According to NHS England, more than half (23) of the 42 Integrated Care Systems (ICSs) in charge of commissioning services have “Significant support needs” as they struggle to meet financial, operational, or strategic targets.
They fall into Segment 3 of NHSE’s NHS Oversight Framework, effectively the NHS ‘naughty step’.
Only one ICS – Frimley – is assigned to Segment 1, and considered to be high-performing across all of the six broad criteria set by NHS England (which break down into a much larger number of metrics against which ICBs and providers are judged.)
Four ICSs (Devon, Hampshire & the Isle of Wight, Norfolk & Waveney, and Shropshire, Telford & Wrekin) have been rated in the worst performing Segment 4, described as having “Very serious, complex issues manifesting as critical quality and/or finance concerns that require intensive support.”
Falling off the naughty step into the lowest Segment 4 is supposed to trigger a range of interventions, with NHS England “reviewing the capability of the ICS’s leadership,” which “may lead, if necessary, to changes to the management of the system.”
Problems lurch from bad to worse in King’s
NHS England “will consider” whether long-term solutions are needed to address any structural issues affecting these ICSs’ ability to ensure high quality, sustainable services for the public, and will appoint an “improvement director,” who will act on their behalf and support the ICS to develop an improvement plan.
This comes with a whole raft of additional requirements, restrictions on spending, and bureaucratic measures. However, there has been little evidence so far that these interventions materially assist financially-compromised organizations.
Similar NHSE ratings show that Trusts are generally performing much better than ICBs: 30 of the 209 trusts make it into the best-performing Segment 1, of which two-thirds (20) are community or mental health trusts, with only six acute hospital trusts making it into the top tier.
Just over a third (36%) of trusts are relegated to the problematic Segment 3, and require external intervention, compared with 40% (84) in Segment 2, where they are judged to have local-level support in tackling problems.
And although 19 trusts are in the most challenged Segment 4 (because they have “significant support needs against one or more of the five national oversight themes” and are “in actual or suspected breach of the NHS provider licence”) this is a similar percentage to the ICBs in the same boat.
Over half (11/19) of the most troubled trusts failing on finances or quality concerns are located in, or strongly linked with the 4 most troubled ICSs.
Two of the others are ambulance trusts, South Central and South East Coast, while the remaining six trusts have become familiar names over the years for financial or other problems. They are Barking Havering and Redbridge Hospitals in North East London, East Kent Hospitals and Medway Hospitals in Kent, Greater Manchester Mental Health, and Nottingham University Hospitals and University Hospitals of Leicester in the East Midlands.
The detailed data on exactly where trusts are failing to meet required standards, and by how much they are failing has not been published. The combination of financial and other measures means that there are many reasons why trusts and ICSs can fall short even where the finances are relatively under control.
But with the whole of the NHS under pressure to deliver large-scale financial savings, the extent to which any of the more challenged trusts can dig themselves out of the holes they are in must be limited.
Many will be hoping that the impending election will shape ministerial decisions and that the traditional relaxation of financial pressures on trusts in an election year will allow them to weather the storm – and hope for better times to come.
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