National bodies step in as health economy's financial risk grows

NHS England and NHS Improvement have stepped in to make it clear the system does not have an agreed aligned incentive contract – despite CCG governing body papers saying a “local agreement” has been reached to suspend payment by results and replace it with a fixed amount. Trusts and CCGs have been told to supply forecasts based on PbR for each organisation separately.

Governing body papers show Eastbourne, Hailsham and Seaford CCG is forecast to miss its control total by £26.6m – with a likely £19.3m deficit – while neighbouring Hastings and Rother CCG may achieve a £3.5m surplus – against a control total of £9.8m – but still has £11.4m unmitigated risks.

The main acute provider, East Sussex Healthcare Trust, is reforecasting its deficit after finances slid in the last few months, leaving it with a £28.8m deficit at the end of month seven. Its full-year control total was £36.4m without sustainability and transformation funding. A reforecast is expected when the board meets in the new year.

However, a report on the East Sussex Better Together alliance – a developing accountable care model for the area – calculates the total risk to system control totals at £80.3m, with the trust’s cost improvement plan risk identified as £14.5m and the risk to the CCGs’ control totals being £48.1m.

A report to the Hastings and Rother governing body said NHS England and NHSI are scrutinising the financial position closely, including plans to mitigate the forecast deficit for the rest of this financial year and 2018-19. Alison Gale, deputy chief financial officer, said the CCGs and trust are having regular meetings with them “to ensure there is complete transparency and understanding of the position” and regulators viewed the deterioration as likely to be “one of the most significant in the South East.”

The East Sussex Better Together alliance had targeted a demand shift and hoped to reach financial sustainability by 2020-21.

Both CCGs – which share some executive staff – are overspent with most acute providers, with Eastbourne, Hailsham and Seaford predicted to overspend £18.7m at the trust, and Hastings and Rother expected to overspend by £6.8m by year end.

The trust’s problems are partly caused by a slowdown in elective referrals – day case activity is 11 per cent below plan – and an increase in non-elective activity. The trust said it was “experiencing some significant variations in elective and planned care work. The reasons for this are multifaceted and reflect pressures that primary care colleagues are experiencing along with wider changes in patterns of referral.” Community based services developed for orthopaedic patients, for example, had led to significant effects on referral and activity patterns, it said.

The trust is also behind plan on its cost improvement plan, which may miss its £28.7m target for the year by £6m. A report to the board said its deficit at the end of month six was £2.4m more than expected and it had lost £2.2m of STF as a result.