Daily Insight: So this is Christmas?

As financial pressures tighten around the NHS, local leaders are starting to show their frustration at the impact this has on their day-to-day work.

North Bristol Trust chair Michele Romaine told her board she was “depressed” by the latest spending curbs imposed by NHS England last month in a bid to rein in trusts which are heading for the red.

NHSE’s new rules mean trusts that forecast missing their financial plans need sign-off from their integrated care board before spending more than £50,000.

This has irritated Ms Romaine, who bemoaned the lack of trust this signalled by NHSE towards trusts.

“It will be an issue about how we tackle some of the things we quite rightly need to solve ourselves because we’re going to be waiting for system or regional approval for really relatively small amounts,” she said.

NBT, which is £5m off plan at the moment, is still forecasting break-even by March 2023 – and a spokesman said this meant the new rules do not apply to North Bristol Trust.

Daily Insight wonders if the rule will only incentivise trusts to delay changing their financial forecast – thereby delaying the need for system approval until the last minute.

Raiding party

A fund marked for improvements in cancer, maternity care and other priority services will lose £1bn this year and faces a similar cut in 2023-24, HSJ has learned.

NHSE is taking the cash to address overspends elsewhere in the NHS, with several NHSE directors saying the service development fund is taking a battering thanks to inflation, a pay deal unfunded by government, and higher than expected covid-related costs.

An NHSE source said spending on the fund was being controlled tightly so unused funds could shore up the bottom line, and that large reductions were also expected in 2022-23 and beyond.

At the beginning of this year NHSE said the fund was worth £3.8bn. It is not clear what its current allocation or planned spend is, and NHSE did not respond to a request for comment. 

The cuts are likely to be linked to ministers’ view that the NHS should focus on “core” priorities and cut other activities, including reducing NHSE national programme work which is typically linked to SDF budgets.