Mapped: The health economies with the biggest overspends and underspends

In the maps below, HSJ has used alternate measures of overspending to identify areas that could be targeted for service closures to make savings.

The first map presents a new picture of the financial performance of each sustainability and transformation partnership, by measuring the extent to which organisations in each patch fell short of their control total targets in 2016-17.

Dark = biggest overspend against control totals, light = meeting or underpspend against control totals.  

Map: STPs’ distance from control totals (£m)

Using this measure would mean regions on course to meet their annual financial target, but which still have large structural deficits, are not identified for additional scrutiny.

A comparison with the second map shows these STPs would include West, North and East Cumbria; Milton Keynes, Bedfordshire and Luton; and Mid and South Essex. The Cumbria and Essex regions are both in NHS England success regimes.

The second method considers the net surplus or deficit position of all NHS organisations in each STP at the end of 2015-16, as a proportion of their total NHS commissioning allocations. It particularly highlights regions that have had deep financial problems for a long time.

Dark = biggest overspend against allocations/income, light= balance or underpspend against allocations/income.  

Map: Outturn of each STP area (£m)

In an interview with HSJ, Jim Mackey, chief executive of NHS Improvement, said two methods are being discussed by NHSI and NHS England, which may result in a “hybrid” approach.

He said: “You’d think because it’s the money it’ll be really black and white and easy to understand. But there’s a load of art in all of this, and a load of subjectivity and judgement required.

“I don’t like the distance from control total [approach]. It’ll end up being a bit of a hybrid, I think.”

STPs highlighted as over-spenders in both versions include Staffordshire; Cambridgeshire and Peterborough; South West London; and Bristol, North Somerset and South Gloucestershire.

Mr Mackey said overspending in an area did not necessarily mean it was doing the wrong thing or avoiding action, so the figures would be used to probe further.

However, he said: “This is the time… let’s confront some hard decisions in this rather than being locked into [current configurations]. Everyone feels a bit uncomfortable being locked into it [overspending], but also feels uncomfortable about saying ‘I need to close something’.

“For me there’s a driving principle about fairness and when everyone’s doing really hard stuff you just want to make sure everyone’s trying as hard as you are, and executing it as well as you are, etcetera. There’s nothing more toxic than thinking ‘bloody hell, they avoided it and got away with it’.”