In our investigation through the recently published papers from Integrated Care Boards, the factors for rising financial issues included:
There is still chronic difficulty in many areas for hospitals trying to discharge patients for lack of adequate community health, primary care or social care services to support them outside hospital. The result is more beds tied up with patients stuck in hospital: time series statistics show that at an England-wide level, the number of beds filled with 14-day plus patients has remained above 29% for the last 12 months. In many major hospitals, acute bed occupancy levels pile pressure on front-line staff and make any reductions in staff numbers more difficult.
There is a rising number of mental health patients with more complex problems who require admission. However, the NHS depends heavily on the costly private sector providers due to the very low number of inpatient mental health beds within the NHS.
The number of patients needing ‘special‘ care is leading to additional costs, such as the need to assign extra staff from an agency or bank.
The number of the most serious Type 1 A&E patients is again on the increase or at least holding steady in many areas despite decades of seeking ways to divert patients away from A&E. Emergency admissions are increasing but promised increases in hospital beds had not been maintained.
Prescribing costs are also rising, partly due to patients’ growing health needs and partly due to the pharmaceutical industry’s cost inflation and the sky-high cost of new drugs.
The pressure to use private providers further pressure on budgets
Staffordshire and Stoke on Trent ICB, for example, beset by chronic financial problems and newly consigned to the relegation zone (fourth tier of increasingly intensive NHS England intervention and control), sum up the problem by including in their plans for system recovery an attempt to extricate themselves from unnecessary expense and use NHS funds to sustain NHS capacity:
“Considering any further opportunities to repatriate patients from the Independent Sector to NHS Providers, while fully bearing in mind Patient Choice.”
Of course, the private sector, for its part, is keeping up the pressure on ministers to hand over more public money on a longer-term basis, leaving the NHS more impoverished and pressurised.
Key points – ICS financial update
- Due to the number of ICSs under extreme financial pressures and managing deficits, NHS England agreed on new financial targets (control totals) for the end of the financial year (2024/5), which allowed for deficits in many cases.
- Even with an agreed-upon deficit, some ICSs are still off course, with a worsening financial position (variance from control total).
- Each ICS has also been required to improve productivity and make substantial savings. Our researchers across all 42 ICS have target savings totalling around £8bn, with the biggest impact on workforce budgets.
What are the reasons that ICBs give for their financial positions?
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