It’s not that unusual to see large deficits in today’s NHS, after almost a decade of brutal austerity limits on funding, but the deficits are so large in the East of England that NHS England/Improvement’s Regional Director is passing round the hat round to five STPs, pressing them each to ‘lend’ £5m to the sixth, the floundering Cambridgeshire and Peterborough STP.

This has caused some bitter resentment, not least in Norfolk where the press reported an angry lay member of North Norfolk CCG, Peter Franzen, responding sharply to the request for £5m:

“Can I ask how we think the public would feel about another £4-£5m of cuts to a system that’s already in debt and being asked to make savings to help another system?” The £25m is barely a drop in the ocean of red ink that has covered the accounts in Cambridgeshire and Peterborough for the fast four years (with end of year deficits in excess of £100m each year since 2015). According to the latest STP Board papers “the underlying exit position for 2018/19 going into 2019/20 was [a deficit of] £212m.”

Remarkably even this level of deficit still meant the STP was eligible for £52m of “Provider/ Commissioner Sustainability Funding” (which used to be restricted to trusts that achieved their targets), bringing the C&P “final system outturn” to a deficit of £148m.

Cambridgeshire and Peterborough health bosses are now focused on the huge challenge for 2019/20:

“Over the past few months, System partners have been developing their financial plans for 2019/20, with a System Control Total set of £142m overspend.” Once again the three acute trusts and the CCG have rejected their control totals; their response seems almost surreal:

“Our latest plan is an overspend of £192.4m; this is still £50m away from the System control total but will, subject to the agreement of our regulators, enable us to access a substantial sum of £80.6m of Provider/Commissioner Sustainability Funding (PSF/CSF) available to this System for those organisations achieving their respective Control Total.”

This is the £192m deficit towards which the other five STPs have now been asked for loans – bringing the deficit down to a mere £167m – and halving the gap from the control total set by NHS Improvement.

Ironically however, Norfolk and Waveney STP which has been press ganged into becoming a grudging donor to this support fund, is itself facing some punitive savings targets in the effort to squeeze their combined deficit down to £16.5m this year, and thereby secure almost £70m of ‘sustainability funding’. The omens are not good: the STP has three major trusts in special measures, and was expected to wind up with a combined deficit of £96m for 2018/19, despite delivering £104m of ‘efficiency savings’. The largest acute trust, Norfolk & Norwich University Hospitals alone ended 2018/19 with a £58.8m deficit, more than £6m worse than planned. The STP drawn up in 2016 aimed to save £300m by 2021, and expected the system to be £4.5m in surplus by 2018/19. Former New Labour Health Minister Patricia Hewitt who now chairs the STP has admitted the plan was “over optimistic”.

But with control totals being wilfully and ignored, and huge deficits concealed year after year by handouts of sustainability funding for fear of the consequences of imposing truly massive cuts, it is clear that Regional Director Ann Radmore is deep in denial, claiming against all the evidence that:

“We expect every NHS organisation to live within their means, and the benefit of taking a joined-up regional approach is that we can tackle the issues together.”

Her region is set for an overall shortfall this year of £76m: all the covert subsidies, handouts and loans can’t hide the fact that the NHS in eastern England and every other area is drastically underfunded

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