More strikes, staff burnout, and relentlessly rising demand for care amid a severe funding squeeze could jeopardise progress in cutting delays for patients, health leaders have warned.
Many NHS trusts expect this winter to be even tougher than the last, according to a survey of 185 NHS leaders from 118 trusts carried out by NHS Providers.
Two out of three (66%) reported that last year was the "most challenging" they had ever seen, with 80% fearing this winter would be even tougher.
"Fault-lines" included workforce challenges and staff shortages, a lack of sufficient capital investment together with wider financial pressures, as well as a need to address health inequalities and place social care on a sustainable footing, the results of the survey conducted online during September and October showed.
However, despite huge challenges, the survey showed an "undiminished determination" to keep improving patient care, and to give patients the "right care in the right place", NHS Providers reassured.
Another Gruelling Winter Ahead
The State of the Provider Sector survey is the latest annual snapshot of the hopes and fears of leaders of hospital, mental health, community, and ambulance services across England.
The survey was sent to leaders from all trusts, representing all types and regions, with just over half (56%) responding.
Worryingly, fewer than one in three (30%) thought that the quality of health care they could provide in the next 2 years would be 'very high' or 'high'.
Asked to rate the quality of care currently on offer, only one in a hundred (1%) ranked it very high, with 40% believing it was high. In 2022, 48% thought care quality was high or very high. Just under half (49%) rated current quality of care as average, and one in twenty (5%) said it was low.
The survey found that almost all respondents (95%) were concerned about the impact of winter pressures, with the majority (78%) worried about having enough capacity to meet demand over the next 12 months – up a third on the 2019 prepandemic figure of 61%.
"There is winter planning in place, but there's too much going on in systems with finite resource," commented an acute specialist trust in London.
Burnout (84%) and morale (83%) in the workforce were of great concern, as were further strikes, which respondents feared would undermine efforts to cut waiting lists and cause additional delays in planned and emergency care, with a "knock-on effect for services right across the NHS".
"The NHS can't afford further strikes," warned Sir Julian Hartley, chief executive of NHS Providers. "As we head into what's expected to be another gruelling winter, the spectre of more strike action continues to loom large over the health service," he alerted.
Money Worries Continue To Mount
More than three in four trust leaders (76%) reported that they were facing a worse financial position than last year. Funding pressures were fuelling concerns about future patient safety and the quality of care as well as threatening to hit trusts' ability to ramp up services as they braced for winter.
Steps being taken to curb costs included shelving plans for more beds, putting recruitment plans to plug gaps in the workforce on hold, and reducing investment in community and mental health facilities.
"Currently, only nonclinical services have scaled back," reported one acute trust in the South West. However, further options were being considered, that "may include closing unfunded beds".
There were also worries around the "relentless rise in demand" for mental health and learning disability services postpandemic amid concerns over the impact of the cost-of-living crisis. "We simply cannot deliver all of our core services within our income," declared a combined mental health/learning disability and community trust in the Midlands.
Trust leaders strongly disagreed, or disagreed, that their trust would have sufficient capital funding to transform and continue the journey to digital maturity over the next 3 years (63%), invest in business-critical ICT infrastructure or systems (60%), or address the high or significant risk maintenance backlog (70%).
"Trusts are having to tighten their belts to find unprecedented efficiency savings while inflation squeezes already strained budgets, leaving little in reserve to invest in the extra capacity they need to deal with winter demand," Sir Julian pointed out.
An NHS spokesperson said that "despite ongoing pressures, the NHS has made significant progress on its recovery plans thanks to the incredible efforts of staff".
Credit must go to trust leaders and their staff for their "unshakeable determination" and for continuing to "work flat out to deliver timely, high-quality care for patients," Sir Julian said.
"They are doing great work, often in the most difficult circumstances, but it's clear the survey results paint a very concerning picture – that they face their toughest test yet as winter and budgets bite," he added.