Imagine you are a family called Sussex and Surrey NHS Trust with an overdraft of £55m. Your bank manager (Mr Hunt) has been writing nasty letters to you for the last 18 months.
You had made a plan to clear the overdraft but Mr Hunt did not agree with your plan. He sent some debt advisors to see you and they have helped you come up with another plan.
This new plan is great! It makes better use of your money and helps you to be a better family. You will travel by bus or walk rather than have a car, you will eat cheaper but more healthy food. It's a real make over....unfortunately it still leaves you with the £55m overdraft. It also does not guarantee you against becoming overdrawn in the future.
Mr Hunt and the bank are now seriously grumpy. You and some other spendthrift families are put on the naughty step (the Capped Expenditure Process) and told sternly that however much it hurts the overdraft has to be fixed by next April, 2018.
You would sell something but you already have a second mortgage on your seaside cottage (£67m debt at the Royal Sussex County)
We hope the story above gives an easier insight into the complicated financial pressures that are currently on the NHS. If you would like to read into the detail of the realities of this situation, please see below:
The current situation
Public services across Brighton and Hove are facing enormous pressures. Local NHS services, as in much of the rest of the country, and Brighton and Hove City Council (including their children and adult social care, Safeguarding and Public Health services), are both faced with having to make difficult choices against a backdrop of more restrictive budgets both now and anticipated in the future.
The local authority financial pressures are very much in the public domain (read more here) with democratic accountability held by locally elected Councillors.
Healthwatch Brighton and Hove recognises that it is difficult to understand how our public services are financed, or why these may operate in deficit. We have therefore called for much greater openness and transparency on the parts of the local Council and Clinical Commissioning Group so that local people can have a better understanding of the pressures and challenges that exist. Read here for further information.
We believe that an ideal opportunity to do this lies with the ‘The Big Health and Care Conversation’ program which forms part of the work of the Sussex and East Surrey Sustainability and Transformation Partnership (STP). The role of the STP is to examine how the NHS and social care can work together to improve and join-up services to meet the changing needs of all of the people who live in our area, crucially within budget.
More information about financial pressures can also be tracked through the various Governing bodies of the NHS provider Trusts and the NHS Commissioners, principally the Brighton and Hove Clinical Commissioning Group (CCG). For further information on Brighton and Hove's CCG:
Please click here for information about:
NHS finances and the Capped Expenditure Process
NHS finances are very complex and as part of ‘The Big Health and Care Conversation’ in Brighton and Hove the CCG have promised in the Autumn to include an explanation of the current and future financial pressures in the NHS and their impact on the City, integration of health and care and other plans. If you would like more information about NHS finances in Sussex and East Surrey please read here.
This year across the NHS Sussex and East Surrey Partnership there is a £55m gap between what is likely to be spent and the available funds. The Department of Health and NHS England have asked the Brighton and Hove and the Sussex and East Surrey Sustainability and Transformation Partnership (STP) to produce a plan to close that gap – we understand that once the plan has been agreed within the NHS it will be shared with local people.
Across the UK there are 44 STP’s and 14 of these, including our local STP cannot balance their books and have been placed in a ‘Capped Expenditure Process’ (CEP) – that involves coming up with the plan described above, to fix the problem.
More information about making difficult financial decisions in the NHS
- The King’s Fund have published several documents which attempt to explain the financial pressures facing the NHS:
- The British Medical Association (BMA) have issued a briefing which provides an explanation of what we know about the process of CEP and its potential implications for doctors, patients and the NHS.
- There has also been a lot of comment in the media about CEP.
- The University of Birmingham has set out factors that can enable CCGs to successfully command the confidence of the public, patients, local politicians and other key stakeholders when making changes.
- The Health Foundation have provided some advice for Commissioners on engaging the public in making difficult decisions.
- The NHS Clinical Senate have produced advice about ‘Quality and Delivering Value.'
David Liley, Chief Officer Healthwatch Brighton and Hove, 13/8/2017