A REGIME of ‘financial special measures’ has been announced for trusts and clinical commissioning groups to ensure the NHS lives within its means by making the most savage cuts and closures in the history of the service.
Five NHS Trusts and nine CCGs (Community Commissioning Groups) have been put in an intervention regime, to be ‘reset’ to get the NHS’s finances and accident and emergency performance ‘back on track’.
The first five trusts to enter financial special measures for ‘resetting’ are: Barts Health Trust, Croydon Health Services Trust, Maidstone and Tunbridge Wells Trust, Norfolk and Norwich University Hospitals Foundation Trust, and North Bristol Trust. They are all in an acute financial crisis!
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.
There are a further 13 trusts that have not agreed ‘control totals’ and are planning for deficits. These are heading for the ‘resetting’ regime. 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.
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 re-set 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’.
To exit this regime a provider must have as a minimum a robust recovery plan and ‘evidence of significant improvement within two months’. 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.
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.