Buckinghamshire, Oxfordshire and Berkshire West (BOB)
Neither the CCG nor BOB ICS publish any useful information to gauge the financial situation for 2022/23. However two of the three major acute trusts are more forthcoming.
Oxford University Hospitals FT: March papers
“The Board is asked to comment on the draft finance plan which indicates that the £47m underlying deficit can be covered by underlying income. However, there is no clear source of funds for investment (other than in elective recovery) and agreed business cases may need to be delayed to achieve breakeven.” (p2)
“7.1. The Trust ended 2019/20 with an underlying deficit of £45m. We estimate, after removing one-off items, the equivalent figure at the end of 2021/22 is £47m. (p11)
“7.8. The ICS has made a “flat cash” proposal to its providers which incorporates all the variable elements of the ICS funding into a single cash offer. (p12)
Buckinghamshire Healthcare Trust March Board Papers report:
“The Draft financial plan for 22/23 … currently shows a deficit of £29m. There are additional downside scenario risks outside of the plan in the range of £8m-£10m, which would increase the deficit to £38m if downside risks materialised. In the best case scenario, if additional funding becomes available in line with a genuine “flat cash” offer, this would result in a deficit of £9m. There are two key drivers for the £29m deficit. Total income has fallen by £20m compared to 2021/22 and an additional £9m of investments have been funded.” (p111)
However the Trust has a “Normalised” (underlying) deficit of £67m, so exactly how this is reduced to £29m is left more and a little hazy. (p149)
Frimley Health and Care
Frimley CCG May Board Papers report:
“… the Frimley system’s elective plan was being supported with demand and capacity modelling commissioned by NHS England in the South East and provided by McKinsey and Company.” (p8) Whether this has resulted in any benefit is not clear.
Frimley Health FT however knows it is up against it, and says so in May Board papers:
“The number of vacant hospital beds is probably at the lowest level we’ve ever seen, elective waiting lists continue to grow, and despite the opening of the new Heatherwood Hospital our total elective capacity is severely impacted by patients requiring urgent care and staying with us for longer.
… 2022/23 is probably going to be the most financially challenging year the Trust has ever faced. The Trust is planning for a deficit of £35.4m. This is particularly driven by the ongoing costs of Covid, operational pressures, and inflation which is far outstripping the assumptions made when the NHS funding settlement was agreed last autumn. The deficit of £35.4m is after taking account of a £28.1m (3%) efficiency programme, and an additional £15m of funding from the Integrated Care Board (which it currently hasn’t identified the money for).” (p116)
“… The ICB deficit is £36m which includes the FHFT position. The ICB position will carry a significant £27.9m risk which is the value of the deficit reduced from the draft submission and represents the system gap …” (p119)
Even hitting this target is dependent on non-NHS income:
- …this assumes private patients, car parking (staff and patients) and catering can return to 2019/20 levels …
- Heatherwood: the business case relies on £10m increase in PPU income at a margin of 28%. PPU income is 33% of the overall Heatherwood income value.” (p125)
And the capacity of the Trust to claim a share of the Elective Recovery Fund is limited by the need to repair another dodgy roof, as the HSJ has noted:
“A well-regarded foundation trust expects to lose £9m for missing elective recovery targets in 2022-23, £2m of which is because it needs to close theatres to fix a dangerous roof.
“Frimley Health Foundation Trust expects to carry out 99 per cent of the amount of elective activity it did in 2019-20, short of the 104 per cent target set by NHS England and government in their elective recovery plan. As a result of this, the FT says, it will lose £9m in funding.”
Hampshire and Isle of Wight
The CCG’s May Board Papers don’t beat about the bush: this ICS faces a substantial deficit:
“The financial plan position across the system represents a deficit across both provider and commissioner totalling £105.6m (3.2% of overall allocation). This is an overall improvement since our draft financial plan submission of £60.8m, but this not where the ICS wants to be, and our expectation is to further improve this position.” (p2)
£86.2m of this is down to local providers, £19.2m to the CCG itself.
This deficit is after hugely ambitious efficiency savings amounting to £159.2m (4.6%), of which “we ascertain that at this stage c£66m of this is high risk.”
The CCG estimates “uncontrollable costs” add up to c£65m – such as “inflation; energy/fuel; NICE approval for drugs; cleaning standards; capital charges on investments (basically understood pressures) and some COVID costs which will require difficult choices on spending”. (p25)
Hampshire Hospitals FT in April initially projected a deficit of £25m, but is now proposing submitting a plan leading to a financial deficit of £18.7m, which “is higher than ideally required and certainly contains substantial risks of unidentified saving plans.” (p251)
University Hospital Southampton March Board papers report:
“The underlying financial position excluding ERF remains at c£4m deficit per month once ERF income is excluded. …” (p120)
“The trust has submitted its draft financial plan for 2022/23 indicating a £24.7m deficit. A separate paper provides more detail on the content of this.” (p121)
Portsmouth University Hospitals Trust March board meeting heard the CEO warn: ““During the last few months we have operated consistently at OPEL 4 level. The number of patients we are seeing in the hospital has reached maximum occupancy levels of around 100% on several occasions with an average of 97.3% in February.” (p22)
Isle of Wight May Board meeting heard that the Trust’s deficit is projected as £22.5m (p92) after a reduction in Trust income of £20m compared with 2021/22. (p158)
Kent and Medway
Dartford & Gravesham NHS Trust April Board, hearing the Trust plan for a £5.4m deficit, heard: “Currently the draft plan does not achieve financial balance or all of the Trust operational and constitutional targets.
“The Trust is not alone in its financial and activity position with all acute Trusts in Kent currently showing deficits, (the Trust is the lowest proportionately to turnover) and struggling to achieve the operational targets. The system draft plan is for a £85m deficit and the South East region at a £693m. Nationally many regions also have planning deficits.” (p226)
East Kent Uni Hospitals May Board papers report a “Draft plan for 2022/23 with a £22m deficit position, a challenging financial year ahead impacted by reduced Covid-19 funding and inflation and energy increased costs, including a £30m efficiency target.” (p13)
Maidstone & Tunbridge Wells NHS Trust April Board was told
“A breakeven position was unable to be included in the initial submissions, so a deficit of £9.7m had been submitted.” (p11)
According to the HSJ “all five providers within Surrey Heartlands ICS have submitted plans for deficits – totalling £143.5m in 2022-23, according to board papers.”
Ashford St Peters May Trust Board CEO report warns:
“The financial risks facing the Trust in 2022/23 are significant. The risks are interconnected and have potential to affect many areas including savings delivery, increased costs or income loss;
“… The ICS recently submitted its second iteration of the financial plan for 2022/23, which predicted a deficit of £143.27m. The Trust’s predicted deficit within this, accounts for £24.45m.
It is worth noting that all five NHS providers in the ICS are in deficit. The system deficit position is likely to drive a third set of financial submissions from each component part of the system, including us. Other providers and the system itself will be required to find further efficiencies and opportunities to reduce costs. Overall, the challenge facing both the Trust and the system to achieve a much greater degree of efficiencies is unprecedented.” (p3)
Surrey and Sussex Healthcare Trust March papers predict a deficit of £39.7m due to “a reduction in income that does not allow time to lose costs within the year and underfunding of pay and prices.”
“The budget includes waste reduction plans that see Divisions and Departments returning to spend within their recurrent budgets from 2019/20 … (altogether this will total £17.8m, a 4.9% saving based on 2022/23 income).”
Royal Surrey FT March Board papers also carry the same message: “The draft plan is deficit -£20.0m compared to a current year [2021/22] surplus of £3.6m.”
Sussex Health and Care Partnership
The ICS document Sussex 2025 – Our Vision for the future is 24 pages of non-stop aspirations, not one of which is costed, and with no plan for workforce, leaving many major questions unanswered, especially given the need to cut spending:
“We are currently spending more money than is available to run services and this means we are unable to invest in new innovation and ways of working that would bring real benefits to our populations. We need to change how we run services to ensure we get more value for the money that we spend.”
University Hospitals Sussex Trust May Board meeting reports:
“The Trust has submitted a plan of £12.55m deficit, which solely relates to excess inflation. Consideration of further support for this is being sought by the Trust and Sussex ICS, from NHSE/I.
“… To deliver the £12.5m deficit plan requires the Trust to deliver £44m efficiency savings (3.7% of Trust income)” (p55)
East Sussex Healthcare Trust April 12 Board paper notes that the Trust is effectively being penalised for having increased staffing:
“… changes to the way the Trust was funded for 2022/23 would present a significant challenge to the organisation. The funding would be based on a pre-covid 2019/20 staffing establishment baseline; since then, the Trust had appointed 532 more whole time equivalent (WTE) employees. Many of these additional staff were brought in to improve community services and help manage during the pandemic.” (p16)
The Trust has also just bought up its own private hospital:
“The Trust was due to take ownership of the private Spire Hospital from 1st April, which would be renamed Sussex Premier Health. It was planned that all private patient services, as well as some NHS work, would be brought through the facility. Acquisition of the unit would bolster efforts to recruit and retain clinical staff and would offer patients greater choice. Any profits made by the venture would be reinvested into the Trust’s clinical services.” (p8)
Still to come: London’s five ICSs.
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