South West

Bath and North East Somerset, Swindon and Wiltshire

Like many areas, BaNESSW faces real problems with the scrapping of funding to assist with more rapid discharge of patients after treatment. The CCG Governing Body in March noted funding for this had totalled £30m in 2021/22:

“Funding for this additional capacity was currently funded through the national Hospital Discharge Programme (HDP) fund and those monies that had been made available at year end to support the Omicron surge.  This was to discontinue on 31 March 2022, detailed work was underway to look at discharge and capacity plans for 2022-23 to understand the recurring requirements. Difficult conversations were to be held with system partners to consider the choice of investments against the limited allocation.” (p6)

HDP funding is just one of the streams of non-recurrent funding boosts that have been withdrawn or cut back in 2022/23: the CCG CEO’s report states:

“This has manifested itself for BSW in a baseline reduction in funding of £48m particularly in areas such as the Hospital Discharge Programme where we have seen complete cessation of support schemes ceased and with covid where support has halved.”

Despite a “minimal upside” of an extra £3m from convergence measures to get systems closer to their fair shares target, based on the needs of their population, the area is still £18m below target funding.

As a result “The system has struggled to respond to this size of reduction and submitted an unbalanced financial plan with a deficit of £58.6m.”

But while nationally these are “deemed to be ‘acceptable’ deviations from plan,” from excess inflation and non-recurrent covid costs which account for £40.2m of the gap, Regional chiefs are taking a tougher line:

“Feedback from the Region is that they are expecting systems to break even and will be requiring us to take steps towards closing the gap – the challenge for us is how much further can we go towards break even.” (p31)

Swindon’s Great Western Hospital April Board papers note that the problems are widespread:

“An in-depth discussion of the Draft Plan for 2022/23, focusing on the high level numbers. The draft Plan for 2022/23 shows a deficit of £26.7m at this stage, largely due to the withdrawal of non-recurrent Covid and associated funding. Other Acutes in BSW and elsewhere are facing similar pressures.”

Salisbury Hospital FT May Board papers show concerns which are affecting many trusts, not least with around a third of its 396 beds filled with patients who have completed their treatment and care episode within Salisbury Hospital and are deemed able to be discharged, but can’t be. “As a consequence of this the hospital [ which is running at 100% capacity] has significantly reduced  patient flow and cannot properly function as clinically intended.”

The need to reduce numbers of these NC2R [No Criteria to Reside] patients is just one of the “significant risks to be managed” as well as  covid-19 staffing absence reducing, inflation not exceeding current assumptions, elective productivity increasing as planned, additional staff being recruited and £4m of unidentified cost improvement plans being achieved.

The Trust is one that cannot sign up to the NHS target of recovering elective capacity up to 104% of pre-pandemic levels: “instead a “targeted” approach has been adopted, based on what is felt to be achievable given the Trusts current operational constraints.”

It is forecasting a £18m deficit, which will lead to pressure on cash management towards the end of the financial year.” (p31)

There are problems in mental health, too: Avon and Wiltshire Mental Health Partnership NHS Trust

has a predicted £34m underlying deficit exiting 2021/22.

“This includes the cost contribution that is currently being made on Out of Area beds (where the internal bed base is being exceeded) and the significant cost premium associated with a high use of agency staff to cover vacancies and high rates of absence.”

The Trust has been told it will receive £24m of system funding support in 2022/23 to contribute towards this underlying deficit and continued expenditure related to COVID. This leaves a total efficiency requirement of £8.4m,” (p110) but so far the Trust has only identified recurrent savings of £2.3m leaving a current savings gap of £6.1m.  (p117)

Healthier Together Bristol, North Somerset and South Gloucestershire

Even in May this CCG’s Governing Body papers focus exclusively on 2021/22 year gone by, giving no sign of serious discussion of financial pressures in 2022/23 or NHS England demands for increased productivity.

The picture is of worsening waiting list performance, with numbers increasing of patients waiting over 52 weeks and numbers waiting over 104 weeks.

62 day referral to treatment time for BNSSG cancer patients also worsened in January to 61.43%: the 85% national standard has not been achieved at population level since April 2019.

Cornwall and the Isles of Scilly Health and Care Partnership

Interestingly this ICS quite openly reveals its concern to identify itself as a ‘brand’.  It has commissioned management consultants KPMG to provide support for the ICS and ICB, and will also be led by Price Waterhouse Coopers (PWC) who have been appointed by NHS England and NHS Improvement as the partner for the south-west region.

However it’s not so clear that they have been any help on one of the main concerns of Kernow CCG – the lack of adequate support for patients discharges from hospital:

“There were approximately 100 patients medically fit for discharge in Treliske Hospital and a similar number in community hospitals. In addition, there were 75 COVID-19 patients, so a total of 275 occupied beds more than needed if there were no pandemic.”

Royal Cornwall Hospital Trust  has been at the sharp end of this, and its May Board papers reveal how it is under combined pressure:

“With the revised arrangements for the 2022/23 financial year just started and significant changes to both income available to the Trust (and wider Cornwall system) and our recurrent cost base the Trust is now facing a significant financial and operational challenge in the financial year just started. This change in income includes for example a 58% reduction in covid funding for the Cornwall system. The Trust’s 2022/23 financial planning submission was approved by the Trust Board at an extraordinary meeting on 26th April in advance of the submission to national timescales on 28th April 22. The financial plan currently forecasts a significant deficit position for the Trust by March 23 within the context of a system deficit also.”

“… For the Cornwall system and RCHT both the March draft plan and this updated submission remain non-compliant with this requirement. It is expected therefore that the Trust and system will be asked to consider further options to improve this deficit plan position.” CEO report, p36

“ … the Board have approved this submission on the basis of a £28.8m deficit, this represents a £4m improvement on the draft submission of £32.8m.” (p302)


This county has a hefty projected deficit despite one of the highest per-capita levels of funding.

Devon CCG’s April Governing Body was told: “The Devon system has submitted its draft System 2022/23 Operating Plan which includes plans to  work towards delivery of key elective care targets and address underlying issues that restrict ability  to deliver elective activity. Operationally the ICS remains under extreme pressure with services  competing for resources.” (p37)

The 2022/23 Operating Plan admits that the deficit “is second highest (proportionate to allocation) in the region, at 5.5%. Work is continuing to  improve the position and 12 April it has reduced by £27m to £104m. An expenditure review process is in place in early April to further impact.” (p40) To make matters worse 50% of financial risks have no mitigating measures in place.

Torbay & South Devon FT April Board papers reveal the scale of the financial disarray in what was once a flagship modernising trust:

“The Trust submitted a draft operational plan to NHSEI for year end 2022/23 which showed a full year adjusted deficit of £32.71m. The plan was unlikely to be accepted by the regulators.” (p24)

“The Trust currently has a planned adjusted deficit of £29.9m for FY 2022/23. The final plan will be submitted on 28 April to NHSE/I. The following areas are worth noting:

  • The plan is unlikely to be accepted by regulators and further improvement would be required.
  • The planned deficit of £29.9m is after the delivery of an efficiency requirement at £28.5m, through transformation and Covid cost reduction initiatives.” (p56)

As with other trusts, it is running at full stretch – with negative consequences:

“In March, the overall bed occupancy at 95% continued to be above required levels to support patient flow to avoid emergency care delays and required the continued stepping down of routine elective capacity. Plans to reduce length of stay and reduce overall bed occupancy continued to be constrained by the levels of delayed transfers of care that averaged 60 patients per day who were classified as medically fit for discharge.” (p103)

‘Our Dorset’

CCG Governing Body’s March Finance report discussed the loss of additional discharge funding, but also identifies a specific concern that is not widely discussed: personal health budgets.

“Personal Health Commissioning (PHC) budgets are showing an increased pressure of £5.0m against its annual budget. This is due to a rise in numbers of the more complex packages which incur higher costs, alongside inflationary pressures in excess of those rated in national guidance.…  Continuing Healthcare (CHC) cost pressures are expected to be mitigated by nonrecurrent efficiency savings, but this represents a significant recurrent cost pressure into 2022/23.” (p2 & p6)

University Hospitals Dorset March Board papers reveal the problems of failing to deliver promised cost savings:

“Cost savings of £3.8 million have been achieved to date against a target of £8.706 million, representing an under achievement of £4.9 million. The Trust is forecasting to deliver … a recurrent shortfall of £7.3 million against the £10.1 million full year target. This places a considerable pressure on future years budgets.” (p56)

To make matters worse the hospital is running well above recommended levels of occupancy, now consistently over 97% on both sites, which impacts significantly on both emergency and elective flow.” (p15)

This lack of capacity is likely to prevent this and other trusts delivering the minimum 104% of baseline 2019/20 activity – and therefore limit the opportunity to draw on Elective Recovery Funding.

One Gloucestershire

Here, too almost no useful information about the state of play of CCG or trust seems to be published looking forward to 2022/23. CCG March papers suggest commissioners are quite happy to look for answers outside the NHS:

“Independent Sector elective activity is above originally planned levels, this additional activity has been agreed with the CCG as part of the overall System plans to improve elective waiting times and the continuation of activity at these levels, and beyond if possible, is planned for 2022/23 to help progress elective recovery within Gloucestershire.” (p85)

Gloucestershire Hospitals FT April papers also duck the issue of the size of the deficit::

“A draft Operational Plan 2022-23 was due to be submitted by 17 March, with final submissions due by 28 April. It was expected that the first submission would reflect a system deficit which was in line with most other systems in the South West.” (p6)


While the CCG’s March Governing Body finance paper gloated over breaking even in 2021-22 on the strength of one-off funding, the Chief Exec’s report pointed to strains on still under-funded services:

“As at 22 March 2022, the escalation level for the whole of Somerset was OPEL Level 4, described as: “Four-hour performance is not being delivered and patients are being cared for in overcrowded and congested department(s). Pressure in the local health and social care system continues and there is increased potential for patient care and safety to be compromised.

“… The key question to be answered is how the safety of the patients in corridors is being addressed, and actions are being taken to enable flow to reduce overcrowding.

“The expectation is that the situation within the hospital will be being managed by the hospital CEO or appropriate Board Director, and they will be on site. Where multiple systems in different parts of the country are declaring OPEL 4 for sustained periods of time and there is an impact across local and regional boundaries, national action may be considered.”

Somerset FT May Board Papers give a red rating to the risk of being unable to reduce demand for services to allow the system savings required to be delivered to meet the overall control total. (p95)

The Yeovil District Hospital group is working towards a planned deficit of £2.858m, “which forms part of the overall system plan deficit of £20.330m.” (p411)

Somerset FT aims to limit the deficit to £8.176m, (p422) based on a Trust savings programme of £14.181m for 2022/23, (p423) of which “… As at the current date, just over 56% of the target has schemes either fully developed, in progress or being scoped.” (p424)

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