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1/10 End year Q4 2018/19 results just published. Summary: providers working flat out & delivering good results - reducing deficit, realising savings & improving productivity. But v long way from where we need to be on access standards, sustainable finances & workforce vacancies.
2/10 Headline year end financial result of -£571m shows good improvement in reducing deficit (but includes £256m of accounting adjustments). Paticularly strong (and unusually strong in terms of previous trends) performance in Q4: £90 million improvement on Quarter 3 forecast.
3/10 Trusts continue to deliver good levels of savings - £3.2 billion - 3.6% of turnover in 2018/19. But we are still hugely & unsustainably reliant on one off non recurrent savings - £1 billion of them vs plan of £451m - 31% of savings realised non recurrent versus planned 13%.
4/10 Trust sector will deliver when given a focussed and realistic task. Trusts were asked to focus on reducing the number of long term waiters (52 weeks plus) in 2018/19 by 50%. On a like for like basis the number was reduced by 63%. Lot better than NHSE mandate!
5/10 Good provider efficiency performance (recognising that this is largely driven by record levels of demand) - Q4 implied efficiency 2.3% versus last year’s 1.2%. Lots of frontline staff working very hard indeed to absorb extra demand with little/no extra resource!!
6/10 We need to be honest about the scale of the performance, finance and recovery task the NHS has in front of it. 96,000 vacancies (8% of workforce) that will take seven years to recover if you take recovery rate between Q1 and Q4 2018/19......
7/10 ...Provider sector still very dependent on cash funding from @DHSCgovuk to get by. Loans outstanding to DHSC have risen £3 billion in a single year and now stand at £14 billion. Performance a long way off constitutional standards & worsening across a wide range of areas.....
8/10 ...This doesn’t feel like the start of a sustainable and rapid recovery to where we need to get back to that we can be confident will continue. It feels more like running at 100 MPH to just stand still and avoid slipping back with clear evidence of slip in some places. Hmm.
9/10 Welcome acknowledgement of real pressure and problems around capital investment in today’s Q4 figures from @NHSImprovement. Providers overspent their share of Departmental capital by c£400m in 2018/19 - clear sign of pressures sector feeling here....
10/10 ....International comparisons rightly quoted in today’s Q4 report show scale of NHS capital problem. OECD average for healthcare capex is 8.9% of revenue. Provider capital spending limit for NHS in 2018/19? 4.5% of revenue, nearly half OECD average. Big hmmmmmm.
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