Daily Insight: If the worst should happen

No expectant parent wants to think about what would happen if their baby arrived too soon or sick, but most would like to think – should that happen – the health system is fully equipped and staffed, ready to help them close to home.

However, data from 19 trusts running level three neonatal intensive care units – which care for the most seriously unwell children – shows thousands of requests to admit either a newborn or a woman about to give birth to a baby likely to be unwell enough to need specialist care have been turned down over the last three years due to a lack of beds.

The situation appears to be leading to families travelling hours away from home for a cot. Indeed, responses to HSJ’s freedom of information requests revealed several journeys exceeding 100 miles, although it is not known why these particular transfers took place.

Experts HSJ spoke to said a lack of suitable staff was a big part of the problem, with units unable to open all their commissioned cots because there simply wasn’t the workforce available.

Official figures indicate the neonatal nursing workforce is growing gradually, while NHS England has announced £45m capital funding to increase NICU capacity within the last year.

Deficit: Not ‘if’ but ‘how big?’

This year’s budget-setting process, which could fairly be described as tortuous, saw most ICSs eventually produce balanced financial plans that NHSE was broadly happy with.

But a few months on – final plans were only signed off in late June – the five holdouts who stuck to their guns and forecasted a deficit look like they possessed remarkable foresight.

Under the most recent internal figures, ICSs are set to rack up an aggregate deficit of more than £1bn by the end of this financial year, senior sources told HSJ, with estimates ranging up to £1.5bn.

Internal NHS figures put the overspend by October at £800m, which would suggest a year-end deficit of slightly less than the upper estimate if spending continues at its current rate.

That’s a big “if” that NHSE is bearing down on. In recent weeks it has made it harder for systems to forecast a deficit and the national finance team is taking a close interest in ICSs furthest from their plans.

Meanwhile, everyone expects that covid cash reserves and balance sheet tricks will be used to improve the final position.  

None of this will affect the long-term gap between funding and spending, however, which will continue – and probably worsen – next year.