Unforeseen post-covid demand is driving overspending, says trust chief

Graham Wareham, chief executive of Surrey and Borders Partnership Foundation Trust, told HSJ there were initially expectations in the sector that the demand increase after the outbreak would “abate”, but this has not yet happened.

It leaves trusts including his own unsure what to plan for, and facing additional short-term costs, such as temporary staffing, as they scramble additional capacity.

The trust exceeded its agency spend target for 2023-24, set by NHS England, by the end of August, mainly for this reason, he said, and it is facing significant overspends in its child and adolescent mental health services. 

Mr Wareham said: “We have seen a really big step up in demand since covid which we expected to abate but has not.

“We are also seeing more complex cases resulting in pressures on inpatient beds as they remain occupied for longer. This has meant that we have had to retain a temporary workforce to meet these needs, especially in children’s services.”

The trust’s Mindworks contract – which provides emotional support and wellbeing for children and young people – is likely to be £10m overspent this year, according to board papers, and children’s services were nearly £5m overspent by the end of August. The trust is planning a £7m year-end deficit.

CAMHS referrals were 1,530 in the 12 months to July 2019, before falling to 1,160 in the same period the following year as the pandemic hit. But after returning to 2019 levels in 2021 and 2022, the year to July 2023 saw them increase by 50 per cent to 2,415.

The trust – working with private provider Elysium – plans to open a 12-bed inpatient unit for children and young people later this year. But its agency spend of £11.1m to the end of August accounted for more than 12 per cent of its total wage bill and exceeded its annual NHSE target. 

Meanwhile, length of stay in the trust’s adult wards has increased from 37 days in 2019-20 to 47 days in 2022-23, which it says is due to severity and complexity of need.

Mr Wareham said the trust was now reviewing longer-term capacity plans, and redesigning services.

He said: “We are now having to think again about whether this is a lasting impact on demand or whether it will settle at a lower level. If this is lasting, then we may have to think about how we redesign services to accommodate this level of demand. Today’s challenges are different from what they were pre-pandemic and to respond to these challenges we need to innovate which is what we are doing.”

For example, Mr Wareham highlighted the issue of anxiety for some children and young people having returned to school, which cannot be addressed by traditional mental health services.

He said: “Our ‘mental health in schools’ team was introduced in 2021… [It] receives between 100 and 150 referrals a month. It is not clear at this point what intensity of support may be needed in the future and that makes it harder to be certain how to use limited resources to best effect.

“Working with different agencies to help them identify needs and provide children with support earlier on is an example of the type of innovation we are focusing on.”