NHS trusts are struggling to improve performance and expand the numbers they can treat due to a lack of staff, worker burnout and a continued inability to discharge fit patients, according to a new report.
The study, from NHS Providers, had responses from 106 chief executives and finance directors of trusts, including those running hospitals, mental health services and ambulance services.
They represent about half of the sector.
Asked what barriers currently exist to prevent their systems from making activity gains in 2022/23, 92% cited workforce shortages, 87% staff exhaustion and burnout, and 86% said there was an inability to discharge medically fit patients in a safe, timely way.
Eight in 10 said the increased pressures on local social care services affected them, while 79% said they were hampered by increasing demand for services and 77% by patients being more sick.
More than seven in 10 respondents also said they lacked enough funding to do what they needed to do, including driving down the treatment backlog caused by the Covid pandemic.
Four in 10 (42%) of those polled who provide planned care such as hip operations said they were “not at all confident” or “not confident” they would be able to delivery recovery targets to reduce long waits in 2022/23.
On the issue of not enough staff, 74% of leaders surveyed said they were not confident or not at all confident that they would be able to recruit and retain enough staff to meet performance and recovery targets.
This was most acute in mental health and learning disability trusts (93% were not confident or not at all confident).
When it comes to people needing tests, only 49% of leaders were very confident or confident that their trust would be able to carry out 95% of diagnostic tests – such as MRIs and ultrasounds – within a six-week target by March 2024.
No-one should doubt the determination of trust leaders to increase activity and bear down on waiting lists
Meanwhile, some 60% said they were very confident or confident their trust would meet the target for 75% of patients urgently referred by their GP for suspected cancer to be diagnosed or have cancer ruled out within 28 days.
Fewer than half (45%) were confident they would be able to reduce the number of outpatient appointments and only 37% thought they would be able to deliver 104% of pre-pandemic elective activity by the end of 2022/23.
The report said that while trusts are “working as hard as they can” to drive cost improvement programmes, they are unlikely to deliver efficiency savings “at the level expected by the Government and NHS England”.
NHS Providers said that while a recent cash injection of an extra £1.5 billion is welcome, there are still questions over its impact given the rising costs faced by trusts.
On staff pay, it said trust leaders “strongly support” an increase but need reassurance that any rise will be fully funded by the Government.
Interim chief executive of NHS Providers Saffron Cordery said: “No-one should doubt the determination of trust leaders to increase activity and bear down on waiting lists.
“They understand only too well the disruption and distress for patients and their carers caused by delays for treatment…
The pandemic exposed and deepened fault lines, and shone a harsh light on worrying health and race inequalities
“We went into the pandemic off the back of the longest financial squeeze in the history of the NHS, with capacity falling behind growing demand – a problem aggravated by severe staff shortages and an underfunded social care system.
“The pandemic exposed and deepened those fault lines, and shone a harsh light on worrying health and race inequalities.
“It is a great credit to trusts, their partners across health and care, and above all to frontline staff that we are seeing real progress in increasing activity and tackling some of the longest waits for treatment.
“Trust leaders are determined to build on this but, given the challenges they face, there is a real chance that some targets will take longer to meet than they would like.”
A Department of Health and Social Care spokeswoman said: “Because of the action this Government has taken, there are record numbers of doctors, nurses and healthcare staff working in the NHS.
“We are over halfway towards meeting our commitment to recruiting 50,000 extra nurses by 2024, and have commissioned NHS England to develop a long-term workforce strategy to provide certainty for the future.
“We are grateful to all the healthcare staff for their tireless work across the NHS and we are taking action to tackle the Covid backlog with record investment, surgical hubs and up to 160 community diagnostic centres – over 90 of which are already open and have now delivered one million checks.”
