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Monitor report highlights pressure on foundation trust A&E services

Overall, the NHS foundation trust sector continues to perform well in the challenging healthcare climate in terms of delivering services for patients and sound finances.

However, Monitor is concerned that there has been a significant increase in the number of trusts failing to meet patient accident and emergency waiting times in Q3. At Q3 more than twice as many trusts (32) have failed to meet this target compared with this time last year (14).

Outbreaks of the winter vomiting bug, discharge delays due to problems accessing community care services, and increased attendances among elderly people were reasons cited by the trusts. These were in addition to the expected seasonal demand.

Of the foundation trusts with an A&E department 36% missed the A&E target, compared with 8% in the previous quarter and 16% in the same period a year ago. Early indications are that pressure on A&E is likely to continue in Q4.

Monitor remains concerned that a small number of trusts continue to miss other waiting times targets, but these are not the same trusts each quarter, and overall the trend across the sector is improving.

We work closely with the Care Quality Commission (CQC) and follow up any concerns it raises about clinical care in foundation trusts. The number of trusts with moderate CQC concerns rose in Q3 (from 15 to 20). Major concerns that might trigger Monitor’s enforcement action were reported at two trusts, compared with one in Q2.

Stephen Hay, Managing Director of Provider Regulation said: "There is a greater demand for A&E service across the NHS, but it is not acceptable that patients have to wait longer.

"Trusts need to work with local healthcare partners to understand and address these issues."

The regulator also remains concerned that only one in four foundation trusts are delivering the cost savings they said they would make this financial year. For the third quarter in a row, delivery of cost savings was substantially behind plan and the cumulative slippage amounts to 16% (£173m) of the total savings planned (£1.07 billion) for the year to date.

Stephen Hay commented, "It is important for all trusts to make sure they deliver cost savings in this tight financial environment, while maintaining and improving the quality of care for patients. Monitor has regularly reminded trusts of the importance of making savings early in the year to prevent problems being stored up for later."

Despite this overall shortfall on planned cost savings, financial performance remains ahead of plan at quarter three with an overall surplus of £365 million. Revenue is 2% more than expected because of increased demand for hospital services.

The number of trusts in deficit in Q3 fell to 19 (from 26 in Q2), although the total amount of their deficit rose from £90m to £112m – largely driven by the five most financially-challenged trusts (Peterborough, Morecombe Bay, Sherwood Forest, Mid Staffordshire and Bolton foundation trusts).

The sector is on track to be in surplus by the end of the year and will therefore have available funds to reinvest in improving the quality of services for patients.

Notes to editors

  1. For media enquiries contact Nick Burke, Press Officer, on 0207 340 2434 (nicholas.burke@monitor-nhs-ft.gov.uk)
  2. This third quarterly report for 2012/13 summarises the key trends drawn from individual reports of the 144 trusts authorised for foundation trust status up to 30 September 2012.
  3. Monitor is the sector regulator of NHS-funded health care services. Under the Health and Social Care Act 2012 its fundamental duty is to protect and promote the interests of people who use them. Information about Monitor's new role can be found here.
  4. Follow us on Twitter - @MonitorUpdate
  5. Unlike NHS trusts, which are expected to break even every year, NHS foundation trusts have more freedom to run their own affairs. Monitor assesses the financial health of foundation trusts on their performance in the medium term and does not require them to break even each year. They are therefore allowed to run a short term deficit, and from a business perspective this can be an acceptable method of managing their finances.

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