Waiting times in the NHS in England could soar as health officials predicted that “waiting times standards, in the round, will not be fully funded and met next year”.
Board papers from NHS England say that the health service needs to be “realistic about what can be expected from the remaining available funds”.
Sir Malcolm Grant, chairman of NHS England, told the national body’s board meeting that the “tightness of the settlement” would be a “catalyst for change”.
“There are going to have to be some tough decisions and trade-offs,” he said.
Papers provided to the board set out some of the issues which could be discussed under the current funding envelope.
The papers say: “Short waits for routine non-urgent elective care matter, and we should do all we can to increase elective activity volumes next year.
“However even with some increased volume, and even assuming this year’s unprecedented elective demand management success continues, our current forecast is that – without offsetting reductions in other areas of care – NHS constitution waiting times standards, in the round, will not be fully funded and met next year.”
The board papers also say that new NHS guidelines made by the National Institute for Health and Care Excellence, should make “affordability assessments” when they are drawn up.
The paper adds: “Our nurses, doctors, and other frontline staff routinely ‘go the extra mile’ for their patients.
“It would however be unfair to set unattainable goals which staff would then be criticised for not meeting.
“In part this therefore means more scrutiny of unfunded new expectations that are loaded onto the NHS.
“For example, new advisory Nice guidelines can only expect to be implemented locally across the NHS if in future they are accompanied by a clear and agreed affordability and workforce assessment at the time they are drawn up.”
NHS England CEO Simon Stevens (Stefan Rousseau/PA)
Simon Stevens, NHS England chief executive, told the meeting that plans to enhance mental health services, cancer care and general practice should be protected.
Urgent and emergency care should also be protected.
NHS England said that plans for services would be made with patients’ groups, the public, and frontline NHS leaders and staff as well as the Department of Health.
It said that it would provide an update at its next board meeting on February 8.
An operating plan for the next financial year would be agreed on March 29, it added.
Health bosses used part of their board meeting to discuss “what it is possible to deliver for patients with the money available” after the health service was not given the funds it requested from the Treasury in last week’s Budget.
The Treasury pledged more money for the NHS in England, with the specific aim of helping the health service “get back on track” amid soaring waiting lists and A&E targets.
Chancellor Philip Hammond acknowledged that the NHS was “under pressure” as he committed resource funding of £2.8 billion to the NHS in England.
This includes £350 million to cope with pressures over the coming winter, £1.6 billion in 2018/19 and the rest the year after.
Earlier this month, NHS England boss Simon Stevens said that, without more money for the NHS, the number of patients waiting to be admitted to hospital in England to have surgery would rocket to five million by 2021.
This meant one in 10 adults would be on the waiting list, he added.
He drew on a new analysis by the Health Foundation, the King’s Fund and the Nuffield Trust which calculated the NHS needed £4 billion more next year to prevent patient care from deteriorating – almost twice the amount allocated during the Budget.
Commenting, Nuffield Trust chief economist Professor John Appleby said: “It is clear from today’s board meeting that the big question emerging from last week’s Budget is how far waiting lists for routine operations like hip and knee replacements are allowed to grow in order to preserve and improve other services like A&E and cancer care.
“With the NHS under severe financial pressure and, as NHS England acknowledges, already spending money it doesn’t have to keep the show on the road, today’s meeting puts down a clear marker that something will have to give.
“As we and the other health think tanks have warned, the budget settlement fills around just half of the funding gap for next year.”
Former health minister, Liberal Democrat Norman Lamb, added: “This is the inevitable consequence of the Government’s continued underfunding of our NHS.
“Patients will suffer longer waiting times for routine operations, while progress towards improving mental health care risks being reversed.
“The public very clearly wants to see more investment in the NHS as a national priority.
“The Liberal Democrats have set out a clear plan to raise £6bn for the NHS and care by putting a penny on income tax.
“We need to be honest with the British people that securing the best possible standards of care will mean all chipping in a little more.”
Meanwhile mental health campaigners and workers welcomed news that plans to enhance mental health services should be protected.
Labour’s shadow health secretary Jonathan Ashworth said: “NHS England’s unprecedented confirmation that NHS constitution waiting times standards ‘will not be fully funded and met next year’ is the direct result of Philip Hammond’s failure to give the NHS the funding it needed in the recent Budget.
“Today NHS bosses have effectively conceded that the 18-week target for treatment can’t be met given continued underfunding of the NHS. This will mean more and more patients waiting longer and longer in pain, discomfort and distress for elective operations.
“This is the real debilitating impact on patients’ quality of life as a result of Tory austerity. What’s more, there are serious questions about the legality of effectively abandoning a standard of care enshrined in the NHS constitution.
“As a matter of urgency Jeremy Hunt must now tell us whether he intends to amend the law and the NHS constitution through legislation and publicly accept his Government’s funding squeeze is jeopardising legally-guaranteed standards of patient care.”