ICB sanctioned for failing to stop trusts’ over-recruitment

The regulator said Black Country ICB had failed to show “sufficient scrutiny” as provider staff numbers had grown by a fifth in recent years.

The West Midlands system has become the latest to be issued with undertakings, which are a form of special measures, due to concerns over its finances. Last month Greater Manchester ICB was formally reprimanded for not holding providers to account.

Black Country Integrated Care System is forecasting a £119m deficit, nearly £30m over its control total set by NHSE. Its planned deficit is the second largest as a share of its allocation of any ICS. It has also been required by NHSE to bring in consultants to assess its efficiency schemes, amid concerns they were falling behind plan.

And a notice published last week said action was being taken “in regard to its [the ICB’s] leadership role in managing the overall financial performance of the Black Country system”.

Its main acute providers – Royal Wolverhampton, Walsall Healthcare, Sandwell and West Birmingham trusts, and the Dudley Group Foundation Trust – have also agreed similar undertakings.

The system failed to deliver its 2023-24 financial plan and made “relatively limited progress in implementing… schemes to reduce financial costs”, the undertakings state, despite the plan being “designed and submitted by the ICB, implicitly indicating that it was deliverable”.

The NHSE document says staffing across the ICS is reported to have grown by just over 20 per cent from 2019-20 to 2023-24, and there are currently 2,000 more whole-time equivalent staff in post than planned.

The notice says: “This level of growth is not financially affordable and has not been subject to sufficient scrutiny by the ICB, post-establishment, to intervene ahead of mandated controls being placed on the system by NHS England.” ICBs were established in July 2022.

The ICB and its partner trusts are now pledging to develop a system-wide recovery plan that will set out a route to eliminate their deficit within a timescale set by NHSE. HSJ asked NHSE when this would be but had not received a response.

The commissioner is also expected to “demonstrate a track record of identifying and addressing financial issues when they arise”.

Black Country is one of around a quarter of systems that have been placed in a separate oversight framework for areas that are struggling to stick to their plans.

This involves consultants carrying out urgent reviews of each organisation’s financial position, and options to immediately reduce spending, including workforce controls, and checking efficiency plans, with measures also subject to checks to ensure patient safety.

ICB deputy CEO Sally Roberts said on behalf of the system: “The NHS in the Black Country performs well and provides high-quality care, and we welcome the external support and review as an opportunity to see how we can continue to do that and find ways to be more productive and balance our books financially.

“Whilst we already have a challenging financial recovery plan in place, we are working with system partners and NHSE to continually improve this position.”