The creation of NHS Improvement comes at a critical time for the NHS. In the next few months the service in general – and providers in particular – will be attempting to reverse the steep rise in deficits and, at the same time, stop the downward drift in performance in key areas such as A&E.
The Public Accounts Committee report says the target for trusts to make 4% efficiency savings across the board is "unrealistic" and better data is needed for more informed savings and efficiency targets.
The report highlights that the Department of Health, NHS England and NHS Improvement have not taken action soon enough to keep trusts in financial balance.
We say the report confirms what our members have been saying for the last 18 months: the financial crisis in NHS hospitals and other providers is due to the fundamental mismatch between what NHS providers have been asked to deliver and the resources they have been given.
Last month 75% of NHS providers and 95% of hospitals were reported as being in deficit at the end of quarter three with an overall provider sector deficit of £2.3 billion. This was followed by a report from the Health Foundation which explained how such a large and widespread deficit has been run up so quickly, pointing to three factors – staffing, the tariff and a demand/funding gap.
The Public Accounts report says Government has not acted quickly enough to keep acute hospital trusts in financial balance—also finding "there is not yet a convincing plan in place for closing the £22 billion efficiency gap and avoiding a 'black hole' in the NHS finances".
There is growing acknowledgement that modern organisations need a finance team which operates collaboratively alongside other professionals; which is seen as a positive advocate of change, not a risk-averse blocker of actions perceived as uncertain. That’s not to downgrade the importance of stewardship and good governance, but to recognise the advantages which can be achieved when, in CIPFA’s definition of the concept
Recent announcements on the Better Care Fund have made for mixed news.
The biggest positive has been the confirmation that the BCF will run for at least the remainder of this parliament.
A further positive is that the minimum size of the BCF will increase from the current £3.8bn to £5.3bn by 2020 – an extra £1.5bn. And this increase will not be top-sliced from CCG budgets.
On the other hand, this is back-ended money: no increase in 2016/1, £105m in 2017/18 and reaching £1.5bn only 2019/20. Given that the purpose of the Fund is largely to invest up front to improve the longer term position that is unhelpful. Moreover, a good chunk of it is funded from an existing local government source, i.e. £800m from reduced availability of New Home Bonus for local authorities.
The figures announced today show that NHS providers have incurred deficits totalling £2.3m in the first three quarters of the year (i.e. to the end of December 2015), making it likely that the year-end position will be an overspend of at least £3bn. When this is combined with deteriorating clinical performance, eg 9% of patients waiting longer than four hours in A&E in Q3, it represents the worst quarterly performance since 2003.
NHS England has earmarked £156m of contingency funds and underspends on its central programmes to help the Department of Health break even in 2015-16, board papers for its meeting on Thursday afternoon show.
NHS England has raised “grave concerns” and demanded action on the financial position of the clinical commissioning group reeling from the collapse of the £800m UnitingCare Partnership contract, HSJ has learned.
The Health Committee holds an oral evidence session as part of its inquiry on the impact of the Comprehensive Spending Review on health and social care.
Our quarterly monitoring report (QMR) provides a thorough review of NHS performance figures along with insight from an accompanying survey of trust finance directors and clinical commissioning group finance leads. Over the past couple of years I’ve often wondered when and if our QMR survey respondents would become more optimistic in their outlook. Not yet, would seem to be the answer.
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For more than a decade, staff across the NHS toiled in the pursuit of foundation trust status. Monitor’s tests were unforgiving, but the prize was worth fighting for: freedom from the grasp of government and a brand that stood for quality and professionalism.