North East and Yorkshire
The ICS website is preoccupied above all with its change of name (from Humber, Coast and Vale) and “producing a brand that is able to be reproduced cost-efficiently”. The shadow board set up in advance of the legislation has published no papers.
A tantalising Hull CCG March Board report on performance and finance (“Part 1”) breaks off without giving any information at all, and there is apparently no Part 2. Minutes of the CCG’s January meeting hint at rows to come over debts in one part of the ICS and surpluses in the other:
“… The net cumulative brought forward deficit for this ICB that would be written off if we could live within the resource allocation for those two financial years would be £96m. The Chief Finance Officer had raised the fact that there was a significant deficit in the North Yorkshire side of the patch but there was a big net surplus sitting with the Humber side that came from the PCTs as the Health and Social Care Act 2012 was implemented ….”
Meanwhile Hull University Hospital Trust has been told it does not have the workforce or capacity to reduce crowding in the hospital or reduce length of stay. (p3)
And on the other side of the Humber North Lincolnshire and Goole FT spent £51m on temporary staff in the nine months to December 2021, up by 24% from the previous year, and has a draft £32m deficit (p145).
This enormous coast-to-coast ICS spans 13 distinct “places” to which commissioning is at least partially delegated: ICB North Area (5 Places): ∙ North Cumbria ∙ Gateshead ∙ Newcastle upon Tyne ∙ North Tyneside ∙ Northumberland; ICB Central Area (3 Places): ∙ County Durham ∙ South Tyneside ∙ Sunderland; ICB Tees Valley Area (5 Places): ∙ Darlington ∙ Hartlepool ∙ Middlesbrough ∙ Redcar & Cleveland ∙ Stockton-on-Tees.
The extent to which this system can be regarded as in any way “integrated” remains to be seen, especially as the various trusts are required to grapple with a projected ICS deficit of £240m (p34).
Among the many local issues, North Cumbria CCG is emerging from 2021-22 with an “agreed deficit of £13.9m” as a problem for the new ICB (p133).
Cumbria, Northumberland, Tyne and Wear Foundation Trust Board approved a final financial planning submission, recognising delivery of financial break-even included delivery of a £24.7m reduction in planned spending levels.” (p10)
North Cumbria Integrated Care Trust’s April Board papers publish figures from February noting that while the Trust had over achieved by £1.8m against its £10m full year savings target: “The underlying position remains challenging …. “The Trust’s underlying deficit based on pre covid income being over £100m per annum.” (p52).
South Tees Hospitals FT May Board report dated May 3 warns: “At Month 12 the Trust reported a deficit of £23.4m, which was in line with the year-end forecast position agreed with the NHSE/I Regional Team….” (p105)
It goes on to state the overall deficit for the financial year 2021/22 was £30.9m (p107) … And the plan is for much of the same in 2022/23:
“The Trust’s plan for the 2022/23 financial year is a deficit of £29.6m… The plan has been developed in conjunction with the NHS North East and North Cumbria ICB….” (p111)
Even this result depends on additional funding: “due to the Trust’s underlying deficit position and PFI contract obligations, the plan assumes receipt of PDC cash support totalling £27.2m over the course of the financial year.” (p113)
South Tyneside and Sunderland FT’s draft financial plan for 2022/23 has deteriorated from a previously reported breakeven position, to a final draft of £20m deficit, predicated on delivery of a £13m CIP. (p34)
Serves a population of 1.5 million, in five local Places (Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield). The ICS hasn’t quite got the post-pandemic austerity message, and has drawn up a bizarre and ambitious list of capital developments it would like to see:
“In anticipation of future capital being made available by government, the ICS has identified £445m of investment requirements covering all aspects of primary, acute and mental health services.” (p61)
By contrast Doncaster CCG has a neat summary of the threats in 2022/23 in its May Governing Body papers:
“[Chief Financial Officer] Hayley Tingle delivered a presentation on the financial plan for 2022/23 and talked through the positions for Doncaster, Rotherham, Sheffield and Barnsley. …” concluding that “The total deficit for CCGs (Commissioner & Provider) is – -£143.7m”
Doncaster and Bassetlaw Teaching Hospitals April Board papers revealed the tensions behind the scenes as trusts are pressured to seek savings that they don’t believe are viable:
“the Trust’s draft financial plan was a £29.7m deficit. However, in the context of the South Yorkshire ICB being a national outlier in terms of its level of deficit compared to peers, organisations were asked to reduce the level of deficit in plans further. …. As part of this process the ICB requested a reduction in the deficit for the Trust to £20.3m (a £9.4m reduction).
“Following these meetings and discussion at Executive Team, it is proposed that the Trust reduce its deficit gap to £25m (£4.7m movement, half of the requested value) …
“The Executive team did not deem the Trust could deliver the full £9.4m reduction requested by the ICB without this potentially impacting on delivery of the national activity and quality requirements in the planning guidance.” (p271)
Other papers in the pack reveal that the initial projected deficit was even higher: “Overall, the 22/23 budget (based on the approach set out in this paper) shows the Trust has a deficit of £44.3m before CIPs, £25m after 4% CIPs/efficiency” (p276)
The same papers include a very useful summary of the state of play of other trusts and CCGs, showing an ICB proposed position of £76.5m deficit, including £5.3m at Rotherham FT, £23.6m in Sheffield CCG and £10m at Sheffield teaching Hospitals. (p274)
Barnsley Hospital FT Board April papers note a real financial deficit concealed by non-recurrent additional funding, resulting in a draft plan submission of a £20m deficit, £13m of which “is outside of the Trusts control, as a result of either ICS funding decisions or national inflationary pressures. The remaining £7m pressure is as a result of ongoing Covid-19 patient numbers being significantly above summer 21 levels at circa 20% of the Trust bed base.” (p138)
West Yorkshire and Harrogate Health and Care Partnership covers 2.7 million people in five “places”: Bradford District and Craven; Calderdale, Kirklees, Leeds and Wakefield. It no longer includes Harrogate, which is now covered by Humber and North Yorkshire ICS.
An HSJ survey reports confirmed initial plans include a £121m gap, while Leeds Community Healthcare Trust has “warned in board papers that it could be asked to ‘improve [its] planned position… delivering a surplus to mitigate deficits elsewhere’.”
Wakefield CCG admits that the numbers waiting for treatment at Mid Yorkshire Hospitals Trust, at close to 40,000, exceeds NHS capacity and has led to increased use of private providers:
“Work continues with the independent sector providers to establish what is required across West Yorkshire Association of Acute Trusts (WYAAT) for the 2022/23 contract. …
“… Elective Inpatient activity – there has been an increase in Month 6 … this is largely due to the Independent Sector but there has also been an increase in activity at Mid Yorkshire.”
Leeds CCG reports: “Other places across WY are indicating more material deficits. Leeds’ risk of £15m is in the context of an overall larger gap across the WY ICS at this early stage of planning. Work is ongoing with the intention to close this gap and submit a balanced ICS position for the national deadline.”
Bradford & Craven CCG March papers project an underlying CCG deficit of £21.6m being taken into 2022-23 (p53) along with local trusts £23.8m bringing the total ‘place’ deficit to £45.4m (p55).
Calderdale & Huddersfield FT May 5 papers, in minutes from March 3 meeting, warn of “£43m challenge for 2022/23 of which £20m is an efficiency challenge (CIP), leaving a £23m deficit.” (p15)
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