The NHS is heading into winter on a knife edge as half of NHS trust finance directors think patient care in their area has got worse over the past year, an influential think tank has warned.
The King's Fund believes the negative outlook from 51% of finance directors, compared with 6% who said there had been improvements, is a sign that a seven-year squeeze on NHS and social care budgets is impacting on patient care.
It found that 89.7% of A&E patients were seen within four hours in September compared with 90.6% in September last year, despite a major drive to improve performance and relaxation of the 18-week referral to treatment target.
The King's Fund's new quarterly monitoring report also found that 89.4% of patients waiting for treatment in August had been waiting up to 18 weeks, compared with 90.9% in August last year.
The think tank said this is missing the 92% waiting target and that 4.1 million people are now waiting for treatment.
There were also 45% of NHS trusts who predicted they would meet this year's financial targets, according to the organisation.
Siva Anandaciva, the King's Fund chief analyst, described the outlook of the finance directors as "sobering" as it suggests NHS funding pressures are having "a real impact".
He said: "This is happening despite the herculean efforts of staff and NHS leaders working to maintain standards of care under huge pressure."
To try and cope with winter demand hospitals are planning to open up more than 3,000 extra beds and work is under way to free up to 2,500 more by improving the availability of community health and social care, according to the spokesman.
It was also noted that £100 million has been spent on introducing front-door streaming at all major A&Es in the country to help ensure patients are directed quickly to the right care and that councils have been given an extra £1 billion this year to ensure that people who do not need to be in hospital can be cared for closer to home.
An NHS England spokesman said: "As the CQC (Care Quality Commission) recently reported, the NHS's high standards of care have been maintained and in many cases improved but in the face of mounting pressures as also set out by the King's Fund."
Eddie Saville, chief executive of the Hospital Consultants & Specialists Association doctors union, said the findings will add to the deepening concern among hospital doctors about a real-terms decline in NHS pay and extra efficiencies.
He said: "Finance directors are the people tasked with making the sums add up at a local level, so it is revealing that a growing number report declining standards of care amid the efficiencies already being demanded to meet their targets.
"The authors also echo our fears that front-line workforces, despite doing their utmost to improve quality, are being set an 'unachievable task'.
"NHS staff, including senior grades who have had almost no input into decisions made about care at arm's length, have now lost confidence in the direction and nature of travel."
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