow, four-hour performance to deteriorate, and the service to be in much the same situation this year as it was in the one just gone.

And a reality-expectation mismatch could come to a head this winter: just as tax-payers learn in the November Budget how much more they will have to pay for the NHS, they could also find themselves waiting longer for operations and longer in emergency departments.

“[When the waiting time performance deteriorates in winter] the public will think it’s mad, because the NHS has just been given all this money,” said one acute chief executive.

Another chief said both the NHS and ministers should be actively managing this potential deficit between reality and expectations, otherwise the NHS could lose public confidence and trust – something which cannot be taken for granted, and could take years to win back.

Concerns were this week also raised about how realistic NHS England and NHS Improvement’s new target to cut the number of patients spending more than three weeks in hospital is.

NHS Providers chief executive Chris Hopson said: “We tried [a similar plan] with delayed discharges last year. Effectively, we got some of the way there. I think the same will happen with this target, and we will end up some way short.”

He added: “If the government wants to try and do something about winter then it really needs to make a decision before we went away for summer. But [this year] given the workforce shortages, I think there’s a danger the die may already have been cast.

“Even if there were a down-payment [on the new funding] let’s not lose sight of how difficult 2018-19 will be.”