• Trust with £11m deficit before end of second quarter
  • It ‘went off track’ early in the year
  • Will not find savings regulator says are necessary to get back on target

A west London trust is resubmitting its budget to NHS Improvement after failing to find sufficient savings to satisfy the regulator.

The Hillingdon Hospitals Foundation Trust is running a deficit of £11m after five months of the financial year. That’s nearly £7m behind where its budget said it should be.

It is about to submit a new savings plan to NHS Improvement as well as a new deficit forecast. Its original budget plan had it hitting its control total in March 2019.

The trust had a savings plan of £12m for the year and “a particular budget we’ve had to meet,” Hillingdon’s finance director, Matthew Tattersall, told HSJ. But “we went off track fairly quickly.”

“As a result of which [NHS Improvement] said ‘what’s going on?’ quite rightly,” Mr Tattersall said.

“We explained to them, and what the potential impact would have on our year end position. They said that’s not good enough, you need to find £4m in savings to make sure you’re back on track.”

However, they were unable to find £4m more savings, he said. “It was a challenging ask.”

The trust is formulating a new plan and is in ongoing discussions with the regulator.

The deviation from the spending plan in August stemmed from overspend on staff, specifically agency staff, combined with £2.4m less income from clinical procedures than hoped.

Hillingdon has gaps in rotas for medical staff and high vacancy rates for nurses on two wards. It is filling the gaps with consultants covering junior doctor shifts and agency staff.

However, Mr Tattersall said the staff shortages are not the reason why it made less income from clinical activity than expected.

Income was down for three reasons, he said. The hospital had fewer births in August, “a phenomena I understand is fairly prevalent across parts of London”.

Elective care activity is down against the plan as well, Mr Tattersall said. That stems from temporarily closing some theatres for maintenance.

The trust’s September board papers said elective care and day case work must “overachieve for the rest of the year” to break even with planned activity come year end.

The trust also saw less emergency activity but its income has held and is on plan for the month.

However, Hillingdon failed to meet the emergency waiting time target for three years. In August, it again missed the national target for 95 per cent of patients admitted to the emergency department to be treated, transferred or discharged inside four hours.

The trust presumed it would not receive its provider sustainability funding thanks to its performance against the emergency target, as well as its financial performance. It has missed out on £1.8m sustainability funding this year, by the end of August.