NHS reality check 2017: Delivering care under pressure

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The Royal College of Physicians’ (RCP’s) NHS reality check: Delivering care under pressure gives a voice to over 2,100 doctors and NHS teams who are overwhelmed by rising levels of demand in hospitals that operate with no slack. Our 2017 report highlights doctors who describe themselves as ‘continuously firefighting, papering over the cracks and hanging on by their claws’, and explains in stark terms what this means for patient care.

Key recommendations

NHS and social care funding

NHS and social care funding NHS and social care budgets have not kept pace with rising demand for services. We need a new financial settlement that:

  • sets realistic targets for efficiency savings
  • invests in the long-term sustainability of the NHS and social care, putting an end to a cycle of short-term planning.

Service transformation

Investment in community and social care provision will ensure that people get the right care, in the right place, reducing avoidable hospital admissions and delayed transfers of care. We need:

  • a significant increase in investment in social care, specifically better stepdown provision to facilitate patients’ transition out of hospital into community or other care settings
  • to allow time in job plans for physicians to build links across teams and settings, and to collaborate and innovate
  • to ensure that sustainability and transformation plans (STPs) reflect current need as well as future aspirations, with doctors contributing to future planning through their local STP.

Prioritise public health and prevention

Supporting people to live healthier lives will reduce avoidable illness and help to keep people out of hospitals. We need to:

  • adopt progressive public health policies, including upstream measures designed to promote healthier lifestyles – for example, using tax mechanisms as a means to reduce overconsumption of alcohol, unhealthy food and drinks, and cigarettes
  • invest in prevention by reversing the cuts to the local authority public health allocation.

Invest in, support and value the NHS workforce

The UK does not train enough doctors, and hospital teams are under increasing pressure from staffing gaps. We need to:

  • ensure that overall training numbers are sufficient to deliver enough doctors across all parts of the medical workforce, from GPs to physicians
  • realign the workload balance across the medical workforce, and create ways to incentivise work in acute and general medicine

Delivering care under pressure

By the end of the 2015/16 financial year, NHS providers logged a record deficit of £2.45 billion, with funding having slowed to an annual growth of just 1.2% a year. Put simply, while the NHS budget has been protected relative to other government spend in the past 5 years, patient need has continued to outpace resources.

As part of the NHS reality check report we asked our members to tell us about their experiences on the front line of care delivery. Shining through their stories is the dedication of a profession deeply concerned about the future of the NHS, but determined to keep the ship afloat. Attention is often focused on the pressures on hospital emergency services, but our evidence shows that doctors providing care across the medical spectrum – in services that are the backbone of hospital care – are struggling to cope.

Speaking out and raising concerns

The RCP is clear that the NHS is currently underfunded, under doctored and overstretched. Patients and NHS staff deserve better; we need a new plan for health and social care. A plan designed to meet the UK’s health and care needs in the long term, and to value, support and motivate NHS staff.