• HSJ analysis shows which providers must deliver the biggest improvement in the final three months of 2016-17
  • If the average performance in the first nine months is projected across the whole year, the sector would report a deficit of £1.14bn, against the £580m control total

Hospital trusts with some of the largest back-loaded savings plans have insisted they can still meet their financial targets.

Analysis by HSJ shows which providers must deliver the largest savings in the final three months of 2016-17, and which therefore present most risk to the sector’s year-end position (see table below).

As reported last week, figures published by NHS Improvement have forecast a provider sector year-end deficit of £873m, against the maximum control total of a £580m deficit.

However, the actual run rates in the first nine months of the year suggest that a major improvement must be delivered in the final quarter, to hit this forecast.

If the average performance in the first nine months is projected across the whole year, the sector would report a deficit of £1.14bn. Around 80 out of 237 trusts were behind the average run rate required to meet their forecasts after the first nine months of 2016-17.

In our analysis, HSJ discounted the £1.8bn sustainability and transformation fund from the calculations, in order to enable like for like comparisons.

The trusts that need to deliver the biggest improvements in Q4

 TrustQ3 YTD ‘000Year-end position if run rate continued ‘000Official Q3 forecast ‘000Gap between projection and forecast ‘000Gap as % of turnover
King’s College Hospital FT -79912 -106549 -50489 -56060 -5.3
Maidstone and Tunbridge Wells  Trust -19277 -25703 -4700 -21003 -5.2
University College London Hospitals FT -23647 -31529 -11149 -20380 -2.2
Royal Liverpool and Broadgreen University Hospitals Trust -9871 -13161 6200 -19361 -3.6
Royal Free London FT -45752 -61003 -43931 -17072 -1.7
South Tees Hospitals FT -15752 -21003 -5942 -15061 -2.7
St George’s University Hospitals FT -61017 -81356 -71000 -10356 -1.4
The Royal Wolverhampton  Trust -10329 -13772 -3518 -10254 -2.0
Imperial College Healthcare  Trust -38412 -51216 -40962 -10254 -1.0
Stockport FT -18593 -24791 -14903 -9888 -3.2

King’s College Hospital Foundation Trust has already revised its underlying forecast deficit down by £19m, to £50m, but reported an actual deficit of £80m after the first nine months of the financial year. If this run rate continued, the trust would post a year-end deficit of more than £106m.

A trust spokesman said: “We are still confident that we can achieve our forecast, although we remain vigilant regarding the level of financial risk. Month 10 saw an in-month surplus of £2.8m, which was the result of the delivery of some phased savings plans.”

He said commercial activity, planned cost improvement schemes and additional income are expected to bridge most of the gap.

Maidstone and Tunbridge Wells Trust did not respond to our findings, but HSJ has previously reported on how it intends to deliver its forecast.

A spokesman for University College London Hospitals FT said there were a “number of one-off transactions” planned in the final quarter, but added: “We are not in a position to share further detail on these.”

Royal Liverpool and Broadgreen University Hospitals Trust pointed to “a number of factors and mitigations”, including invoicing Liverpool Clinical Commissioning Group in relation to loss of income related to increased length of stay for patients ready for discharge.

Stockport FT said it has “agreed an additional £3.5m from partner organisations”.

South Tess Hospitals FT, St George’s University Hospitals FT, The Royal Wolverhampton Trust and Imperial College Healthcare Trust did not respond.

Other trusts told HSJ they are planning for additional income from commissioners, and various technical accounting measures.

NHS Improvement could instigate other one-off and technical accounting measures in the final quarter to reduce the deficit, but regulators may struggle to cover significant further deterioration within operating budgets.

The Treasury has forced commissioners to hold back £800m as a risk reserve in case of provider overspending this year. Breaching this would be a significant blow to NHS Improvement, and could lead to greater scrutiny from the Treasury.

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