Read Jack Serle's latest HSJi Review, which notes how the NHS is in a dire financial state. The additional spending provided by the chancellor in her Autumn Budget is being consumed by higher pay, inflation and increased activity. It has effectively served to keep NHS funding for the year flat in real terms, but real terms cuts are on the cards for 2025-26.

The efficiency savings trusts and integrated care boards are having to make are unprecedented in the NHS’s history, according to our finance expert Henry Anderson.  Read the full article here.

Latest investigations

Berkshire Healthcare Foundation Trust

The bed occupancy in Berkshire Healthcare Foundation Trust’s adult mental health wards rose from 92.6 to 97.5 per cent between March and September. Occupancy of more than 95 per cent can undermine the quality of care. Therefore, it is struggling to reduce out-of-area placements and seeking to improve discharge rate and reduce admissions. Nursing vacancies in inpatient wards are very high. Associate roles and apprenticeships are being used to fill gaps. It is on track to deliver surplus and cost improvement programme.

Hampshire Hospitals Foundation Trust

Hampshire Hospitals Foundation Trust remains part of the national recovery support programme. Consultants appointed after under-performance on cost improvement programme. Closer links to other providers, especially University Hospitals Southampton, are key to long-term sustainability. The entire HIOW ICS was escalated into tier 1 of the national oversight framework for urgent and emergency care following a review in July. It was included in the New Hospitals Programme. The project includes new hospital and major refurbishment of existing site. However, the £900m scheme is being reviewed by the government.

The NHS in Scotland: Winter 2024 update

The first stages of much-discussed reform within NHS Scotland are finally becoming evident. NHS Scotland chief operating officer John Burns recently set out a new approach that will see boards increasingly expected to work together regionally. The government is to draw up a list of services that each board is required to deliver. This opens the door to smaller boards being told to surrender the delivery of some specialised or fragile services to larger, better-equipped and more stable counterparts.

Medway Foundation Trust

The trust is short of beds, but cannot expand its main site and must instead seek to repurpose it. An elective hub may be built in Chatham. The trust has a backlog maintenance bill totalling £120m. The trust’s poor financial performance means it has been placed in the highest level of NHS England’s oversight regime – SOF 4. This means all but its most minor spending decisions are subject to system and national oversight. Poor patient flow is behind very long accident and emergency waits. The trust is increasing work in the community to reduce demand for its services.

Data

Last week, the following datapoints were updated:

• Discharge delays due to ‘internal’ reasons, Discharge delays due to ‘external’ reasons, Emergency care streaming indicator, Type 1 Departments - Major A&E %, Emergency care streaming indicator, Type 3 Departments - Other A&E/Minor Injury Unit of Acute in November
• Number of cases waiting over one year, Proportion of cases waiting over one year % of Acute, community, MH and specialist in October
• Super stranded patients, % beds occupied by delayed discharges of Acute in November
• 62 day cancer target, 31 day cancer target, Drug and alcohol treatment target of Scotland in Q2 2024-25