Demands on its services are at an all-time high and will grow inexorably in years to come as numbers of frail elderly increase.
At the same time, budgets have remained at best broadly flat – but in the hospital sector they have fallen in real terms since 2009.
The “perfect storm” means the old NHS model based on hospital-centred care is showing its age and becoming unaffordable.
The cash crisis is such that NHS England forecasts £30 billion of efficiencies will be needed between 2015 and 2021 on top of £20bn saved from 2010-15.
Increasing difficulties facing GPs, who deal with around 90 per cent of NHS patient contacts, a general failure to develop health services in the community and modern demands for instant access are also piling pressure on hospitals.
It is estimated by 2025 numbers of people with long-term conditions – among them dementia, diabetes and strokes – will rise to 18 million across the UK, taking up 50 per cent of GP appointments, 65 per cent of outpatient consultations, 70 per cent of inpatient bed days and 70 per cent of health and social care spending.
Emergency departments have for the most part seen major increases in demand putting increasing strain not just on the “front-door” of hospitals. More people are being admitted to hospital, many with illnesses of old age, which do not need specialist expertise.
One survey at Rotherham’s hospital found 98 patients who had been treated for more than seven days – 62 per cent – did not need to be there.
Yet huge cuts in social services budgets – councils have suffered reductions of 25 per cent – mean many face delays returning home.
Cracks are beginning to show. Five of the 15 NHS trusts running acute hospitals serving the region are certain to be in debt by the end of March.
Part of this lies in increasing costs of extra nursing and medical staff in the wake the Mid Staffordshire scandal, while further heavy costs are expected from a move to seven-day working.
Meanwhile longer waits in A&E units have been a major problem for the last 18 months.
The problems are leading health chiefs to consider radical solutions which will significantly alter the role of district general hospitals – the local and much-cherished symbols of the NHS providing care from the cradle to the grave.
It is hardly surprising such changes are controversial – proving Aneurin Bevan’s maxim about the NHS that “it will last as long as there are folk left with the faith to fight for it”.
In Yorkshire, there will be different solutions. Some may involve wholesale changes to hospital services -– such as those which will see Dewsbury lose services including full A&E and maternity care – but others are likely to be more gradual, recognising it will take time to build community services.
Siva Anandaciva, head of analysis at the Foundation Trust Network, said the financial position was “rapidly deteriorating”. He said: “We knew 2013-14 and 2014-15 were going to be tough years financially but the pace that it’s getting tighter is quite stunning.”
At the moment a “more for less” funding approach risked rationing of care largely through longer waiting times and “gradual service decline”.
A new payment system was required for urgent and emergency care which together incentivised hospitals, ambulance services and GPs, while a longer-term approach was needed to planning so that NHS trusts knew what their budgets would be for up to four years and could plan rather than move from year to year.