NHS 'will not make £20bn savings' to stay in budget, say senior managers

Economist John Appleby said hospitals had to choose – make cuts or maintain standards

Most senior NHS managers are no longer confident they can make the £20bn of savings needed to keep the health service in budget and able to pay for the growing cost of patient care.

An authoritative survey of NHS finance directors found that just one in 10 rated his or her chances of meeting the national savings target as better than 50/50. More than half identified a high or very high risk that the target would not be met, while nearly a third said patient care in their area had got worse over the past year – compared to 14 per cent who said it had improved.

The survey, by the influential health think-tank The King’s Fund, also found trust finance directors had become distinctly more pessimistic over the last year. More than 80 per cent were very or fairly pessimistic compared to about half surveyed last year.

Under government plans, the NHS is expected to find £20bn in efficiency savings by 2015. Although NHS budgets have been increasing in real terms, the pressures of rising demand means that costs will have to be cut just to stand still.

In comments to The King’s Fund, the finance directors expressed concern that this would be impossible to achieve.

“The easy stuff has been done and delivered,” said one. “[There is] not much evidence of politicians being prepared to make and support the necessary difficult decisions (like shutting and merging services to meet the target).”

Another added: “We will have [to have a] trade off in terms of quality of services. I think it’s noticeable in this year that the efficiency targets have cut too deeply into the front line.”

The survey, which provides a regular update on how the health service is coping, includes responses from clinical commissioning groups (CCGs) that are responsible for spending the majority of NHS money as well as hospital trust finance directors.

It found that only a third of hospitals surveyed expected to meet their cost improvement targets for 2013-14 – a sharp fall on the same quarter last year when nearly three-quarters were confident of meeting their targets.

The poll found commissioners were more optimistic, with 72 per cent expecting to meet their organisation’s targets, but 11 per cent said they expected their organisation to be in deficit in 2013-14. The report also analysed NHS waiting times statistics and concluded that while most indictors were broadly stable there were causes for concern.

The median waiting time for outpatients has risen to more than five weeks – the highest level since January 2008 while the proportion of patients waiting more than four hours to be admitted from A&E to hospital remains high by recent historical standards.

Professor John Appleby, chief economist at The King’s Fund, said the finding suggested that hospitals were having to make the unpalatable choice between balancing the books and maintaining the standards of patient care.

Andy Burnham MP, Labour’s shadow Health Secretary, said: “David Cameron’s reorganisation has placed the NHS in the danger zone and the alarm bells are getting louder by the day. This survey makes clear that large parts of the NHS are losing their grip on finances and waiting times.”

A spokesman for the NHS Confederation, which represents hospital managers, said it would not comment on the report’s findings. But a Department of Health spokeswoman said that the money was available to improve patient care.

“Our priority is to deliver better care and a more sustainable NHS,” she said.