Daily Insight: School of hard knocks

Graduates who were fortunate enough to go to university post-2012 face a lifetime of payments that will never come close to clearing their mountain of debt.

It’s the perfect analogy for local NHS trusts and commissioners, who are now on the hook for billions in deficits they racked up in previous years.

The smallest integrated care system, Shropshire, Telford and Wrekin, has an outstanding balance of £300m, more than a third of its annual allocation.

It is one of 30 systems paying money back to NHS England, with 10 systems technically owing more than £200m. The total outstanding has doubled to more than £4bn in the last two years.

In common with Generation Z, ICSs will never pay off their eye-watering obligations. Repayments that are around £20m a year for some of the larger systems are capped at a rate that would take a lifetime to clear.

NHSE’s attempt to incentivise financial discipline by dangling the promise of debt forgiveness in exchange for balanced budgets looks to have fallen flat.

The government writes off student loans after 30 years. ICS leaders will be hoping for more generosity from NHSE. 

Directors cut

Over the past three months, three directors have lodged grievances about the leadership of an integrated care board, HSJ has learned.

Senior staff at Shropshire, Telford and Wrekin ICB raised concerns regarding chief executive Simon Whitehouse’s capability, conduct, and capacity.

The ICB confirmed to HSJ that it received two grievances, one later withdrawn, and a third complaint as a “freedom to speak up concern.” Insiders insist all three were initially grievances, with one withdrawn under an exit agreement.

This unfolds amid significant leadership changes, with six senior staff departing since November, including the chief nursing officer, chief medical officer, and chief operating officer.

A senior manager noted staff are “voting with their feet”.

The ICB attributed departures to varied reasons, including retirement, promotions, and organisational changes. A spokesperson said: “The ICB is undergoing significant change, impacting staff and prompting career reviews. We’re pleased with new recruits and committed to a supportive environment.”

Shropshire, Telford and Wrekin is the smallest of 42 integrated care systems and faces significant challenges. It has been in NHS England’s most challenged tier since 2022, with a large financial deficit despite some care quality improvements.