NHS may 'break' due to large patient demand and is 'poorly placed' to cope with an ageing population, warns spending watchdog

The NHS has become less efficient and may 'break' before it can deliver the standard of care patients expect, the spending watchdog has warned.

In a damning report, the National Audit Office yesterday cast doubt on the health service's financial sustainability and stressed it is poorly placed to cope with an aging population.

It highlights how recent increases in funding have not delivered an equivalent boost in output and laments how productivity still lags behind pre-pandemic levels.

Officials say the scale of the challenge facing the NHS is 'unprecedented' and there is a 'growing mismatch' between demand for care and funding.

The government can no longer rely on the NHS to deal with the nation's increasing ill health without it becoming 'much bigger and more expensive', the report adds.

Ministers must instead work across departments to reduce demand and implement measures that prevent people from getting sick in the first place.

This may include encouraging more exercise and better diets.

The report references previous research by the Health Foundation think tank, which estimates 9.3million people in England will have a major illness in 2040 - up 39 per cent from 6.7million in 2019.

It warns that failing to cut demand or significantly increase funding will mean 'service levels will continue to be unacceptable and may even deteriorate further'.

The authors add: 'We are concerned that the NHS may be working at the limits of a system which might break before it is again able to provide patients with care that meets standards for timeliness and accessibility.'

In 2023/24, many NHS bodies failed to break even and integrated care boards, which manage the health service locally, ran up a deficit of £1.4billion - double what was anticipated.

Wes Streeting declared the NHS 'broken' on his first day as health secretary and launched a review to guide Labour's ten year plan.

He has also stressed additional funding is conditional on reform.

The NAO said the NHS's financial position is getting worse and blamed a failure to invest in crumbling hospitals and equipment.

It also said inflationary pressure and the cost of recovering from the Covid-19 pandemic are also factors.

In a gloomy assessment, it says: 'NHS performance has been well below what patients have been told to expect, despite NHS England revising some performance targets downwards.

'The timeliness of NHS treatment is generally poor.'

Among the NAO's recommendations is a call for the Department of Health and Social Care, NHS England and ICSs to 'intensify their efforts to manage current and future demand for healthcare by preventing more serious ill-health'.

It said there is scope for NHS England to 'make better use' of its funds, but long-term sustainability depends on how the Government addresses the 'steeply increasing demand for healthcare'.

Elaine Kelly, head of economics research at the Health Foundation, said the NAO report 'paints a picture of systemic failures and inefficient decision-making – including low spending growth, chronic under-investment in capital, and a culture of agreeing to unrealistic targets.

'For patients, this has contributed to longer waits and reduced satisfaction with the health service.'

Ms Kelly warned 'pressures on our fractured health service will only increase'.

Siva Anandaciva, chief analyst at the King's Fund think tank, said the report 'should act as a warning to politicians of the tough decisions yet to come'.

'Deep financial deficits have now spread widely across the NHS and are having a substantial impact on patients,' he added.

Saffron Cordery, deputy chief executive at NHS Providers, which represents NHS trusts, said: 'This report highlights the significant strain on NHS trusts as they continue to grapple with compounding financial pressures, including the cost of industrial action, inflation, workforce pressures and a deteriorating estate.

'Despite trusts' best efforts to deliver record levels of activity last year, NHS productivity has struggled to rebound to pre-pandemic levels.

'Ever-rising demand for healthcare will also mount further pressure on the health service.

'In the face of these unprecedented financial challenges facing the NHS, trust leaders want and need to see greater emphasis on long-term investment.'

A Department of Health and Social Care spokesperson said: 'The NHS is broken.

'Not only has this government inherited the worst economic circumstances since the second world war, but also an NHS in deficit. Getting the NHS back on its feet is our priority but it will take time.'