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No more savings can be made, hospitals tell regulators

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Trusts have told regulators they will not be able to improve their financial positions without affecting frontline services, senior acute trust leaders have told LGC’s sister title Health Service Journal.

  • Trust leaders say they cannot improve financial position without “significant compromise” on standards
  • Follows Monitor/TDA letters telling providers to revise their 2015-15 plans
  • One foundation trust says it will consider letting patients wait longer


Monitor and the NHS Trust Development Authority wrote to trusts earlier this month asking them to submit plans by 21 August for how they could improve their 2015-16 financial positions, either by reducing their planned deficit or improving their surplus.

Acute trusts are facing a deficit of at least £2bn this year, according to their forecast positions.

One trust chief executive said they had told the TDA they could not improve their financial position “without a significant compromise to access standards, the provision of service and quality of care”.

They added: “With the array of regulatory requirements, including from Monitor and TDA, we cannot improve our position unless we are specifically advised that other standards and requirements can be dropped in the short term.

“It is the centre that has over-promised and the centre that needs to rebalance between what the service offers and what can be afforded.”

Several foundation trust finance directors said they would not be able to cut their deficits any further without affecting patient safety and they had said this to Monitor.

All trusts and some foundation trusts have been given specific new outturn targets.

Imperial College Healthcare Trust has been told to reduce its planned £18.5m deficit by £11m.

A trust spokeswoman said they were “currently exploring options and developing proposals to enable us to make the required savings”.

Aintree University Hospital FT is one of the 43 FTs with the largest deficits receiving targeted help from Monitor. It has a planned deficit of £12.9m.

A trust spokeswoman said it would not be able to cut its deficit without a “restructure of services across a wider footprint or a change to current tariff payments”.

A spokeswoman for University College London Hospitals FT said it had not been given a target by Monitor, but its £43m cost improvement programme was “proving extremely challenging”.

She added: “We are currently considering options as to how best to meet this through looking at capacity and activity on all our sites, along with introducing money-saving actions for all staff in relation to agency costs, discretionary spend and minor works at our sites.”

Monitor’s letter said trusts should ensure “waiting list management optimises both patient experience and the trust’s financial position”.

One senior FT trust leader said their organisation would consider letting patients wait longer for elective treatment in an attempt to address the deficit, but only if other cost saving actions had been exhausted.

HSJ asked Monitor and the TDA what the next steps would be if trusts were unable to improve their financial positions.

A Monitor spokesman said: “We are currently reviewing the updates submitted by trusts, and if necessary will be in touch with them once this is completed.”

A spokesman for the TDA said: “Following the submission of revised plans, we are planning on having discussions with each of our NHS trusts.”

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Readers' comments (1)

  • This is unfortunately the wrong end of the telescope and will not move the system away from a "throw money at it culture". More meaningful attention should be given to deploying effective preventative measures across the care and health system which would ease the burden on the acute sector. The resultant easing would, I suggest, address some of these concerns.

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