The NHS will only balance its books next year thanks to £350m raided from budgets for public health, training and education, under current plans.
The NHS will only balance its books next year thanks to£350m raided from budgets for public health, training and education, under current plans.
The figure emerged when the Department of Health published for the first time quarterly figures showing the financial forecasts of NHS organisations for year-end.
Overall, predictions are for an£18m surplus. This is reached by offsetting a gross deficit of£883m (compared with the£1.2bn reached last year) against£135m surplus from primary care and acute trusts, and£415m from strategic health authorities, plus a new£350m 'contingency fund'.
The fund comes from£5.5bn devolved to SHAs this year from central funds previously devoted to areas like public health, medical education and clinical training (news, page 5, 30 March). The same budget covers clinical excellence awards, GPs' performance-related payments and services such as walk-in centres, out of hours and NHS Direct.
The DoH said that the SHAs had 'undertaken to deliver savings by better targeting and management of resources using their local knowledge'. And it promised to 'monitor the performance of individual SHAs to ensure the quality of patient care is safeguarded'.
The Faculty of Public Health expressed dismay at the latest raid on public health funds. President Professor Rod Griffiths told HSJ: 'I'm very disappointed that something as important as this has been so clumsily managed. The overspends have not been caused by community medicine; it is poor commissioning and poor management of acute services.
'It is not as if we have not had the analysis that highlights the importance of public health. Choosing Health, and Your Health, Your Care, Your Say? both point to that.'
RoyalCollege of Physicians president Professor Ian Gilmore said: 'We know from working with postgraduate deans that their budgets have been cut. If this is likely to lead to cuts at trust level then that could add to further strains and give us cause for concern.'
NHS Confederation policy director Nigel Edwards said SHAs needed to ensure they did some 'pretty careful planning' because cutting medical education budgets in particular was not a sensible long-term strategy. He warned that postgraduate medical education was likely to be most at risk, particularly in minority disciplines such as healthcare scientists.
The first set of quarterly figures, broken down by SHA and trust, also demonstrates the scale of the ambition in some of the most troubled parts of the country:
- London is forecasting a deficit of£90m, compared with its debt of£168m racked up last March.
- East of England is forecasting to be£125m in the red, compared with the£214m end-of-year figure.
- South Central is promising to bring its£58m debt down to£11m.
Overall, the figures suggest that tough savings are being made across the country, but the NHS Confederation warned that predictions this early in the year were hard to rely on.
Quarterly figures provided to the DoH - but not published - this time last year show that a number of forecasts across the same areas differed wildly from end-of-year figures.
East of England forecast it would be£169m in the red, but passed the figure by£45m, while South West's£15m deficit forecast hit£49m nine months later.
Although the number of trusts and PCTs predicting a deficit has fallen to 120 from 174 last year, the deficits are still concentrated in a small number of organisations. Ninety per cent of the deficit can be found within 13 per cent of all organisations.
The only SHA that has forecast a bigger deficit after the first quarter than at the end of the last financial year is South East Coast, which is predicting a deficit of£94m compared with an end-of-year£89m.
Mr Edwards said it was difficult to determine the significance of figures produced so early in the financial year. But he said he was optimistic that their publication would reassure government and allow managers to get on with the task in hand.
'The real hazard is people tinkering, and these figures show that progress is being made - which may remove some of the anxiety from the service,' he said.
Meanwhile, figures for England's 48 foundation trusts show they are also predicting an£18m surplus.
See Comment, page 3.