• NHS England’s forecast surplus rises to £453m
  • Bulk of the underspend expected to come from central budgets
  • But underspend may need to increase further to offset provider deficits

NHS England has increased its forecast surplus by a further £160m, as it anticipates the need to offset deficits in the provider sector.

In its finance report for the first eight months of 2018-19, the national commissioner said its year-end forecast underspend has increased to £453m, up from £293m at the mid-year point.

Around half of NHS England’s expected underspend appears in “central programme” costs including contingency; operations and information; strategy and innovation; provider support; nursing; and over-recovery rates and fraud costs.

Around £120m appears in the “other central budgets” line, for which there is no further detail.

However, it is likely that the forecast surplus will need to increase further by the end of the year, as the trend in previous years suggests the provider sector deficit will approach £1bn.

If this deficit cannot be offset by NHS England, there could be a significant risk of the Department of Health and Social Care breaching its spending limit, as happened in 2015-16.

The report by Matthew Style, interim chief financial officer, said: “The full year forecast at month eight is for an underspend of £453m, although this forecast will be kept under close review (including through a series of ‘deep dives’ with regional and national teams) to ensure that the commissioner sector can continue to make an appropriate contribution to delivering financial balance across the NHS as a whole.”

There still appears to be risk of deterioration in the year-end position, however, as clinical commissioning groups were overspent by £148m after eight months, yet are forecasting a year-end overspend of £48m.

The report said there are 48 CCGs with year-to-date overspends, with 15 CCGs forecasting they will end the financial year with overspends.

On a health economy basis, the largest overspends have been forecast by CCGs in Staffordshire (£34.2m), East Kent (£16.9m) and London (£39.3m).

Mr Style added: “The regional teams continue to work to ensure that any CCG deterioration is contained as far as possible.”