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“Just not realistic” was one trust CEO’s verdict on NHS England’s expectation that integrated care systems will break even in 2022-23.

That “new joint legal duty” appears to have run into financial reality as HSJ understands that several health systems are locked in negotiations with NHSE after they set initial deficits of more than £100m.

As one trust CEO put it: “Some of it is a negotiation, but some of it is also us being able to say, with ambulance handovers what they are, [and] with the need for elective recovery… we just can’t do it.”

Part of the thinking was that systems would manage financial planning themselves, balancing out deficits in one provider with surpluses elsewhere, instead of NHSE having to step in. But with covid, inflation and energy costs all “running a lot hotter” than anticipated, as well as recovery asks, that is providing tricky.

Richard Murray, King’s Fund CEO, said the breakeven ask was not going to happen: “One of the problems that we’ve had over recent years is the belief you can performance manage away reality,” he said. “And you can’t, just shouting even louder doesn’t make anybody more able to do it.”

Unbalanced boards

With the 2021 workforce race equality standard now out, HSJ has identified the trusts with no declared ethnic minority executives or very senior managers despite high representation in their workforces.

Analysis of the data, published last week, found there were multiple trusts where more than a fifth of their workforce comprised staff from ethnic minority backgrounds. However, all their executive board members and non-clinical very senior managers were white.

Yeovil District Hospital Foundation Trust was the only provider where its entire board, including its non-executives, were declared as white while 21 per cent of its workforce comprised staff from ethnic minority backgrounds.

The data was collected by NHSE through submissions from trusts via the NHS Digital strategic data collection service and was correct as of March 2021, but this does not appear to have changed since then for Yeovil.

Barking, Havering and Redbridge University Hospitals Trust, which had the highest composition of ethnic minority staff across its workforce at 52 per cent, has since appointed an executive-level director of equality, diversity and inclusion alongside several VSMs from ethnic minority backgrounds.

While some trusts told HSJ they did not have VSMs in their structures, WRES data held figures for those positions.

Also on today

In Mental Health Matters, our new mental health correspondent Emily Townsend looks at what was controversially described recently as a “thorn in the flesh” of clinicians, and in a comment piece, Ellie Orton explains why local NHS charities are so valuable in helping the health service and staff recover from the pandemic.