Daily Insight: Signed, sealed but not exactly delivered

The number of health systems failing to meet their primary financial targets rose significantly last year, despite NHS England’s chief finance officer previously offering assurance that many more areas would “definitely” deliver on their plans.

According to HSJ analysis, 25 integrated care systems — more than half of the 42 — missed their financial plans in 2023–24, up from 18 the previous year, indicating increasingly widespread financial issues.

Local leaders criticised the 2023–24 planning process, claiming national leaders pressured them into setting unrealistic plans.

Last summer, NHSE’s chief financial officer Julian Kelly expressed confidence that more ICSs would meet their targets, expecting many to hit their plans due to efforts in addressing financial recovery.

NHSE provided extra funding during the year to counter the impact of industrial action.

Systems such as Greater Manchester, North East London, Derby and Derbyshire, and Nottingham and Nottinghamshire overspent, despite plans to break even. Others, such as Devon, Kent and Medway, and Shropshire, Telford and Wrekin, ended with larger deficits than planned.

ICSs started 2023–24 with a £650m deficit, which ballooned to around £2bn. The Department of Health and Social Care and NHSE had to redirect funds from central budgets and receive Treasury injections to manage costs incurred from industrial action.

James slots into the jigsaw

In the latest development around NHSE’s shake-up of clinical leadership, the first ever medical director for mental health and neurodiversity has been appointed.

Former Royal College of Psychiatrist’s president Adrian James’ appointment was announced by NHSE on Monday and said he would “support the transformation of services for people with mental health needs, autism, a learning disability and those who are neurodiverse”.

Dr James will report to national medical director Sir Steve Powis along with other national medical directors, including Claire Fuller for primary care and Aidan Fowler for patient safety.

The appointment comes at a tough time as the five-year funding cycle of the 2019 NHS long-term plan — which substantially increased spending on some mental health services — ended in April. There is also rising demand and waits for many mental health and neurodiversity services and close scrutiny of major failings in inpatient units.

Of his appointment, Dr James said he was looking to further improve outcomes, the experience of care and timely access to MH and neurodiversity services.