The NHS is in danger of a sharp decline in its services around its 70th birthday next year, with the risk of the quality of care becoming precarious, the health service’s regulator has warned.
The Care Quality Commission said staff shortages, rising demand and increasing numbers of patients with preventable illnesses meant services were straining at the seams.
An increase in the number of older people who are frail, many with dementia and have multiple long-term conditions, was placing unprecedented pressure on the system, it added.
“Quality is being maintained in the face [of this] ... and that is due to the dedication of staff but the future quality is precarious,” said David Behan, the CQC’s chief executive.
Examples of pressure in the system include the fact 2.5 million people spent longer than four hours in A&E in 2016-17, up from 1.8 million the previous year. Hospital bed occupancy reached record levels of 91.4% this year.
Behan said the NHS was in need of modernisation and it had been created almost 70 years ago when the big issues were diseases such as TB and polio.
“Today, the NHS and social care are dealing with obesity, diabetes, coronary heart disease, cancers, dementia. All of which are driven less by those diseases of the middle of the last century and more by lifestyle choices.”
He continued: “We are living longer but are not living healthier so I think what we are signalling is that the system now and into the future has got to deal with those increased numbers of older people who are going to have more than one condition.”
The CQC warning has prompted concern among politicians and health experts. The Lib Dem health spokesman, Norman Lamb, said: “Our NHS and care services are surviving on borrowed time. Unless the government gets to grips with this funding crisis, the quality of patient care will suffer in the years ahead.”
John Appleby, the director of research at the Nuffield Trust, said the report showed the system was struggling to cope and that the warnings must be seen in the context of the unsustainable financial squeeze.
Winter is coming and the situation in the NHS is desperate
The CQC said there had also been substantial rises in the number of patients needing care. As well as coping with new demand, the service is working with insufficient staff numbers in some areas. The watchdog noted that the number of vacancies across all NHS settings rose by 16% in the year to April 2017.
The CQC report is based on its inspections of hospitals, ambulance services, GP surgeries and mental health care in England.
The quality of care was maintained in the last financial year largely because of staff efforts, it said, but added that staff resilience was not inexhaustible. It said some services previously deemed good were deteriorating and two-thirds of hospital A&Es were not performing well on safety.
The report highlighted problems in adult social care, with the number of beds in nursing homes falling by 4,000 in two years. The CQC said long-term funding continued to be a problem, despite the government investing £2bn into the social care system.
Behan said: “The future of the social care system is one of the greatest unresolved public policy issues of our time – a long-term sustainable solution is urgently required.” He added that the number of nurses in nursing homes was “clearly insufficient”.
The number of older people with unmet care needs rose to 1.2 million, up from 1 million the previous year.
The health minister, Philip Dunne, said the report recognised that the “vast majority of patients” were receiving good care and that many parts of the NHS had improved.
“We are determined to make the NHS the safest healthcare system in the world and are investing in more staff and in services – including £2bn extra for social care, £1.4bn to improve young people’s mental health services and an extra £100m this winter to help A&E departments cope with demand,” he said.
Dr Chaand Nagpaul, who chairs the British Medical Association council, said: “It is certainly encouraging to see that the NHS is providing good levels of care for patients, particularly in general practice where we know that GPs are consistently under enormous pressure, but it is worrying that almost one in four acute hospital services and almost a quarter of mental health services are having their performance affected by lack of resources, system pressures and chronic underfunding.
“We are just one bad winter away from another crisis in our health system. The government should urgently bring spending on health in line with other leading European economies and produce a long-term strategy that addresses the fundamental workload and funding challenges that are overwhelming our health service.”
The NHS marks its 70th birthday next July.