Despite experiencing the worst winter in a decade, frontline NHS staff and managers have risen to the challenge and cared for more patients than ever before. However, this surge in demand has affected the NHS’s performance in key areas, such as waiting times and its reliance on temporary workers.

Key findings of the report

Unprecedented demand for A&E

More than 5.87 million people went to A&E in January, February and March 2018 – that’s over 220,000 more than the same period last year.

During January, February and March alone, there were 1.1 million people who attended A&E who needed to be admitted for treatment – 70,000 more than the same period last year.

Despite these enormous pressures, staff worked extremely hard and cared for more people in A&E within the expected four hours than the year before. A total of 277,150 more patients were seen within four hours at A&Es in 2017-18 than in 2016-17.

However, performance against this standard slipped nationally – 88.4% of patients were seen within four hours in A&E, compared to 89.1% the year before. The national target is 95%.

Higher than planned levels of A&E activity meant hospitals had to cancel operations and hire temporary staff to cover vacancies and sickness. At the end of March 2018, 2,647 patients were waiting over a year for elective treatment compared to 1,513 in March 2017. Also, the rise in A&E activity at the expense of more profitable elective work led to a significant shortfall of £505 million in elective and outpatient income against providers’ plans over the year.

Staff vacancies

At the end of the year, the sector was faced with 92,694 staff vacancies – which equates to an 8% vacancy rate. This includes 35,794 nursing vacancies and 9,982 doctor vacancies. However, providers ensured that 95% of nursing and 98% of medical vacancies were filled with temporary workers so that patient safety would not be compromised. This led to £976 million more being spent on NHS bank staff than planned.

The sector spent £527 million (18%) less on filling shifts from expensive agencies compared to the previous year. This reduction marks a significant achievement for the sector and comes after we introduced agency spending caps for all trusts in 2015-16.

Impact on finances

The high level of demand and a combination of other pressures led to an overspend in the NHS provider sector in 2017-18. While more than two thirds of providers (156 out of 234 trusts) finished the year at or better than planned financially, the surge in patient demand contributed to the provider sector as a whole having a deficit of £960 million at the end of 2017-18.

This figure is £464 million above what was anticipated by trusts at the start of the year and it is £30 million above what the sector anticipated at the end of December. It is, however, an £1.5 billion improvement from 2015-16, when the sector’s deficit stood at £2.45 billion.

While the provider sector was in deficit during 2017-18, viewed as a whole the NHS was broadly in balance. Last week, NHS England provisionally reported a £955m underspend for the healthcare commissioning sector in 2017-18.

Acute hospitals have been largely responsible for the sector’s deficit, mainly due to the increase in demand within A&E mainly over the winter months, with all other providers, including ambulance, mental health and community healthcare trusts, collectively underspending during 2017-18.

We are providing intensive support to 12 of the most financially challenged providers through its special measures programme, all of which are in the acute sector. In 2017/18 three trusts joined the programme and one trust made significant financial improvements and left.

The number of NHS trusts in deficit fell to 102 in 2017-18, down from 157 in 2015-16 and 105 the year before (2016-17).

As NHS trusts continue to plan for 2018-19, the sector will need to rely less on one-off non-recurrent savings, such as by selling off hospital-owned land and buildings. We are helping the sector do this by demonstrating how similar trusts save money through procuring medicines, planning operations better and utilising technology.

‘Hundreds of thousands more patients have been to A&Es this year but the NHS did not buckle under the pressure.

‘Despite epic challenges, NHS staff up and down the country displayed incredible resilience and saw more patients than ever before within four hours.

‘More than two thirds of providers ended the year on budget or better than planned. Given rising demand and record vacancies, this is an important achievement.’

Ian Dalton, Chief Executive