NHS trust deficit nearly twice as much as expected

31 May 18

NHS trusts in England ended the last financial year with a deficit of £960m - £464m above the projected deficit of £496m, a regulator’s report out today has shown.

This was mainly because of unforeseen demand on emergency services, according to NHS Improvement’s end of year performance report for the health provider sector.

More than 5.87 million people went to A&E in January, February and March 2018 –220,000 more than the same period last year, the report pointed out.

The update also highlighted extra pressure on the NHS came from the cyber-attack last year, terrorist attacks in Manchester and London, the Grenfell Tower fire and “one of the most challenging winter periods that the NHS has had”.

“The high level of demand and a combination of other pressures led to an overspend in the NHS provider sector in 2017-18,” the report said.

“While more than two thirds of providers (156 out of 234 trusts) finished the year at or better than planned financially, the surge in patient demand contributed to the provider sector as a whole having a deficit of £960 million at the end of 2017-18.”

But Sally Gainsbury, senior policy analyst at the Nuffield Trust think-tank, believed the deficit figure could be more like £4bn.  

She called the NHS Improvement’s data “window dressing” due to the NHS’ use of one-off savings and emergency extra cash.

“Today’s report reveals that the £960m reported deficit figure is arrived at after around £850bn of one-off savings - even higher than last year,” she said.

“Taking these into account, along with other short-term fixes, the true underlying deficit is likely to be in the region of £4bn - similar to our own projections.” 

Chris Hopson, chief executive of NHS Providers, which represents 99% of trusts, said: “The figures we see today reflect the worrying gap between what the NHS is being asked to deliver and the resources available following almost a decade of austerity.

“There are not enough staff, ambulances, community and mental health capacity or hospital beds to cope.”

The increased pressure on A&E services this winter meant hospitals had to cancel planned operations leading to 2,647 patients waiting more than a year for elective treatment at the end of March 2018, NHS Improvement highlighted. 

This number was just 1,513 in March 2017.

Use of non-recurrent savings, such as the sale of hospital buildings and land, totalled £842m by the end of the financial year, compared to a planned £316m.

Other providers, including ambulance, mental health and community healthcare trusts, collectively underspent during 2017-18.

Separately, The Times has reported an umbrella-group for Britain’s 220,000 doctors has called for a 4% rise each year in the NHS and social care budget for more than a decade.

The Academy of Medical Royal Colleges signed a letter written to The Times calling for a funding settlement “which goes beyond managing short-term crises” – saying they will not be able to bring down waiting lists or treat mental illness properly without an annual £7bn increase to health spending.

In March, Theresa May promised a multi-year funding plan for the NHS.

Comments on today's NHS Improvement report: 


“Despite epic challenges, NHS staff up and down the country displayed incredible resilience and saw more patients than ever before within four hours.”

Ian Dalton, chief executive NHS Improvement


“Theresa May and Philip Hammond cannot allow this financial knife-edge to continue. Whether the chancellor announces the extra funding in time for the NHS anniversary this summer or waits until the Autumn Budget, it must be both substantial and genuinely new money.” 

Janet Davies, chief executive Royal College of Nursing


“In spite of heroic efforts by staff, too many patients are being let down by an understaffed and underfunded system.

“This is not just about hospitals. The whole system is struggling to cope.” 

Niall Dickson, chief executive NHS Confederation

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