CCGs and NHS England report growing budget shortfalls

Finance officials are expecting NHS England and CCGs together to record a total surplus of £596m at the end of 2013-14, but only after £303m of the surplus built up by the NHS in previous years is used, which had not been included in previous plans.

The figures are revealed in a board paper, published in advance of the national commissioning organisation’s board meeting due to take place on Friday, which reports on performance at the end of September following a “detailed half-year stocktake”. It says predictions are uncertain because “robust activity information” is unavailable.

The number of CCGs expected to record a deficit at the end of the year has increased from an earlier prediction of nine to 24, of the total 211. NHS England will not identify the CCGs forecasting deficits until after the meeting.

No more than three primary care trusts − CCGs’ predecessors as local NHS commissioners − recorded end of year deficits in any of the three years before 2013-14.

NHS England blamed three factors for the CCGs’ shortfalls − increased activity; failure to make quality, innovation, productivity and prevention savings; and “finalisation on the impact of specialised commissioning adjustments”.

CCGs nationally are expected to fall short of their total £1.6bn QIPP savings target by £176.8m.

NHS England has been making adjustments to CCGs’ budgets through the year, largely because of miscalculations of the split of responsibility for specialised services between CCGs and NHS England and between different areas.

This has angered many CCGs which have seen their allocations cut.

HSJ understands NHS England is not planning to accept further adjustments to CCG budgets, except in unusual or “egregious” cases. It has not yet announced the overall impact of adjustments, or published CCGs’ final 2013-14 budgets.

Some commissioning group leaders believe budgets are still incorrect.

However, officials are expected to use CCGs’ allocations as of the end of September as a baseline to calculate their allocations for next year and the following year, which are due to be published in December.

Blackpool CCG chair Amanda Doyle, who is also co-chair of the NHS Clinical Commissioners leadership group, said: “While we accept that at some point we have to agree our positions for this year, this situation is still leaving a lot of CCGs with very significant problems, and recurrent shortfalls.”

Meanwhile, NHS England is expecting to have spent £317.8m more than planned on its own direct commissioning budgets at the end of the year, resulting in a £93.2m deficit in these budgets. The largest contributor is specialised services, and the board paper says the causes are “emerging activity trends and resolution of baseline [budget problems] issues”.

NHS England is also planning to release £60m of its contingency fund “to increase the planned support to NHS [provider] trusts, reflecting substantial calls on transitional support”.