Waiting times for hospital and other care services are under severe strain and are unlikely to improve in the near future.
This the key finding in the Nuffield Trust and Health Foundation’s annual assessment of the quality of care being delivered to patients in England.
However, the report highlights many areas of continued improvement in care quality, from high vaccination and screening rates, to reductions in unplanned admissions for children.
For example, it points to a 9.4% reduction in unplanned hospital admissions for diabetes, asthma, epilepsy and convulsions in the under 19s over 10 years.
It notes that in areas around access to care performance has continued to deteriorate. Performance against the four-hour A&E target in major A&E units reached its lowest level in more than 10 years.
The number of people waiting more than four hours after the decision is taken to admit them from A&E into hospital (trolley waits) grew by 45% from 167,941 (3.2%) of patients in 2013/14 to 304,276 patients (5.5%) of patients in 2014/15.
The target that 75% of life threatening emergency calls should be attended by an ambulance within eight minutes was regularly missed, reaching a low of 61% in December 2014.
The report also highlights areas of variation in care quality, pointing to disparities between child and adult diabetes services and differences between the care received by people with mental and physical health needs.
For example, last year 26% of people waited more than eighteen weeks for their first outpatient appointment under a mental health speciality compared with 6% for people waiting for a physical health appointment.
On staffing, the report notes the persistently high stress levels felt by those working in the NHS (38%) and high vacancy rates across primary and hospital care, which the two organisations say could already be reducing the quality of care patients receive.
Nuffield Trust Chief Executive Nigel Edwards and Health Foundation Director of Policy Richard Taunt jointly say in the report that: “the warning lights on care quality that we observed last year now glow even more brightly.”
They add that “people working in the NHS want to deliver high quality care, but they are increasingly battling against the odds to do so”.
Despite NHS England’s Five Year Forward View containing many of the solutions, they warn that the conditions for maintaining care quality and improving services as well as meeting the financial challenge “do not appear to be in place”.
Specifically they point to a lack of realism about the level of quality the NHS can provide within the funds available; financial pressures on other services like social care and public health; and ‘some disarray’ at the top of the health service, exemplified by mixed messages on quality and finance from regulators and high profile chief executives leaving their jobs.
They also highlight areas where there are huge data gaps in understanding care quality – from social care to child and adolescent mental health services – saying this means “we lack the answers to many of the questions most fundamental to understanding the impact of financial austerity on quality”.
Edwards and Taunt conclude: “It is very difficult to predict whether crises in the quality or availability of services are likely to become more common…or whether the gradual decline we are tracking through QualityWatch will continue. One thing that is clear is that patients cannot expect the speed at which they access care to improve anytime soon.”