nurse photoThe nursing workforce increased by almost 9,000 over the past six months to nearly 315,000 – the highest on record, according to research by The King's Fund. 

The report, analysed by Onmedica, warns that cracks are beginning to appear in NHS performance as a result of the growing financial pressures and rising demand for services. 

Although the A&E waiting time target was just met over the quarter (April – June) when all types of unit are included. The report shows that 4.9 per cent of patients spent four or more hours in A&E over the last quarter - the highest level for this time of year since 2004/05.

But the hospitals with major A&E departments have now missed the target for 51 weeks in a row. Meanwhile, more than 3 million people had waited at least 18 weeks for hospital treatment at the end of the quarter, the highest number since 2008. During the quarter April-June, 9.9 per cent of inpatients waited more than 18 weeks for hospital treatment, the highest level since early 2011. The number of patients waiting more than six weeks for diagnostic tests stood at more than 18,600 at the end of May 2014, an increase of nearly 12,000 on the same month last year.

This report shows that a quarter of NHS trust finance directors surveyed are forecasting a deficit in 2014/15 – the highest since the King’s Fund began reporting this information in 2011. The average cost improvement target set by trusts for 2014/15 is 4.7 per cent, and only 40 per cent of finance directors are confident of meeting their target.

The report also finds worrying inconsistencies between the plans of hospitals and clinical commissioning groups (CCGs). While 55 per cent of CCGs surveyed are planning a reduction in emergency admissions, only 8 per cent of NHS trust finance directors are working on this basis. CCGs are also forecasting less elective activity, with only 32 per cent expecting an increase in planned treatment compared to 69 per cent of trust finance directors.

John Appleby, chief economist at The King's Fund, said: “Our latest quarterly report paints a picture of a service under huge pressure, with cracks beginning to appear in NHS performance. It once again underlines the need for new funding if services are to be maintained.

“The increase in the nursing workforce signals a very welcome commitment to improving care, although it remains to be seen whether hospitals will be able to sustain current staffing levels when money becomes tighter later in the year. The disparity in the plans of providers and commissioners points to a worrying mismatch between activity and funding, which could have serious financial consequences.”

Dr Mark Porter, BMA chair, said: "The NHS has now endured several years of under-investment and the system is starting to buckle. Growing queues in our GP surgeries and emergency departments are the daily reality for many patients now.

"We cannot continue to meet rising demand on our NHS with under-funding, without the quality of patient care being affected.

"The BMA has criticised the move from planned services to a market economy in healthcare. This report demonstrates the disconnect between those commissioning services and those delivering them, leaving the NHS - and ultimately patients - vulnerable to the effect of large gaps opening up access to services."