Its going to get tougher – ICB round up

However tough the financial regime has been for 2022/23, it is set to get even tougher in the next two years – in which the NHS is expected to deliver £12 billion in “efficiency savings”, while reducing waiting times and waiting lists.

While some local issues may also play a role, research from the Lowdown finds that all ICBs are confronted with a similar set of problems, and seeking ways to cope with inadequate resources – beds, staff, diagnostic services, mental health capacity and of course funding.

The problems itemised in nearly every ICB include:

  • Assumptions of inflation at 1.8% (the official prediction of 2.9% minus an “efficiency” target of 1.1%) – while actual inflation continues in double digits, and no costs are coming down.
  • Large numbers of beds filled with Covid patients (for whom almost all funding has now ceased): 4,585 front-line English hospital beds were filled by Covid patients as of May 3, with 370 in East of England, and 846 in London. But while these beds are not available for routine and emergency patients, additional funding for Covid has been largely or completely ended.
  • thousands more beds (throughout March over 13,000 in England, more than one in eight of England’s 95,200 occupied acute beds) filled with patients who are medically fit but cannot be discharged for lack of community health and social care: on March 31 there were 992 in East of England acute hospitals and 1,451 in London – just under one in ten occupied beds. This again hampers efforts by trusts to meet tough targets to increase numbers of elective patients treated and reduce the 7.2m waiting list.
  • under-funded pay awards,
  • staff shortages (forcing up spending on agency staff, in many cases well above the “cap” imposed on agency spending by NHS England, or in some cases expansion of the trusts’ directly employed workforce to reduce spending on temporary staff.)
  • Failure of NHS providers to meet tough targets for “efficiency savings” in 2022/23, (or sometimes imaginary assumptions or unassigned savings) along with almost universal  over-reliance on one-off “non-recurrent” measures and budgetary fiddles, which leave an underlying deficit rolling in to an even tougher 2023/24.

Full story in The Lowdown, 17 May 2023