Northamptonshire’s commissioner of health services only just managed to balance its books last year and used all of its contingency reserve to do so.
There was just a £40,000 surplus on the £941m of spending carried out by the county’s two clinical commissioning groups (CCGs), which say ‘they continue to face significant challenges on delivering their commissioning objectives in 2019/20’.
A huge £4m has to come out of the reserves of the larger Nene Commissioning Group to make the books balances and £561,000 has been taken from the Corby contingency reserve, which means the health commissioning groups will no longer have a financial buffer.
A new financial management executive group has been set up and will meet on a fortnightly basis.
At its board meeting last week (June 18) the chief finance officer for both CCGS Stuart Rees said the finances are in a ‘critical position’ and that things are getting ‘harder and harder’.
A report to the board on finance, transformation and savings said: “Although the CCGs have achieved a small surplus in year the underlying position for both CCGs is worse than planned heading into 2019/20 and this will lead to financial difficulties if the problems are not addressed.
“Northamptonshire CCGs continue to face significant challenges on delivering their commissioning objectives in 2019/20; including continued increases in urgent care activity and challenges in delivering 18-week targets and the impact on waiting lists. The financial management executive has been established to manage this position and ensure triangulation of issues and actions across the health economy. “
The total spend of the Nene CCG was £828m and the smaller Corby CCG spent £112m. The groups commission services from providers such as the county’s two hospitals, GPs and mental health services.
The section of the report about the Nene CCG says: “During the year the CCG experienced cost pressures in acute activity with out of county providers, continuing healthcare budgets and prescribing budgets. These pressures impact the underlying financial position carried forward into 2019/20 and therefore need to be addressed by the CCG.”
The section about the Corby group says: “The CCG experienced cost pressures in continuing healthcare budgets and on prescribing budgets. These pressures impact the underlying financial position carried forward into 2019/20 and therefore need to be addressed by the CCG.”
Planned-for efficiency savings of £5m did not happen and had to be met from the contingency reserves.
The number of people accessing services is being pointed to as part of the issue.
Up to week seven of this current financial year there had been 24,008 people accessing accident and emergency services in the county. This is a five per cent increase on the 22,920 people accessing the service in the same period the year before.
The increase reflects a three-year trend of growing pressure on health services.
The pressures have come in part from the increasing population across the county which is not being matched by health investment. Chief executive Toby Sanders has said that the county is the only one in the entire country that has not received any capital investment for new buildings and infrastructure in the past three years.
There is currently a consultation happening about whether to merge the two CCGS, which would then have a shared budget.
Chief executive of the two CCGs Toby Sanders has said this is being done to make saving efficiencies on areas where there is duplicate activity, such as external audit.