Almost 40 NHS providers are now forecasting to miss their financial plans in 2018-19, as regulators reported another deterioration in the sector’s finances.

NHS Improvement’s mid year performance report showed a combined deficit of £1.23bn for the first six months of the year. This was around £80m worse than for the same period in 2017-18, despite an increase in the “provider sustainability fund”.

The year end position is forecast to improve to a deficit of £558m, but performance in previous years suggests this is unlikely to be delivered.

Thirty six providers were now forecasting to miss their financial plans (excluding the impact of missed PSF payments), of which nine were expecting to be at least £5m adverse to plan, NHSI said.

In total, the 36 providers account for deterioration of £152m.

Trusts forecasting the worst performance against plan

 Plan (£m)Year end forecast (£m)Variance (£m)
University Hospitals of Leicester NHS Trust -21.2 -51.8 -30.6
Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust -15.8 -34.2 -18.4
University Hospitals Plymouth NHS Trust -16.3 -30.9 -14.6
Mid Essex Hospital Services NHS Trust -47.3 -60.7 -13.5
Barts Health NHS Trust -56.8 -69.6 -12.8
Dartford and Gravesham NHS Trust -10.3 -20.4 -10.1
Countess of Chester Hospital NHS Foundation Trust -4.3 -12.8 -8.4
Kettering General Hospital NHS Foundation Trust -15.3 -23.6 -8.3
Oxford Health NHS Foundation Trust -0.8 -8.4 -7.6
Northern Lincolnshire and Goole NHS Foundation Trust -39.6 -44.5 -4.9

After three months of the year, just one trust was forecasting to miss its plan.

NHSI’s report said: “The reported deterioration among a small proportion of providers explains most of the overall deterioration in the provider sector.

“This requires focused and firm action by their boards – the whole NHS is under considerable pressure and it is clearly not appropriate for a few organisations to receive disproportionate financial support.”

It said any shortfall would have “significant implications” for 2019-20 and the start of the long term NHS plan period. The plan, which is being finalised in response to the government’s funding increase announced in the summer, is due to be published in December.

The report added: “All of the net overspending occurred in the acute sector… Key factors cited by providers as contributing to adverse variances include slippage in making planned efficiency savings, volume changes, operational and cost pressures relating to temporary staffing and substantive workforce pressures, and the (Agenda for Change) pay award.”

After the first three months of the year, providers were planning to deliver a combined deficit of £519m. Despite the pattern of deterioration in recent years, and the forecast outturn worsening, NHSI today said trusts were now planning - despite the deterioration in the forecast - to deliver a deficit of £439m.

The report added: “We are working through our regional teams to reduce this forecast overspend as well as close the residual local planning gap.”

Meanwhile, NHS England is forecasting a commissioning underspend of £293m for 2018-19, but has indicated this could rise to £450m.

This would not be enough to offset the expected provider deficit, and the gap would need to be bridged within other Department of Health and Social Care budgets if it is to avoid overspending its allocation from the Treasury.

NHSI: Restoring performance may take until 2023