UK: Insights From King’s Fund Report On NHS Performance Under Coalition Government

Last Updated: 9 April 2015
Article by Karen Taylor

Most Read Contributor in UK, August 2017

This week the Kings Fund published its report 'The NHS under the coalition government'. This report examines the NHS's performance between 2010 and 2015, based on routinely available data (inputs such as funding and staffing and outputs such as hospital admissions and A&E attendances). It also draws on surveys of patient and staff experience; data on access and waiting times targets; and measures of safety and quality of care. The report concludes with an analysis of NHS productivity and an assessment of its prospects in the next parliament and beyond.1

This latest report by the King's Fund recognises that evaluations of performance are not straightforward and indeed are often contested, with competing views on how performance should be measured and the weight that should be attached to different aspects. However, given the King's Fund's experience and expertise in tracking and evaluating NHS performance we thought it would be helpful to share a short synopsis of the key findings and encourage you to read the report for yourselves to ensure you have a deeper understanding of the NHS's performance over the last five years and are thus better equipped to help improve services over the next five years. The main findings from the March 2015 report include:

  • NHS performance held up well for the first three years of the 2010–2015 parliament but has since come under increasing strain as its workload has increased at a faster rate than its funding has grown 
  • Performance is declining with waiting times, bed occupancy and delayed discharges all increasing 
  • Patient experience of the NHS generally remains markedly positive, and public confidence is close to an all-time high 
  • The limited data on outcomes, safety and quality of care indicate some improvements, although concerns have increased over the limited emphasis given to mental health compared with physical health 
  • The NHS is on track to record a substantial NHS deficit in the 2014-15 financial year, and the number of trusts reporting financial deficits has increased 
  • Much of the NHS is working close to its limits, and staff morale is a growing concern – making prospects for NHS performance in the next parliament extremely challenging.2

The King's Fund analysis found that over the first three years 2009-10 to 2012-2013, the NHS appeared to be on track to deliver the savings set by the Nicholson Challenge (£20 billion a year by 2014-15). Much of this, however, being due pay restraint, reductions in tariff and cutting management costs. Over the last year or so, efficiencies have become harder to deliver and increasing numbers of hospitals are now struggling to meet their A&E waiting time targets, 62 days cancer waiting time targets and reduce delayed discharges. At the same time the proportion of patients reporting delays in getting an appointment with their GP and their overall experience of general practice is declining.

The pledge to cut management costs and 'rebalance' its workforce, appears to have been achieved, and consultant, GP and nurse numbers have increased. However for GPs and nurses these increases have not kept pace with population growth. Furthermore, difficulties in nursing recruitment have resulted in high levels of spending on more expensive agency and locum staff. Meanwhile, bed occupancy rates are creeping up to very high levels (from 85.8 in 2010-11 to 87.6 per cent in 2014-15), with many hospitals now operating at over 90 per cent bed occupancy). This is causing particular concerns given the National Audit Office finding in 2013 that hospitals with occupancy levels above 85 per cent can expect to have regular bed shortages, periodic bed crises and increased numbers of hospital-acquired infections.3

Recent indications, are that staff satisfaction may be decreasing. However, on the quality side, health care-acquired infections have reached historic lows, patient satisfaction with the care received remains high and public satisfaction with the NHS has increased.4

The King's Fund, like many other commentators, concludes that whoever forms the next government, additional resources will be needed, while avoiding grand reforming gestures, and that without more funding there is a real prospect of accelerating decline in NHS performance. It also calls for the NHS to renew its commitment to productivity improvements.

Our own research indicates that the gap in funding that will be needed means that resources and staff productivity alone are unlikely to be enough and, that the NHS England's Five Year Forward View, call for new models of care alongside more investment in workforce, technology and innovation, needs to be expedited.5 Furthermore, as suggested by the The Forward View into action: Planning for 2015-16, the need for life science and health technology industries to partner with the NHS to demonstrate how digital innovations can deliver improvements in outcomes, patient experience and cost-effectiveness, will also be of crucial importance.6


1 The NHS under the coalition government Part two: NHS performance

2 Ibid

3 Emergency admissions to hospital: managing the demand. National Audit Office (2013). HC 739 session (2013–14) 31 October 2013. London: The Stationery Office. See also.

4 The NHS under the coalition government Part two: NHS performance

5 Five Year Forward View, NHS, Oct 2014. See also:

6 The Forward View into action: Planning for 2015-16, NHS England, Dec 2014. See also:

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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