As the remaining 135 Clinical Commissioning Groups (CCGs) throughout England begin to hold virtual meetings in public and publish Governing Body papers once again, it is becoming clear that many face daunting financial pressures.
Even the limited number of CCGs that have published up to date information show deficits from 2019-20 combining with historic underlying deficits to total almost £1 billion, even before the costs and dislocation of the Covid epidemic are included.
While many CCGs have either not met, or not published any up to date financial figures in the last few months, a quick snapshot survey of CCG websites by The Lowdown (May 25) has revealed at least 13 CCGs with deficits or underlying deficits in excess of £20m (and totalling £654m), including:
- Staffordshire and Stoke on Trent £76m,
- Cambridge and Peterborough £75m,
- Surrey Heartlands £62m,
- North West London £51m,
- Derby and Derbyshire £56m,
- North Central London on £46m,
- both North Yorkshire and Shropshire on £45m,
- and Cheshire on £41m.
- Bristol, North Somerset and South Gloucestershire CCG (BNSSG), faces the biggest problems, with an accumulated debt of over £117m (approx. 5.9% of in year allocation) at the end of the 2019/20 financial year, according to its chief executive Julia Ross.
She has told local campaigners from Bristol Protect Our NHS that while hospital trusts have had a total of £13.4 billion of loans effectively written off, the same approach has not been taken with CCGs, and “NHS England has not published formal guidance for resolving their historic deficits.”
These deficits seem certain to result in fresh efforts by CCG bosses to drive through additional savings, which we have seen in so many areas are likely to include “demand management” – restricting access to care.
Pandemic funding
Extra funding has been promised to trusts and CCGs to cover the inflated costs of the epidemic itself; but it’s not clear how long this will go on, and there has been no increase in the core cash allocations to the NHS above the inadequate £33.9 billion that the Johnson government has written into law by 2024.
This will go nowhere near the costs of getting the NHS back on an even keel, or tackling the massively rising waiting list.
NHS England’s Operational and Planning Guidance for 2020/21 published in January did make clear that some of the larger CCG deficits (over 4% of allocated budget) could be reduced by up to 50% (on a case by case basis).
However this would be only on condition that each CCG tackles the underlying issues that caused the overspends, to deliver in-year financial balance, and also sticks to the agreed repayments.
No help for biggest problems
In other words the CCGs with the largest deficits would have to make substantial cuts in spending in order to get any help at all, and those with deficits below 4% would get no assistance.
BNSSG is the biggest of the CCG deficits revealed so far, but far from the only CCG facing major financial pressures.
Of course CCGs that are preoccupied with cutting back on spending will not be able to respond to NHS England’s stated desire to begin to reopen thousands of closed hospital beds and restart elective services, to begin the herculean task of reducing the bloated waiting list, which is estimated to top seven million by the autumn.
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