Commissioning support units made a collective surplus of nearly 6 per cent, HSJ can reveal after obtaining financial performance data for the entire sector for the first time.

Figures released to HSJ under the Freedom of Information Act also showed that overall CSUs turned over £808m in their first year of operation, significantly higher than earlier assumptions of around £750m.

The total sector surplus for 2013-14 was £45m - or 5.6 per cent - with all but one unit hitting or coming close to NHS England’s requirement to deliver a 5 per cent surplus. The figures indicated that while around three-quarters of the surplus was reinvested in improving or expanding CSU services, the remainder was returned to NHS England to be “carried forward”.

CSU surpluses and where they are invested

An NHS England spokeswoman said the sum - totalling £10.7m - “is now an integral part of the overall NHS England resource and will be used in the most appropriate manner that benefits patients”.

CSUs will be able to draw the resource down “at a time when NHS England deem it is appropriate in relation to other priorities”, she added.

A senior CSU source said the strong performance raised questions about whether NHS England would want CSUs to become independent of the NHS.

Although units are planned to become “autonomous” in 2016, they asked: “Would this level of reinvestment in improving services be possible in the private sector, where shareholders would want to take a cut of the profits every year?”

All but three CSUs reinvested two-thirds or more of their surpluses, according to the data. Kent and Medway CSU made a £1.4m surplus - worth 5 per cent of turnover - and reinvested it all. North Yorkshire and Humber, Staffordshire and Lancashire, and South CSUs were also among those which reinvested more than 95 per cent of their surplus.

However, North of England CSU, which made a 6.6 per cent surplus worth £3.7m, opted to hand the full amount back to NHS England to be carried forward.

Greater Manchester CSU made the biggest margin - at 7.8 per cent - and reinvested around half of this, or £2.1m. CSUs are only allowed to recycle surpluses for reinvestments with business cases signed off by NHS England chief finanical officer Paul Baumann.

Stephen Childs, North of England CSU managing director, said: “We have been very careful not to rush into premature investments that deliver a less effective return than those we will make from a more informed position. With so much uncertainty in this young and rapidly developing market, we felt it important to have a strong financial platform to move forward.”

He said he expected to reinvest the surplus in future years.

Andrew Ridley, North and East London CSU managing director, said the unit spent almost all of its £3.2m surplus on training and developing staff, and improving the business intelligence service it offered.

He said the data demonstrated that CSUs had been successful in winning new business and generating efficiencies. “If you judge us by the business we’ve won, we’ve done very well,” he said.

“Resources are very tight so people are having to take practical, value based decisions about where to buy their support from, and actually CSUs offer great value.”

The data also revealed that last year only one CSU - Surrey and Sussex - had a surplus greatly below 5 per cent. It closed in April. The next smallest surpluses were made by Anglia CSU, which also closed, and Central Midlands CSU, which has been taken over by Staffordshire and Lancashire CSU.

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