North West

Cheshire and Merseyside Health and Care Partnership covers the 2.7m people in the nine local authority areas that make up Cheshire and Merseyside.

Most recent Cheshire CCG and Cheshire & Merseyside joint CCG meetings have focused only on 2021-22 finances and not addressed NHS England’s Delivery Plan or the financial pressures to come in 2022-23. 

There is more honesty in Mid Cheshire Hospitals Trust board, which discussed ICS Revenue Allocations 2022/23 at its April Board meeting, and noted:

“The system has £183m less resource than in 2021/22, which is a 3% reduction in funding after inflation has been applied. There are several factors which are influencing the movement and some key risks to receiving the funding in full. 

“1. Convergence: C&M funding levels are currently above its calculated target allocation by £338.5m, and has a target to reduce this over time, leading to the additional reduction of £51.67m. 

  1. Elective Recovery Fund (ERF): The system at present only has access to 1 funding stream which is based on the performance standards which must be met before the funding of £91m is issued to Trusts. 
  2. COVID funding: COVID funding has been reduced by 57% in 2022/23 in recognition of the reduced covid activity within healthcare settings. 
  3. Winter & Hospital Discharge planning: the system is not expecting any additional funding to support hospital discharge planning or supporting Winter schemes.“

Draft Financial Plan The approach has been taken to work as a system to generate the initial draft financial plan, a £219m deficit, which is summarised in Tables 2a and 2b.” (p127)

The Trust itself is a significant part of the problem, after submitting a deficit plan of ‘circa £25m,’ noting the changing financial landscape for funding in the NHS: 

“MCHFT was in receipt of both system top up and covid funding totalling £50.5m. In addition, along with other organisations in Cheshire & Mersey it also received additional funding of £9.6m which honoured the requirement to break-even. When this funding is removed along with other non-recurrent items, as outlined Above in Table 4b – this takes the Trust to an underlying deficit of £62.8m.” (p130)

St Helens & Knowsley Trust minutes of March Board meeting reveals its draft financial plan for 2022/23 gave a deficit of £34.1m. Of this, c.£16.7m relates to income shortfalls, £19.4m relates to national pressures, £11.4m relates to system pressures and £5.1m relates to local pressures. These pressures are partly offset by assumed CIP of £18.5m (3.5%). (p9) However the April Board report revised the deficit down to £24.5m (p44)

Wirral University Hospital Trust (April Board papers) forecast a £17.4m 2022-23 deficit, assuming Elective Recovery Funding £15m and a cost improvements of £20.8m of which £13.8m to be recurrent. “The biggest areas of cost pressure are Emergency Department staffing, ward cover and high cost drugs.” P144

Warrington and Halton Teaching Hospitals Trust has also forecast a £19.2m deficit in 2022-23, with “further work required before final submission in April 2022.” (p59)

It would be worse: with “all system top up and all cost pressures included, currently deficit is £83m.” (p182)

Southport & Ormskirk Hospitals Trust May forecast:

The financial plan for 2022/23 was presented with an overall deficit of £20.5m. … 

“The context of the organisation’s plan is that Integrated Care System (ICS) is still planning a significant deficit for 2022/23, which may well impact on the system’s ability to attract both revenue and capital resources.” (p170

Greater Manchester Health and Social Care Partnership: covers 3.1 million people in the ten boroughs of Greater Manchester, and has been devolved as a largely self-governing sector of the NHS since 2015.

However it does not live up to the claim that “as a partnership, we want to make sure we do things properly, and as efficiently and transparently as possible.” It does not publish any board papers and gives no detail at all on the current state of play of services in the area. Most of the website is well out of date.

Nor can any up to date information be found on the website of the largest acute provider the Northern Care Alliance, whose April Board papers – despite over 500 pages of documentation – include no financial projection for 2022/23.

There are some clues that all is not well in March board papers from Bolton Hospital FT which reports a sharp deterioration coming, from break-even in 2021-22 to a £45m in-year deficit for 22/23 in year deficit before any cost improvement (CIP). The trust is expected to deliver 5% savings (£20m) this year, (2% non-recurrent (= £8m) 3% recurrent (= £12m). However: “Even with £20m CIP, 22/23 deficit is £25m” (p153).

Lancashire and South Cumbria: The system covers a region made up of five local areas (Central Lancashire, West Lancashire, Pennine Lancashire, Fylde Coast, and Morecambe Bay) with a population of around 1.8 million.

East Lancashire & Blackburn with Darwen CCGs in a joint meeting in March expressed concern at prospect of a £90m deficit budget for the ICS in 2022/23, of which £30m relates to financial inflation, noting “It was nationally recognised that all ICBs will be posting a deficit plan.” (p5)

The shadow ICS Board has been warning since the end of 2020 of the threat of a truly massive deficit, with Feb 2021 forecast concluding : “all in all the implication of the guidance is that L&SC could be in deficit somewhere within a range of £240m to £340m”.

The ICS Board’s January 2022 meeting was more focused on the need for massive levels of investment: “We need in excess of £3bn investment in our infrastructure over the next 10+ years. The cost and availability of national public funding for all of this remains uncertain.” (p32)

University Hospitals Morecambe Bay heard in March that: “… the [ICS] plan leaves a significant CIP requirement … with 5% being asked from each organisation. The system gap was £370m, but adjustments and additions resulted in an improved position of £90m deficit, significantly as a result of not funding cost pressures and deploying growth allocations etc. … After excess costs of inflation of £30m which the system cannot cover there was £123m of efficiency saving apportioned across the organisations.” (p182)

The Trust’s own 2022/23 plan began with a projected £152.6m deficit but has been revised downwards to a £44.3m deficit (p234).

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