• Five trusts and nine CCGs in new “financial special measures” regime
  • Trust regime could involve organisations losing control over spending decisions, leaders being removed and the DH exchanging “surplus assets for cash”
  • CCGs could be disbanded, made to share a joint management team or turned into an accountable care organisation
  • Map: The trusts and CCGs in new special measures regime

A new regime of “financial special measures” has been announced for trusts and clinical commissioning groups to ensure the NHS lives within its means.

Five trusts and nine CCGs have been put in the intervention regime, which forms part of a long awaited package of “reset” measures designed to get the NHS’s finances and accident and emergency performance back on track.

The national bodies said the financial special measures intervention regime would apply to trusts and CCGs “who are not meeting their commitments”.

Trusts in financial special measures

The first five trusts to enter financial special measures are:

  • Barts Health Trust
  • Croydon Health Services Trust
  • Maidstone and Tunbridge Wells Trust
  • Norfolk and Norwich University Hospitals Foundation Trust
  • North Bristol Trust

There are a further 13 trusts that have not agreed “control totals” and are planning for deficits. These may end up in the regime if there is not a “resolution”. They are:

  • Barnet, Enfield and Haringey Mental Health Trust
  • Imperial College Healthcare Trust
  • Cambridge University Hospitals Foundation Trust
  • East Midlands Ambulance Service Trust
  • Staffordshire and Stoke on Trent Partnership Trust
  • Wye Valley Trust
  • 5 Boroughs Partnership Foundation Trust
  • Alder Hey Children’s Foundation Trust
  • University Hospital of South Manchester Foundation Trust
  • Dorset County Hospital Foundation Trust
  • Dorset Healthcare University Foundation Trust
  • Plymouth Hospitals Trust
  • Poole Hospital Foundation Trust

Trusts will be considered for the regime in the future if they have not agreed a control total and are planning a deficit this year, if they have agreed a control total but are significantly off track, or if there is an “exceptional financial governance failure” such as fraud or irregularity.

Once a trust is in special measures, NHS Improvement will arrange a rapid “on site process” to identify key issues and agree a recovery plan within a month. They will consider whether further regulatory action is needed, including “removal of autonomy over key spending decisions or changes in leadership”.

According to the reset document, the Department of Health will also be able to “exchange surplus assets for cash for providers under a programme of financial special measures and does not intend to accept business as usual loan applications from these providers”.

Providers in special measures will not be able to lead on new care model vanguards or organisational transactions.

To exit the regime a provider must have as a minimum a robust recovery plan and “evidence of significant within two months”.

CCGs in financial special measures

For CCGs, interventions under the regime could include adjusting a group’s area and membership practices, disbanding the CCG, requiring them to share a joint management team or creating an accountable care organisation.

The nine CCGs entering the regime are:

  • Coventry and Rugby CCG
  • Croydon CCG
  • East Surrey CCG
  • Enfield CCG
  • North Somerset CCG
  • North Tyneside CCG
  • South Gloucestershire CCG
  • Vale of York CCG
  • Walsall CCG

The organisations placed in special measures all have acute financial troubles. For example, Barts Health Trust finished 2015-16 with a deficit of £134.9m – the largest in the NHS.

North Bristol Trust experienced the biggest deterioration in its finances in the final months of last year, with the trust recording a £55.6m deficit which was £17.9m worse than its forecast at the end of the third quarter.

Among the commissioners, East Surrey CCG had a cumulative deficit close to £25m at the end of 2015-16, and is already subject to NHS England legal directions. The CCG also spent £500,000 on two “off payroll” interim executives last year – a practice which the NHS is trying to crack down on.

Vale of York CCG is forecasting a cumulative deficit of £13.4m this year.