NHSE rejects ‘unacceptable’ ICS deficit

NHSE took the step after Lincolnshire ICS warned that its constituent organisations, including the commissioning body and all provider trusts, could post a combined year-end deficit of £35m.

Lincolnshire has a long-standing structural deficit and has been in the recovery support programme, the sucessor to special measures, which involves mandatory oversight from NHSE, since July 2021. Under original plans the ICS was to exit the regime in March, but this could now be pushed back to the end of September, though any revised date has to be agreed with NHSE.

The details were revealed in papers discussed at the ICS board meeting yesterday, which included correspondence from NHSE’s regional team following review meetings in December.

One letter warned of a “lack of progress” on the organisation’s finances, adding: “Whether this is down to a suboptimal plan, execution or both, we stressed the importance of each constituent organisation within the system contributing to this imperative…

“[At the review meeting] we expressed significant disappointment at the position you are in and stressed the need for stronger grip.”

An earlier letter warned any decision to keep the ICS in special measures will “most likely attract attention from the secretary of state…”

The system will now focus on savings in prescribing, productivity and bed closures, the letters state, as well as reducing agency spend.

The ICS now estimates the combined deficit could be improved to £27m, but remains in discussions with NHSE, according to a report to its board yesterday. The report adds NHSE has “suggested this would not be accepted and that this will be required to reduce to c.£20m”.

In November, Lincolnshire became one of the first ICSs to request permission to change its year-end financial forecast from breaking even to a deficit, under a new protocol that set out a series of extra conditions for overspending trusts and systems.

The new guidance was introduced as major deficits began to emerge in the first half of the financial year, with HSJ revealing two-thirds were falling behind their plans.

In recent weeks Devon has followed and other areas have indicated they are likely to do so in coming months.

An integrated care board spokesperson said: “Whilst we are committed to Lincolnshire exiting the national RSP as soon as possible, we must manage and prioritise the multiple demands upon the local health services to deliver the safest and most effective care for people that we can.

“This has meant that we have not progressed as quickly as we would have liked and so we continue to work closely with NHSE to accelerate the programme and achieve a strong, sustainable financial position in Lincolnshire that will enable our long-term exit.”