The Friday Blog: The Gravy Runs Out
The Christmas Tree is still up in the back garden. It is partly because I think I am probably hedging at about 60:40 to go full on Candlemas this year (see last time). It is partly because the weather has not been conducive to even merely stepping outside onto the wet and slippery patio slabs, let alone trying to untangle a mass of lighting wires encased in razor sharp pine needles while doing so. And it is partly because it looked fantastic covered in snow this time last week. Well, it did for about half an hour at least. That is the thing with snow. Put me in a nice hotel with three or four bars and a couple of decent restaurants in it, and I can sit and stare out of the window at the white stuff for as long as you like, but if I am at home with things to do, the novelty wears off pretty quickly.
It started coming down steadily here late on Thursday afternoon, so much so that by about nine o’clock the school had decided that it would not bother opening the next day, news which produced a spontaneous expression of joy from daughter. Flurries continued throughout the night and when the sun came up, we were greeted with an exceedingly seasonal scene. It was ok for a bit, obviously, what with the tree, a happy daughter and an excited dog, but it got tiresome quickly enough. By the time you were reading the Blog and I should have been in the Horse and Jockey with daughter enjoying Friday snacks and the school week debrief, I was pulling on my wellies and traipsing through the slush with a rucksack on my back to see what was left in a delivery-free Co-op with which to feed the girls. Steak dinner on Friday and a Gammon roastie on Saturday as it happens. Aside from being snowed in the car park, Friday was not too bad, although it was wishful thinking in the extreme on my part to opine to the people in the paper shop that, given the relatively warm temperature, it would all be gone by the evening. It was not. The snow was so deep that it had become compacted by the activity happening on the surface and was not for thawing. It got cold on Friday night and on Saturday morning it was treacherous underfoot. I took the dog for a walk on what was, by rights, a 90 minute route. It took a full two and a half hours and was seriously hard going, especially on the bits where walking on the road was not possible, and there was very little in the way of virgin snow on which to step. Proceedings were further impaired by a very large tree being down on the canal towpath, and getting a big dog through the branches and up and down the embankment was far from straightforward. On Sunday, it was virtually impossible to stand up on the car park, not even the bin waggon, playing catch up after being put off by Monday’s light dusting, tried to come down, focussing instead on the posh new builds around the corner whose roads are, somehow, less susceptible to the ice than ours.
Eventually, enough was enough, and we somehow slipped and slid our way into the car for an outing to the McArthurGlen Designer Outlet at Cannock, an idea seemingly shared by a very large proportion of the population of the West Midlands. Actually, we seemed to have timed it to perfection, probably arriving as numbers inside were rapidly falling from their mid-afternoon zenith. Indeed, although I have never seen the car park as full, the shops were far from overrun and there was not even the usual queue of “daughter misses out again” length at Wagamama, which led to more spontaneous joy and saved the kitchen further punishment. By the time we got home the temperature was in double digits, it was raining and the snow was gone.
This was the week in which we finally finished the Christmas gravy. Of all the bits of festive feasting, it is the gravy that is the most labour and time intensive. It is probably, actually, a month’s work when you think about it. First there is the autumn menu planning to create space in the pitifully small freezer. Then a few carcasses and assorted veg cuttings are boiled up over a period of weeks to make the stock which fills the space in the freezer. Then it is roasting some chicken wings and more veg with various assortments of oils, vinegars and wines before bringing the two together with the juices from the bird, or such juices as there are in the crown and a small joint procured from the Co-op for a fiver on Christmas Eve. It actually paid off this year, and we lacked in neither quantity nor quality. And it is now that time of the NHS financial year when it is all about quantity and quality. The quantity of deficits and the quality of the forecasting which has forecast, for the last three quarters, that there would be no deficits. But deficits there are.
But it is not so much bad quality forecasting as dishonest forecasting. Keep saying you are on target and stay off the naughty step for as long as possible, and when it becomes obvious your forecast is dodgy, almost everyone else will also be on the naughty step too, so stigma and associated sanctions are reduced. At some point, someone has to stand up and be the first to say that their ever-increasing cost improvement plan target is merely a balancing figure between the promised break-even and the inevitable deficit which will be posted. Stand up colleagues from my old South West stomping ground, the Royal Devon University Healthcare Foundation Trust has revised its year-end 2025-26 forecast position from said break-even to a deficit of £44m. This followed an extraordinary Board meeting on Friday, and having been in a few of those as a Chair of the Finance Committee myself, I can imagine how it played out. Great bit of theatre and one for the memoirs for the NEDs and a sense of ever impending doom for the Execs. In a quote that could be issued by pretty much any Trust, RDUH said “the deteriorated position is mostly down to a failure to meet its “ambitious” cost improvement plan of £68.8m (5.6 per cent of turnover).”
Fair play to the Devonians for coming clean given the pressure from Big Sir Jim and others for Trusts to achieve financial balance this year. But, amid some curious goings in those gentle rolling hills, it was on the cards. In December, Devon was one of 10 systems to have deficit support funding withheld in Q3 due to NHSE’s concerns over financial plans not being hit. RDUH was the only Trust in the system not expecting to receive deficit support funding in 2025-26, with University Hospitals Plymouth Trust and Torbay and South Devon FT expecting to receive £23m and £30.8m, respectively, throughout the year. But requests from RDUH to Devon Integrated Care Board for a share of the deficit support funding have been turned down in recent months, and a request to NHSE for dedicated redundancy funding has also been rejected. In news that will have caused audible groans from beleaguered Execs, a turnaround and recovery director for RDUH, Jules Martin, has been appointed by NHSE’s South West region.
If there is more to come, and there will be, then University Hospitals Tees Group is getting the retaliation in early for next year. CEO Stacey Hunter said the control total proposed for South Tees Hospitals Foundation Trust in 2026-27 would require a cost improvement programme “in excess of 10 per cent” and that there was not “a credible path” to deliver this in one year. Oh dear. Hunter has gone on the offensive and written to the Regional Director indicating this and outlining a high-level opportunity to deliver financial balance for South Tees over three years, which is, after all, not entirely inconsistent with the future operating model proposed in the 10 Year Health Plan. She does also have a point on the reality of short-term expectations. A 10 per cent CIP would be more than double the Trust’s 4.6 per cent efficiency plan for this financial year. Probably more in hope than expectation, the group has agreed a “significant and stretching” efficiency programme of £85m (about 5.6 per cent of its turnover), ahead of the final submission next month, admitting that it had been too reliant on non-recurrent efficiencies in previous years.
What actually interested me most in this drama was the fact that Hunter also said the group was not confident it would deliver key elective and cancer targets. That is a microcosm of one of the key tensions playing out across the NHS. The Government’s stated number one priority for the NHS is to return RTT to constitutional standards by the next election, and that is probably what your swing voters most care about, but, given there is no money, the message to NHS leaders is that keeping the finances on track is even more important. The two are not reconcilable, more activity means more money, and a lack of it means that the system is already behind the required elective run-rate. There are hopes that a so-called elective “sprint” will help drive Trusts forward to meeting the 65 per cent elective target for March. But the elective situation becomes more challenging in 2026-27, when NHSE is demanding a minimum 7 per cent improvement in the proportion of elective patients seen within 18 weeks to ensure the system hits 70 per cent overall. And, of course, they must do this without a commensurate amount of additional funding, while the financial contract next year retains an effective elective activity cap for next year. This has got providers of all shades worked up, but it is a zero-sum game, and commissioners are faced with the perennial issue of how best to ration a finite pot of funding.
Young Wes has an interesting take on the conundrum and reckons that some NHS organisations are struggling to cut waiting lists because they have “over steered” on avoiding deficits. Make of that what you will, but I suppose that if you are a Trust CEO, the choice is do you get fired for overspending or get fired for not doing enough activity. Answers on a postcard to #howmuchdoineedtolivelikeannhsceoinretirement.
And so to the weekend. This week feels even longer than last, but, and this might be some more extreme wishful thinking or maybe some sort of Christmas gravy cold turkey, but do I sense the nights are noticeably beginning to draw out?
