June 2012

Key points from the 2012 survey of the leaders of the NHS

Healthcare chiefs say the financial position is very serious

The pressure is greater than 12 months ago and is set to increase further

Many say care has been affected, particularly the experience of patients

They expect to see the impact on care spread over the next year

There is also serious concern about the outlook for patient care nationally

Do you think the quality of patient s ervic es will improve, decreas e or s tay the s ame acros s the whole of the NHS over the next 12 months ? (n= 247)

0%

15%

38% 42%

5%

0%

20%

40%

60%

80%

100%

Will improves ignific antly

Will improve Will s tay thes ame

Will decreas e Will decreas es ignific antly

Cuts in local authority funding have added to the pressure

What impact have local authority cuts had on the following s ervices commis s ioned or provided by your organis ation over the pas t 12 months ?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Delays to dis charge (n= 161)

Demand for community s ervic es (n= 133)

Demand for mental health s ervic es (n= 127)

Demand for primary c are s ervic es (n= 87)

Ac ute admis s ions (n= 151)

A&E attendances (n= 138)

E mergenc y re-admis s ions (n= 141)

Demand for ambulance s ervices (n= 84)

Increas ed s ignific antly Increas ed No impact Decreas ed

Managing these financial pressures while also meeting the needs of an older population will be the NHS’s biggest challenge over the next decade

Other

Spread of innovation

Service redesign or reconfiguration

Reducing health inequalities

Integration of care

Ensuring people take greater responsibility for their own health

Technological advancements

Demographic pressures

Managing expectations of patients and the public

Growth of long-term conditions

Increased demand

Pressure on finances

Care of the elderly

0 0.1 0.2 0.3 0.4 0.5

0.03

0.01

0.08

0.02

0.06

0.06

0.01

0.11

0.09

0.07

0.14

0.17

0.15

0.02

0.05

0

0.09

0.11

0.13

0.2

0.17

0.23

0.25

0.19

0.25

0.27

What do you think are the challenges facing the NHS over the next decade?

Biggest challenge

Other challenges

There is strong consensus that more radical longer-term action is necessary

In the short-term, the NHS is mostly responding by cutting costs

Whatever the benefits of government reforms, the process of transition to the new system has added to the risks facing the NHS

What do you think are risks to the success of the G overnment's NHS reforms? (n= 245)

7%

18%

17%

23%

17%

10%

18%

28%

37%

31%

40%

1%

1%

5%

2%

4%

4%

1%

5%

2%

10%

10%

0% 20% 40% 60% 80% 100%

Failure to s ec ure independent s ec tor involvement

Management c os t c ons traints for CCGs

Other

L ac k of c linic al s upport

Inc reas ed bureauc ratic burden

Too muc h c entral direc tion from the NHS Commis s ioning Board

Unc ertainty about roles and res pons ibilities

L ac k of s ys tem management

Financ ial pres s ures or c os t s aving targets

Dis ruption due to organis ational res truc turing

L ac k of expertis e or experienc e in new organis ations

B igges t ris k

Other ris ks

Confidence varies in the readiness of parts of the new NHS system

Monitor

NHSCB

NTDA

PHE

CSSs

CCGs

LA s

AHSNs

HWBs

CQC

Healthwatch

0 10 20 30 40 50 60 70 80

How confident are you that the different parts of the new system will be ready to ef-fectively discharge their roles and responsibilities in 2013?

Very confident

Quite confident

%

Healthcare leaders want the government to back them in addressing long-term challenges facing the NHS

Asked how the government could help the NHS implement the reforms, the most commonly cited responses were:

•Ending top-down interference

•Supporting NHS leadership

•Backing integration of care and reconfiguration of services

•Acknowledging the financial pressures

About the survey

The NHS Confederation asked the Picker Institute Europe to survey the chairs and chief executives of all its member organisations. The survey was conducted between 26 April 2012 and 16 May 2012. It was sent to 625 chairs and chief executives in 362 organisations. There were 252 completed - a response rate of 40 per cent - from 200 organisations.