NHS England faces 'most difficult budget year'

Its chief operating officer Dame Barbara Hakin said: “[I will] put my hand on my heart and say that this is the most difficult year that we’ve faced in terms of balancing the plans.”

Her comments came after papers submitted to the board revealed NHS England had not yet agreed on plans to balance its £97bn budget for 2014-15.

NHS England chief finance officer Paul Baumann, who wrote the report, told the meeting: “I don’t think we’ve ever been quite this late in the year without a set of plans which are all laid to rest and ready to be acted upon.

“[It] is just an indication of the difficulties around the country [that] different health economies have been facing.”

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NHS England deputy chair Ed Smith, who also chairs its audit committee, told the meeting the organisation had to “get into a rhythm of having a balanced budget on 1 April rather than on the end of the first quarter”.

He said he was “sympathetic” to the task being “massively complicated and difficult” and that “we ought to be able to do it for the start of the year”.

Mr Baumann said this year’s plans were the “riskiest” the NHS had faced “for a while”. He noted that last year there was a “large proportion of the draw down” available to NHS England not allocated. He said: “We needed some of it. Some of it led to a slightly higher surplus at the end of last year than we had anticipated. This year all of that draw down - of the £400m of money from previous years - has had to be allocated.”

He said NHS England’s risk mitigation was “very limited… That really means that we’re going to have to focus a lot of attention on the risk assessment and the mitigation assessment that we do”.

Dame Barbara said she was “particularly concerned” about specialised commissioning, “even more so than the [clinical commissioning group] plans” because some risks “are very significant indeed”.

A dispute with University College London Hospitals Foundation Trust over £75m of its specialised services contract for this financial year was also highlighted at the meeting. NHS England chair Malcolm Grant described it as “disquieting” and a “significant outlier”.