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King’s Fund report finds NHS finance directors pessimistic about health service reforms as waiting times rise NHS finance directors predict ward closures, job cuts and other reductions as they struggle to make ends meet and prepare for the reorganisation of England’s health system, according to the King’s Fund thinktank. With some hospital waiting times the worst for three years, A&E departments overstretched , and surgeons warning that patients are being denied key treatments, the first in a series of planned quarterly monitoring reports highlights “significant concern” among some of those responsible for contributing to £20bn of “efficiency savings” in the NHS over four years and for ensuring that new bodies taking over services in the next three years do not start with deficits. Most say they are unlikely to meet productivity targets this year. The challenging picture painted by the report, from a respected independent analyst of the health service, comes during the government’s two-month “pause ” in trying to push through its controversial legislation. It has promised to listen and make “substantive” changes to its plans, although NHS staff have been told by the chief executive, David Nicholson, to “maintain momentum on the ground” . The report analyses recent government figures, including those pertaining to the period between referral to hospital and treatment . In February this year, nearly 15% of hospital patients had waited more than 18 weeks to be admitted, the highest figure since April 2008, and part of a steady increase since the government relaxed waiting-time targets in June last year. The views of 26 trust finance directors, collected over the internet last month, provided government critics with more ammunition. The panel, made up of directors from acute hospital, mental health and primary care trusts, was not intended to be statistically representative, but to give “a qualitative account” of what is happening, according to the report. Most warned that they are unlikely to meet this year’s productivity targets. Workforce changes, sometimes involving only cuts to agency staff, were mentioned 16 times as a way of meeting targets, and closures of wards or other services were mentioned 12 times. Four directors specified reducing the length of time people spent in hospital, with one panel member commenting: “A saving is not a saving until the activity has reduced AND the beds or theatres have closed AND the jobs taken out, Only then do commissioners and providers save money.” “Back-office” savings were listed by six directors, although others expressed scepticism, with one saying that although these were “particularly popular with politicians”, they made only a modest contribution. More than half the panel said the government should be more realistic, including over the impact of treatment tariff changes on trust incomes and the need to ration treatments. Several wanted an end to incremental pay progression for staff. John Appleby, chief economist at the King’s Fund and lead author of the report, said: “It highlights significant concern amongs NHS finance directors – who are well placed to report the stresses in the system – about the prospects for the years ahead. With hospital waiting times rising, the NHS faces a considerable challenge in maintaining performance as the financial squeeze begins to bite.” The shadow health secretary, John Healey, said the report would increase concerns that the NHS was “slipping backwards again” under the Tories. “Frontline staff and managers are massively distracted by David Cameron’s top-down reorganisation of the health service, and the signs of strain are now there for all to see. So much for Mr Cameron’s pledge to ‘protect’ the NHS – it is fast becoming his biggest broken promise.” David Flory, deputy chief executive of the NHS, said: “Average waiting times remain low and broadly stable; just nine weeks for admitted patients and 3.5 weeks for outpatients. People with cancer symptoms continue to see a specialist quickly, MRSA and C difficile rates are at their lowest level since records began, and the NHS has achieved a healthy financial surplus in line with its plans. “Despite continued good performance, the NHS is still facing pressure from growing demand and will do so for many years to come. This particular snapshot shows that the NHS must maintain its focus on waiting times and improving patient outcomes, while dealing with the extra demands on the service.” A Department of Health statement added that the King’s Fund had used data that did not take account of patients who declined two reasonable offers of admission, for example, to allow them to go on holiday before an operation. Figures adjusted to take account of “patient initiated pauses” showed nearly nine in 10 patients admitted to hospital started treatment within 18 weeks of referral from their GP. Follow the NHS reforms blog at guardian.co.uk Public sector cuts NHS Public finance Public services policy James Meikle guardian.co.uk