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NHS finance chiefs have privately always been more worried about the next financial year – 2023-24, which begins in a few weeks – than the current one.

Extra covid funding has been slashed and reserves or one-off savings have been depleted.

What’s left are big scary numbers: HSJ can reveal that initial integrated care systems’ plans for 2023-24 added up to an eye-watering £6bn national deficit.

The usual caveats: this is a very early stage in the process and numbers come down dramatically as the plans are revised ahead of final submission.

But the sheer size is causing consternation among finance chiefs and, one suspects, the highest echelons of NHS England.

One seasoned ICS leader with 25 years in the health service said the deficit was the biggest they had seen at this stage “by some way”.

Another finance director said the figures were “evidently not real” amid uncertainty about financial arrangements for next year.

But even they reckoned the deficit could still end up being as much as £3bn.

NHSE is now exerting a huge amount of pressure on ICSs to make the sums add up in time for the start of the year. Whether they survive contact with the real world is another matter. 

A matter of concerns

NHS staff are significantly less comfortable raising concerns and are less confident in their organisation to address them, the service’s annual staff survey has revealed.

The 2022 results of the NHS staff survey yesterday showed a decline on all measures relating to the raising of concerns about clinical safety and speaking up.

The percentage of staff feeling secure in raising concerns about clinical safety dropped from 75 per cent in last year’s survey to 71.9 per cent this year – a level not seen since before the pandemic in 2019. Up until this year, agreement with this statement had been steadily rising.

HSJ has analysed the full results of the survey for general acute and acute/community trusts.

HSJ has also analysed the results for mental health trusts and ambulance and community trusts.

More than 630,000 staff responded to the survey between September and December 2022 – a 46 per cent response rate, down from 48 per cent in 2021.

Nationally, across all trust types, 57.4 per cent said they would recommend their organisation as a place to work in 2022. That was down from 59.4 per cent in 2021, and from 63.4 per cent in 2019.

Also on hsj.co.uk today

In The Ward Round, Annabelle Collins fears the impending long-term workforce strategy is being watered down by the Treasury, and in comment, James O’Shaughnessy lobbies for a declaration of intent from policymakers to make the UK the top destination for health and life science research.