ICS admits ‘doubts’ it can fix decade-old deficit by 2026

Staffordshire and Stoke-on-Trent Integrated Care Board’s chief financial officer Paul Brown said in a board paper that the commitments it had signed, along with NHSE, required it to return to “underlying balance” by March 2026.

Although the system now plans to “work… at pace of the summer and into the autumn” on new plans, Mr Brown warned: “Many people are doubtful that a turnaround could be achieved that quickly.”

He added: “The deficit is hampering our action to strategically develop services and tackle inequalities.” The system is also “losing much needed capital allocation as a consequence” of the deficit, under new national financial rules.

The CFO said annual attempts to regain financial control were “doing nothing to dent the underlying deficit that was camouflaged during covid”, and said the system needed “a longer-term strategy” to improve. The “underlying deficit has been in the system now for about a decade”, his report added. 

The undertakings — agreed in May and published unnoticed on NHSE’s website — are a form of special measures from NHSE, which specify a set of agreed improvements to be delivered by a given date. They say the system is “failing to discharge one or more of its functions” and there are ongoing concerns about its financial sustainability. 

SSOT ICB is also one of 11 systems NHSE wrote to in recent weeks to warn it had “significant concern” about their spending in 2024–25, asking them to show how they will improve. The system has an efficiency target of £203m and a £90m deficit plan.

Two more systems under ‘undertakings’

Two other ICBs in the Midlands were also issued with NHSE undertakings this spring: Shropshire, Telford and Wrekin; and Nottingham and Nottinghamshire.

Nottinghamshire’s “undertakings” are also for poor financial performance (it ended the last financial year with a deficit of £113.7m), but STW’s notice also instructed it to make improvements to its operational performance, including urgent and emergency care, and “challenges in leading and facilitating collaborating across system partners”.

STW, which is the smallest ICS, is currently dealing with leadership problems, as well as financial and performance.

A STW spokesperson said: “As a system we have a number of local challenges, including those associated with our geography, configuration of estate and availability of substantive workforce.”

They added the system will “continue to work closely with NHS England and our system partners to undertake the necessary improvement plans inclusive of financial recovery and UEC operational performance”.

Undertakings put on Greater Manchester ICB, which also has severe financial problems, were reported earlier in July.