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The bodies that coordinate and deliver NHS care across England are on track to spend £4.9bn more than previously planned this financial year, Sky News has found.

The data was obtained through freedom of information requests to England’s 42 integrated care systems (ICSs), which are responsible for allocating the NHS budget to local trusts and commissioning services in their area.

Sky News obtained figures from 41 ICSs, every one of whom reported being in deficit in their latest financial disclosures.

As of September, six months into the current financial year, England’s ICSs had overspent by an estimated £2.5bn. If overspending continues at the same pace, that will mean spending of £4.9bn more than planned by the end of March 2024.

“This is the most worried I’ve been about financial pressures in the NHS since 2017,” says Siva Anandaciva, chief analyst at the King’s Fund, a health thinktank.

“In the old days, you would have had maybe a handful or two of organisations that are under serious financial pressure, but these figures show that financial pressures are incredibly widespread.”

ICSs can’t go bankrupt, but they can be forced to cut back on services and long-term investment.

“That’s been the same story now for over five years,” says Sally Gainsbury, senior policy analyst at the Nuffield Trust.

“There’s money put aside in the budget for improving services, and then much of it never gets spent on that because it ends up that they can’t even afford the day-to-day running costs.”

On 7 December, NHS England announced that additional funding had been made available to ICSs, some of which was taken from other areas of spending.

The additional funding has reduced the deficit faced by ICSs to £420m as of October. However, no additional funding has yet been made available to address additional costs resulting from the upcoming strike by junior doctors.

As part of their regular financial reporting, ICSs produce their own forecasts for where they think their deficit will end up at the end of the year.

Across the 41 systems, which accrued an estimated £2.5bn deficit by September, forecasts for the next six months suggested that the ICSs will cut this deficit to just £745m.

“Winter is not the time when the NHS makes money,” Mr Anandaciva says.

“What happens during winter, at least during the last 15 years, is you start cancelling electives and losing income on those.

“I look at those charts and I just don’t… I think they’re optimistic. Wildly optimistic, in some cases.”

Which areas are struggling most financially?

Sky News was able to obtain the latest financial disclosures for 41 of England’s 42 ICSs. Every one of them, as of their latest disclosure, was in deficit.

Many ICSs were already facing challenging spending targets at the start of this financial year in March, with one in three submitting deficit plans.

Systems are supposed to submit balanced budgets for the year. Mr Anandaciva says it’s an “incredibly painful” process for a system to agree a deficit plan with NHS England.

All of the 15 ICSs that submitted deficit plans have overspent those plans, according to their most recent published disclosures.

“So, they were planning for a bad-case scenario and things have gotten even worse,” he adds.

Lancashire and South Cumbria ICS, for instance, was planning for a £27m deficit by July, but instead overspent by £112m – equivalent to 8.4% of its overall budget for that part of the year.

Like many ICSs facing large, unplanned deficits, Lancashire and South Cumbria forecast in July that it would meet its year-end commitments and cut its deficit to the planned £80m. That would have required a surplus of £32m in the final eight months of the year.

A spokesperson for Lancashire and South Cumbria Integrated Care Board said: “During the financial year 2023/2024, the Lancashire and South Cumbria Integrated Care System has responded to a number of in year pressures which have contributed to the reported financial deficit.

“At month 04 [July], the cumulative reported position across the system as a whole was off plan and organisations are working hard, both individually and collectively to improve this.”

In Shropshire, Telford and Wrekin, the six months to September saw the local ICS accrue a deficit of £74.5m – equivalent to 7.9% of the entire budget for that half of the year.

A spokesperson for NHS Shropshire, Telford and Wrekin, said: “Shropshire, Telford and Wrekin Integrated Care System continues to be financially challenged due to increased and sustained system pressures in urgent and emergency care, planned care activity costs and inflation related cost pressures in areas such as prescribing and the purchase of individual care packages.

“We are working to reduce the deficit and each organisation within the system is currently assessing how they could improve the financial position, with a focus on efficiency, productivity and building a sustainable workforce in order to help achieve targets.”

Industrial action adding to soaring spending

One of the major pressures on NHS budgets this year has been industrial action, with strikes forcing NHS systems to hire expensive temporary staff to fill the gaps left by striking workers.

In their annual plans in March, 34 ICSs set out what they expected to spend on agency and locum over the course of the year.

Six months into the year, in September, Sky News estimates that these 34 ICSs had already spent three-fifths of this budget.

Altogether, these 34 ICSs spent an estimated £1.4bn on agency and locum staff in the first half of this financial year.

Shropshire, Telford and Wrekin ICS has been one of the largest over-spenders, spending £29.5m on agency and locum staff in the six months to September. That’s already more than the £27.2m annual limit on agency spending that the system had agreed with NHS England at the start of the year.

“The strikes are a big part of the story this year, but I still think we’d be in financial pressure without them,” Mr Anandaciva says.

“I think fundamentally, the story is there wasn’t enough funding in the system to meet the demands that were being asked of the system.”

An NHS spokesperson said:

“This story is misleading – although significant additional costs have been caused by the impact of strike action and higher than expected inflation, further funding has been made available to local areas which means their remaining year to date overspend is £471million – which is £2 billion less than Sky has estimated.

“Thanks to the NHS expanding staff numbers, agency staff spend has dropped compared to last year – despite strikes meaning the NHS needed to employ more agency staff than planned.”

A Department of Health and Social Care spokesperson said:

“While spending has increased in the last year due to workforce pressures, industrial action and the recovery of services, we are supporting the NHS with record funding, with the budget in England due to increase to £162.5 billion in 2024-25, up from £121.7 billion in 2019-20.

“Where organisations do get into financial difficulty, NHS England will provide intensive support with their Recovery Support Programme. To ensure the continuity of patient services, the government will provide short-term cash support to help pay their bills.”

Methodology

Sky News obtained financial data from 41 out of England’s 42 Integrated Care Systems through their board papers and freedom of information requests. Not all ICSs provided data to September 2023.

Where necessary, and following consultation with the Nuffield Trust and King’s Fund, data was extrapolated based on current trends. Aggregated estimates for September required data for some ICSs to be extrapolated from July or August. Estimates for March 2024 were based on extrapolations from the latest data available (July, August or September), in order to provide a full-year estimate based on current trends.

The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

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UK economy grows by 0.1% between July and September – slower than expected

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UK economy grows by 0.1% between July and September - slower than expected

The UK economy grew by 0.1% between July and September, according to the Office for National Statistics (ONS).

However, despite the small positive GDP growth recorded in the third quarter, the economy shrank by 0.1% in September, dragging down overall growth for the quarter.

The growth was also slower than what had been expected by experts and a drop from the 0.5% growth between April and June, the ONS said.

Economists polled by Reuters and the Bank of England had forecast an expansion of 0.2%, slowing from the rapid growth seen over the first half of 2024 when the economy was rebounding from last year’s shallow recession.

And the metric that Labour has said it is most focused on – the GDP per capita, or the economic output divided by the number of people in the country – also fell by 0.1%.

Reacting to the figures, Chancellor of the Exchequer Rachel Reeves said: “Improving economic growth is at the heart of everything I am seeking to achieve, which is why I am not satisfied with these numbers.

“At my budget, I took the difficult choices to fix the foundations and stabilise our public finances.

“Now we are going to deliver growth through investment and reform to create more jobs and more money in people’s pockets, get the NHS back on its feet, rebuild Britain and secure our borders in a decade of national renewal,” Ms Reeves added.

The sluggish services sector – which makes up the bulk of the British economy – was a particular drag on growth over the past three months. It expanded by 0.1%, cancelling out the 0.8% growth in the construction sector.

The UK’s GDP for the most recent quarter is lower than the 0.7% growth in the US and 0.4% in the Eurozone.

The figures have pushed the UK towards the bottom of the G7 growth table for the third quarter of the year.

It was expected to meet the same 0.2% growth figures reported in Germany and Japan – but fell below that after a slow September.

Read more from Sky News:
Chancellor vows to rip up financial red tape
Massive winter fuel payment ‘cut’ no one ever talks about

The pound remained stable following the news, hovering around $1.267. The FTSE 100, meanwhile, opened the day down by 0.4%.

The Bank of England last week predicted that Ms Reeves’s first budget as chancellor will increase inflation by up to half a percentage point over the next two years, contributing to a slower decline in interest rates than previously thought.

Announcing a widely anticipated 0.25 percentage point cut in the base rate to 4.75%, the Bank’s Monetary Policy Committee (MPC) forecast that inflation will return “sustainably” to its target of 2% in the first half of 2027, a year later than at its last meeting.

The Bank’s quarterly report found Ms Reeves’s £70bn package of tax and borrowing measures will place upward pressure on prices, as well as delivering a three-quarter point increase to GDP next year.

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Meeting the deeply radical anti-tax group that is ‘growing in popularity’

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Meeting the deeply radical anti-tax group that is 'growing in popularity'

“If you are a member of something, it means you’ve accepted membership. Anything with ‘ship’ on the end, it’s giving you a clue: it’s telling you that’s maritime law. That means you’ve entered into a contract.”

This isn’t your standard legal argument and it is becoming clear that I am dealing with an unusual way of looking at the world.

I’m in the library of a hotel in Leicestershire, a wood-panelled room with warm lighting, and Pete Stone, better known as Sovereign Pete, is explaining how “the system” works. Mr Stone is in his mid-50, bald with a goatee beard and wearing, as he always does for public appearances, a black T-shirt and black jeans.

With us are six other people, mainly dressed in neat jumpers. They’re members of the Sovereign Project (SP), an organisation Mr Stone founded in 2020, which, he says, now has more than 20,000 paying members.

As arcane as this may sound, it represents a worldview that is becoming more influential – and causing problems for authorities. Loosely, they’re defined as “sovereign citizens” or “freemen on the land”.

Sky News meets members of the Sovereign Project
Image:
The Sovereign Project claims to now have 20,000 paying members in the UK

Their fundamental point is that nobody is required to obey laws they have not specifically consented to – especially when it comes to tax. They have hundreds of thousands of followers in the UK across platforms including YouTube, Facebook and Telegram.

Increasingly, they are coming into conflict with governments and the law. Sovereign citizens have ended up in the High Court in recent months, challenging the legalities of tax bills and losing on both occasions.

More on Leicestershire

In October, four people were sentenced to prison for the attempted kidnapping of an Essex coroner, who they saw as acting unlawfully. The self-appointed “sheriffs” attempted to force entry to the court, one of them demanding: “You guys have been practising fraud!”

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Moment ‘cult’ tries to kidnap coroner

The Sovereign Project is not connected to any of those cases, nor does it promote any sort of political action, let alone violence.

Instead, they are focused on issues like questioning the obligation to pay taxes, as Mr Stone explains, referencing the feudal system that operated in the Middle Ages.

“Do you know about the feudal system when people were slaves and were forced to pay tax?” he asks.

“Now, unless the feudal system still operates today, and we still have serfs and slaves, then the only way that you can pay taxes is to have a contract, you have to agree to it and consent to it.”

Another member, Karl Deans, a 43-year-old property developer who runs the SP’s social media, says: “We’re not here to dodge tax.”

Local government tends to be a target beyond just demands for tax. Mr Stone speaks of “council employee crimes”.

I ask whether, considering the attempted kidnapping in Essex, there is a danger that people will listen to these accusations of crimes by councils and act on them.

“Well that’s proved,” Mr Stone says. “We only deal with facts.”

Sky News meets members of the Sovereign Project
Image:
Sky’s Tom Cheshire (second left) meets ‘Sovereign Pete’ (left) and other groups members

Evidence suggests this approach is becoming an issue for councils across the UK, as people search online for ways to avoid paying tax.

Sky News analysis shows that out of 374 council websites covering Great Britain, at least 172 (46%) have pages responding to sovereign citizen arguments around avoiding paying council tax. They point out that liability for council tax is not dependent on consent, or a contract, and instead relies on the Local Government Finance Act 1992, voted on by Parliament.

But the Sovereign Project’s worldview extends beyond council tax. It is deeply anti-establishment, at times conspiratorial. Stone suggests the summer riots may have been organised by the government.

“The sovereign fraternity operates above all of this,” he says. “We look down at the world like a chessboard. We see what’s going on.”

He explains that, really, the UK government isn’t actually in control: there is a shadow government above them.

“These are the people who control government,” he explains.

“A lot of people say this could be the crown council of 13, this could be a series of Italian families.”

People protest in Sunderland city centre following the stabbing attacks on Monday in Southport.
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Violence broke out in numerous towns and cities in August. Pic: PA

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Professor Christine Sarteschi, an expert in sovereign citizens at Chatham University, Pittsburgh, says she’s worried about the threat sovereign citizens may pose to the rule of law, especially in the US where guns are readily available.

“The movement is growing and that’s evidenced by seeing it in different countries and hearing about different cases. The concern is that they will become emboldened and commit acts of violence,” she says.

“Because sovereigns truly believe in their ideas and if they feel very aggrieved by, you know, the government or whomever they think is oppressing them or controlling them… they can become emotionally involved.

“That emotional involvement sometimes leads to violence in some cases, or the belief that they have the power to attempt to overthrow a government in some capacity.”

Professor Christine Sarteschi, an expert in Sovereign Citizens at Chatham University, Pittsburgh
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Professor Christine Sarteschi

Much of this seems to be based on an underlying and familiar frustration at the state of this country and of the world.

Mr Stone echoes some of the characteristic arguments also made by the right, that there is “two-tier policing”, that refugees arriving in the UK are “young men of fighting age”, that the government is using “forced immigration to destroy the country”.

Another SP member, retired investment banker David Hopgood, 61, says: “I firmly believe it is the true Englishman – and woman – of this country – that has the power to unlock this madness that’s happening in the West.

“We’ve got the Magna Carta – all these checks and balances. We just need to pack up, go down to Parliament and say: It’s time to dismiss you. You’re not fit for purpose.”

The members of the Sovereign Project are unfailingly patient and polite in explaining their understanding of the world.

But there is no doubt they hold a deeply radical view, one that is apparently growing in popularity.

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Wes Streeting ‘crossed the line’ by opposing assisted dying in public, says Labour peer Harriet Harman

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Wes Streeting 'crossed the line' by opposing assisted dying in public, says Labour peer Harriet Harman

Wes Streeting “crossed the line” by opposing assisted dying in public and the argument shouldn’t “come down to resources”, a Labour peer has said.

Speaking on Sky News’ Electoral Dysfunction podcast, Baroness Harriet Harman criticised the health secretary for revealing how he is going to vote on the matter when it comes before parliament later this month.

MPs are being given a free vote, meaning they can side with their conscience and not party lines, so the government is supposed to be staying neutral.

But Mr Streeting has made clear he will vote against legalising assisted dying, citing concerns end-of-life care is not good enough for people to make an informed choice, and that some could feel pressured into the decision to save the NHS money.

He has also ordered a review into the potential costs of changing the law, warning it could come at the expense of other NHS services if implemented.

Baroness Harman said Mr Streeting has “crossed the line in two ways”.

👉 Click here to listen to Electoral Dysfunction on your podcast app 👈

“He should not have said how he was going to vote, because that breaches neutrality and sends a signal,” she said.

“And secondly… he’s said the problem is that it will cost money to bring in an assisted dying measure, and therefore he will have to cut other services.

“But paradoxically, he also said it would be a slippery slope because people will be forced to bring about their own death in order to save the NHS money. Well, it can’t be doing both things.

“It can’t be both costing the NHS money and saving the NHS money.”

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Review into assisted dying costs

Baroness Harman said the argument “should not come down to resources” as it is a “huge moral issue” affecting “only a tiny number of people”.

She added that people should not mistake Mr Streeting for being “a kind of proxy for Keir Starmer”.

“The government is genuinely neutral and all of those backbenchers, they can vote whichever way they want,” she added.

Read more on this story:
‘Fix care before assisted dying legislation’
Why assisted dying is controversial – and where it’s already legal

Prime Minister Sir Keir Starmer has previously expressed support for assisted dying, but it is not clear how he intends to vote on the issue or if he will make his decision public ahead of time.

The cabinet has varying views on the topic, with the likes of Justice Secretary Shabana Mahmood siding with Mr Streeting in her opposition but Energy Secretary Ed Miliband being for it.

Britain's Secretary of State for Energy Security and Net Zero Ed Miliband walks on Downing Street on the day of the budget announcement, in London, Britain October 30, 2024. REUTERS/Maja Smiejkowska
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Energy Security and Net Zero Secretary Ed Miliband is said to support the bill. Pic: Reuters

Shabana Mahmood arrives 10 Downing Street.
Pic: Reuters
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Justice Secretary Shabana Mahmood has concerns. Pic: Reuters

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The Terminally Ill Adults (End of Life) Bill is being championed by Labour backbencher Kim Leadbeater, who wants to give people with six months left to live the choice to end their lives.

Under her proposals, two independent doctors must confirm a patient is eligible for assisted dying and a High Court judge must give their approval.

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Labour MP Kim Leadbeater discusses End of Life Bill

The bill will also include punishments of up to 14 years in prison for those who break the law, including coercing someone into ending their own life.

MPs will debate and vote on the legislation on 29 November, in what will be the first Commons vote on assisted dying since 2015, when the proposal was defeated.

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