Hospital trusts across England reported higher than planned deficits in the first month of the financial year, linked to winter pressures dragging on into the spring, HSJ analysis has revealed.

Four out of 10 trusts with published financial figures for April have experienced increased cost pressures in that month because of unplanned demand on emergency departments or because they kept beds open, which were previously paid for by the national winter pressure fund.

This funding - distributed to trusts to help them cope with increased pressures on accident and emergency departments during winter – finished at the end of March.

The unexpected pressure hit a significant minority of trusts, the analysis revealed.

The numbers

Almost 30 per cent of the 99 trusts examined reported higher than planned deficits, which were partly due to winter pressure costs.

The remaining 42 of the 141 non-specialist acute trusts in England were yet to report financial figures for April.

The analysis showed a wide geographical spread in the trusts reporting increased deficits linked to winter pressures.

This group includes six trusts in London and four in Yorkshire and the West Midlands. Croydon Health Services Trust’s April deficit was £2.6m over its planned amount - the largest increase in cash terms in all 99 trusts examined. Almost £250,000 of this was spent on staff costs to cover winter pressure beds that stayed open in April.

This increased financial pressure reported by trusts in April corresponds to a reversal in the usual decline in demand in A&Es during April. Official figures showed that emergency admissions inched up from 306,288 in March to 306,500 in April, compared with last year’s 6,000 drop in admissions over the same period.


Richard Murray, director of policy at the King’s Fund with whom HSJ shared the findings, said the unexpected demand would make costs mount up.

He said: “You would normally expect as you come out of winter that the number of admissions for A&E and emergency admissions would drop off, and the A&E performance would improve.”

Mr Murray said it was unusual for trusts to have larger deficits than planned so early in the financial year because budgets had only just been signed off. He said: “What you normally see in month one is trusts just have the same numbers that they would have put in their plans. It is very odd for people to be making downward adjustments this quickly. Quarter 1 is looking quite grim now.”

One trust chief executive told HSJ that winter pressure funding did not match the pattern of demand. “Your winter pressures don’t stop at the end of March”, the chief executive said.

“You’ve got the ongoing pressure of the kind of activity you were seeing on 31 March carrying on into 1 April, but some of the money that you had in support of winter pressures you don’t have. You can’t just turn off the tap.”

Sivakumar Anandaciva, head of analysis at the Foundation Trust Network, said: “Operational pressures in urgent and emergency care last throughout the year not just winter.

“NHS providers are investing in more staff, new facilities and redesigned care pathways, and as a result are bearing unprecedented levels of financial risk. This risk is compounded by the non-recurrent nature of ‘winter funding’, which leads to providers paying premium rates for temporary staff at short notice, rather than being supported to invest in a stable permanent workforce.”

A spokesman for the Department of Health admitted that “some parts of the NHS are running hot”.

“That’s why we’re giving the NHS extra support again to ensure urgent and emergency care services are sustainable year round,” he said. “But it’s also essential that chief executives have a tight financial grip and live within their means.”