The General Medical Council has warned a crunch is coming, and polls suggest the public is getting worried. John Appleby of the Nuffield Trust reviews the evidence.by John Appleby / November 17, 2016 / Leave a comment
Published in December 2016 issue of Prospect Magazine
England’s hospitals are rapidly plunging into the red
At the end of the expansionary New Labour days, austerity arrived and the rapid growth of NHS spending slowed to a crawl. But hospitals’ books did not immediately indicate any great distress. For a time, small surpluses suggested they had learned to do more with less. But in 2013/14 the surpluses vanished, and a small average deficit crept in. By last year, this had ballooned to £2.5bn, and the real figure—once we strip out Whitehall’s bailouts, which will have to be repaid—is more like £3.5bn, or about 5 per cent of hospitals’ budget. The deficit is not concentrated in a few institutions: the vast majority are now running overdrafts. They have limited flexibility and little obligation to close wards or A&E doors. So the crisis plays out through drift—with the NHS spending as if it could print its own money, running up a tab the Treasury will not tolerate forever.
Patients are beginning to suffer
Danger lights are flashing on all sorts of indicators of quality, from long delays in A&E to excessive waiting times for operations. But this chart looks at “trolley waits,” the number of patients stuck in the no-man’s land between the emergency department and the ward, waiting in corridors for between four and 12 hours. It is an interesting gauge of the whole system because it reflects not only the increased pressure of numbers coming through the front door, but also the blocking of beds at the other end. Inadequate care and medical services in the community prevent patients being discharged, which means fewer free beds, and more patients left on trolleys. This is a number that has been growing exponentially. The “trolley tally” is up 10-fold since 2010—and that is stripping out seasonal variation by looking at August alone.