NHS England lifts restrictions on CCGs facing £71m deficit

Horsham and Mid Sussex CCG and Crawley CCG had originally expected a year-end combined overspend of £46.6m, but have now reforecast at £71m, estimated to be around 10-15 per cent of their total funding allocation.

They have put the increased overspend down to the failure of some anticipated savings, and more activity taking place than forecast at their main acute provider, Surrey and Sussex Healthcare Trust, resulting in extra contract payments.

However, NHS England has this week lifted the “legal directions” which were placed on the two CCGs’ operations because of financial concerns. They are both due to merge with Coastal West Sussex CCG on 1 April.

The legal directions were applied in November 2017 — meaning major decisions became subject to NHSE’s approval — but those related to governance, capability and capacity were lifted a year later, with the finance-linked rules left in place until now.

The CCGs’ latest governing body papers show Crawley, which had planned for a £13.1m overspend for 2019-20, is anticipating one of £26.7m, while Horsham and Mid Sussex’s shortfall is expected to grow from £33.5m to £44.3m.

The new combined deficit of £71m has been agreed with NHSE but it is £25.8m more than the control total the CCGs had originally been given, meaning they will receive no commissioner sustainability funding.

The governing body papers also stated the contract with SASH had originally been agreed “with acknowledgement by both parties” it was £3.8m more than the two CCGs could afford.

In 2018-19, Crawley CCG had a deficit of £1.6m after commissioner sustainability funding, rather than the planned breakeven. Its auditors gave a qualified opinion, noting “weaknesses in proper arrangements for planning finance effectively”. Horsham and Mid Sussex had a deficit of £3.6m after CSF, rather than a planned breakeven, and auditors made similar comments.

The CCGs indicated work they were doing with neighbouring East Surrey CCG, which is part of Surrey Heartlands Integrated Care System, had assured NHSE that financial grip was improving.

A spokesman for the Sussex CCGs said: “Sussex CCGs are working closely with the Surrey Heartlands ICS to undertake an assessment of the NHS financial position for the Crawley, East Surrey and Horsham system.

“Sussex CCGs and Surrey Heartlands ICS are developing a joint understanding of the causes of financial deterioration and are exploring a series of next steps to address the key system challenges going forward.”

Crawley and Horsham and Mid Sussex CCGs clinical chair Laura Hill said the lifting of legal directions was “extremely positive for our CCGs”. 

Adam Doyle, who is chief executive of all the Sussex CCGs, said: “The significant progress we have made across both our local and wider system has been down to greater collaboration between partners, strong leadership and, most importantly, a real collective focus on making improvements for the people we serve.”

HSJ asked NHSE why the CCGs had been taken out of legal directions, given their large and increased deficits, but has yet to receive a response.