An NHS trust has been strongly criticised for its financial management during a year in which it had four different deputy directors of finance.
In a public interest report, the Audit Commission says the financial position of Ipswich Hospital trust 'deteriorated sharply' after the end of the last financial year, resulting in a total deficit that now stands at£24.1m.
Some£5.4m of this was as a result of carrying out thousands of elective procedures which commissioning primary care trusts had not contracted for.
At a board meeting in March this year the trust was forecasting a deficit of£4.2m for 2005-06, after running up deficits of£1.4m and£6.4m in 2003-04 and 2004-05 respectively.
But the report notes that the then deputy director of finance told the meeting that there was a 'significant risk' that the deficit would be higher than that forecast.
These risks included£5.4m of 'data queries' raised by the Suffolk PCTs in relation to procedures that were never contracted for; a£4m reduction in income as a result of changes in service-level agreement baseline funding; and£2m of planned savings which had not yet been achieved.
The report says the financial problems were against the backdrop of 'ongoing staffing difficulties regarding senior management'.
The trust started the financial year with an acting chief executive and an acting director of finance and performance until current chief executive Andrew Reed took over in July 2005.
During the year a total of four people held the post of deputy director of finance, 'generating a lack of consistency and accumulated knowledge in the role'.
The trust's director of operations went on sick leave and subsequently resigned, and a full-time replacement was not made until May this year.
And trust chair Christine Smart announced she would not reapply for her post when it came up for reappointment in July.
The Audit Commission says the trust should develop a 'robust and comprehensive recovery plan' which identifies significant and strategic savings across the organisation. It said the trust should continue to liaise closely with the strategic health authority and other stakeholders to agree a strategy for recovering its accumulated deficit.
The trust said it had already commissioned an independent review of its financial position, which made a series of recommendations, including a review of capacity compared with forecast activity and a closer monitoring of its performance against service-level agreements with PCTs. A spokeswoman said the commission's report largely mirrors the review's findings.