It’s evolution, but not as Darwin would know it.

A table in NHS Birmingham and Solihull’s most recent board finance report titled Evolution of QIPP targets and (the rest is left mysteriously blank) charts the incredible development of the cluster’s financial plans.

The ambitious £26m surplus predicted in its “initial system plan”  written in January 2011 dropped to a £50m deficit in June, before rising steadily to a break-even position in December.

However, the restoration of its financial fortunes from Neanderthal to Homo sapiens status hasn’t been left entirely to natural selection: an intervention from NHS West Midlands has seen the cluster’s agreed year end surplus reduced to a £2m, freeing up £4m.

Adding to this, a further £4.5m of contingency funds has been released, and a recovery plan launched in July is also “starting to have a significant impact”, the paper says. The latter has saved £32.2m so far.

But predicted QIPP savings have fallen from £98m to £45.6m. “Nearly 70 per cent” of the smaller sum has been secured; planned care and mental health carry the greatest risks.

The financial picture varies across the cluster, with NHS Birmingham East and North reporting a year to date deficit of £6.8m, requiring a transfer of £5.5m from surpluses in Heart of Birmingham and South Birmingham PCTs. NHS Solihull has a £5m deficit, being offset by £7.5m of “additional resources”.

Three out of five of the emerging species of clinical commissioning groups are overspent on delegated 2011-12 budgets. With indicative QIPP savings of up to £23.7m per CCG area next year, will a desire to speed up their own evolution encourage tough commissioning decisions?