Dozens of NHS trusts saw their financial position deteriorate further in the final months of 2015-16, despite regulators’ last ditch efforts to improve the bottom line. We list those with the biggest deteriorations.

In January, NHS Improvement called for “collective urgent action” to reduce the provider sector deficit, including “headcount reductions” at some trusts, but its year-end finance report suggests a further deterioration of around £350m.

Partly due to the changing financial plans throughout the year, many trusts did not state a year-end forecast in January, making a comprehensive analysis problematic.

But, of those which did, a significant proportion of acute trusts reported an outturn position in April which was worse than forecast in January.

Analysis by HSJ suggested the following ten trusts, which were all asked to comment on the numbers, reported the biggest absolute deteriorations in the acute sector.

 Forecast at end of Q3 (£ millions)Reported outturn (£ millions)Variance (£ millions)Capital-to-revenue transfer (£ millions)
NORTH BRISTOL NHS TRUST -£33.70 -£51.6 -£17.9 0
IMPERIAL COLLEGE HEALTHCARE NHS TRUST * -£30.10 -£47.9 -£17.8 £3.4
UNIVERSITY HOSPITAL OF NORTH MIDLANDS NHS TRUST -£16.80 -£26.9 -£10.1 0
NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST -£14.40 -£21.9 -£7.5 0
BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST -£37.70 -£45.0 -£7.3 0
KING’S COLLEGE HOSPITAL NHS FOUNDATION TRUST -£65.00 -£70.1 -£5.1 £3.2
WEST HERTFORDSHIRE HOSPITALS NHS TRUST -£37.20 -£41.2 -£4.0 0
EAST AND NORTH HERTFORDSHIRE NHS TRUST -£12.00 -£16.0 -£4.0 0
MEDWAY NHS FOUNDATION TRUST -£48.50 -£52.5 -£4.0 Unknown
ISLE OF WIGHT NHS TRUST -£4.60 -£8.4 -£3.8 £0.6
*Deterioration a result of one-off accounting adjustment        

At the end of January, the provider sector was forecast to be £2.82bn in deficit by the end of March.

Within this period, “financial improvements” of £724m were made, of which just £51m was down to operational improvement such as reduced agency spending. Much of the improvement was achieved by transferring capital funds to revenue budgets, and other “one-off technical measures”.

The size of the reported year-end deficit of £2.45bn suggests the improvements were negated to a large degree by a continued deterioration of around £350m.

In its year-end finance report, NHS Improvement said the reasons for this included a failure to deliver planned efficiencies, “ongoing high level use” of agency staff, high demand for emergency services, and fines and penalties being applied.

A spokesman for North Bristol Trust, which had the most dramatic deterioration, said spending on agency staff was a major factor. He added: “In addition, issues around patient flow and timely discharge has meant that we have had to reschedule some operations and procedures which have impacted on our ability to meet national targets.

“This has meant we have undertaken less work than we planned and has had a direct result on the amount of income we have received.”

The deterioration at Imperial College Healthcare Trust between January and April was a result of a one-off accounting adjustment, primarily to reflect a reassessment of the condition of its estate.

The trust’s outturn was still £11.5m worse than planned at the start of the year, however, partly due to lower than expected NHS income, less growth than planned in its private health division, and provisions associated with estates and backlog maintenance.

University Hospitals of North Midlands Trust said its position was affected by continuing winter pressures.

East and North Hertfordshire said it received less money than forecast from its CCGs, while West Hertfordshire Hospitals Trust and Norfolk and Norwich University Hospitals Foundation Trust pointed to fines and penalties by commissioners.