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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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Eight arrests in connection with two separate terrorism investigations

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Eight arrests in connection with two separate terrorism investigations

Eight men have been arrested by the Metropolitan Police in two unconnected but “significant” terrorism investigations.

In one operation on Saturday, counter-terror officers arrested five men – four of whom are Iranian nationals – as they swooped in on various locations around the country. All are in police custody.

The Met said the arrests related to a “suspected plot to target a specific premises”.

In an update shortly after midnight, the force said: “Officers have been in contact with the affected site to make them aware and provide relevant advice and support, but for operational reasons, we are not able to provide further information at this time.”

Commander Dominic Murphy, head of the Met’s Counter Terrorism Command, said: “Counter-terrorism policing, supported by police and colleagues from across the country, have conducted arrests in two really significant operations, both of which have been designed to keep the public safe from threats.

“There are several hundred officers and staff working on this investigation, and we will work very hard to ensure we understand the threats to the wider public.”

He refused to say if the plot was related to Israel, but described it as “certainly significant” and said “it is unusual for us to conduct this scale of activity”.

He also asked the public to “avoid speculation and some of the things that are being posted online”.

MI5 director general Ken McCallum said in October that the intelligence agency had responded to 20 “potentially lethal” Iran-backed plots since 2022. He warned of the risk of an “increase or broadening of Iranian state aggression in the UK”.

Read more: Terror arrests came in context of raised warnings about Iran

Children ‘petrified’ by armed police

Rochdale resident Kyle Warren, who witnessed one of the arrests at a neighbouring house, said his children had been playing in the garden when they came running into the house, saying a man in a mask had told them to go inside.

“Obviously, I was a bit worried,” Mr Warren told Sky News’ Lisa Dowd, and so he went into the garden to investigate.

“As we’ve come out, we just heard a massive bang, seen loads of police everywhere with guns, shouting at us to get inside the house.”

Kyle Warren said his children were 'petrified'
Image:
Kyle Warren said his children were ‘petrified’

From upstairs in his house, he then heard “loads of shouting in the house” and saw a man being pulled out of the back of the house, “dragged down the side entry and thrown into all the bushes and then handcuffed”.

There were about 20 to 30 officers with guns, he believes.

“It’s just shocking, really. You don’t expect it on your doorstep.”

His daughters were “petrified… I don’t think they’ve ever seen a gun, so to see 20 masked men with guns running round was quite scary for them”.

Mr Warren, who only moved into his house a year ago, said he had “never really seen anyone going in or out” of the house and actually thought it was empty.

One suspect was arrested in Cheadle Hulme, Greater Manchester. Pic: Sarah Cash
Image:
One suspect was arrested in Cheadle Hulme, Greater Manchester. Pic: Sarah Cash

One suspect was arrested in Cheadle Hulme, Greater Manchester. Pic: Sarah Cash
Image:
One suspect was arrested in Cheadle Hulme, Greater Manchester. Pic: Sarah Cash

Arrests and searches around the country

The Met added officers were carrying out searches at a number of addresses in the Greater Manchester, London and Swindon areas in connection with the investigation.

It said those detained were:

• A 29-year-old man arrested in the Swindon area
• A 46-year-old man arrested in west London
• A 29-year-old man arrested in the Stockport area
• A 40-year-old man arrested in the Rochdale area
• A man whose age was not confirmed arrested in the Manchester area.

Passenger footage of a police van in Stockport over the terrorism arrest SQUARE OR PORTRAIT
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A 29-year-old man was arrested in the Stockport area

Terror arrests in separate investigation

Police also arrested three further Iranian nationals in London on Saturday as part of another, unrelated counter-terror investigation.

The suspects were detained under section 27 of the National Security Act 2023, which allows police to arrest those suspected of being “involved in foreign power threat activity”.

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Home Secretary Yvette Cooper said: “These were two major operations that reflect some of the biggest counter state threat and counter terrorism operations that we have seen in recent years.

“This reflects the complexity of the kinds of challenges to our national security that we continue to face.”

Earlier, she thanked police and security services in a statement, and called the incidents “serious events that demonstrate the ongoing requirement to adapt our response to national security threats”.

Last year, the government placed the whole of the Iranian state – including its intelligence services – on the enhanced tier of the new foreign influence registration scheme.

It means anyone asked by Iran to carry out actions for the state must declare it, or face prison time.

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Terror arrests came in context of raised warnings about Iran, with ongoing chaos in its own backyard

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Terror arrests came in context of raised warnings about Iran, with ongoing chaos in its own backyard

These are two separate and unrelated investigations by counter-terror officers.

But the common thread is nationality – seven out of the eight people arrested are Iranian.

And that comes in the context of increased warnings from government and the security services about Iranian activity on British soil.

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Counter terror officers raid property

Last year, the director general of MI5, Ken McCallum, said his organisation and police had responded to 20 Iran-backed plots presenting potentially lethal threats to British citizens and UK residents since January 2022.

He linked that increase to the ongoing situation in Iran’s own backyard.

“As events unfold in the Middle East, we will give our fullest attention to the risk of an increase in – or a broadening of – Iranian state aggression in the UK,” he said.

The implication is that even as Iran grapples with a rapidly changing situation in its own region, having seen its proxies, Hezbollah in Lebanon and Hamas in Gaza, decimated and itself coming under Israeli attack, it may seek avenues further abroad.

More on Iran

The government reiterated this warning only a few weeks ago, with security minister Dan Jarvis addressing parliament.

“The threat from Iran sits in a wider context of the growing, diversifying and evolving threat that the UK faces from malign activity by a number of states,” Jarvis said.

“The threat from states has become increasingly interconnected in nature, blurring the lines between: domestic and international; online and offline; and states and their proxies.

“Turning specifically to Iran, the regime has become increasingly emboldened, asserting itself more aggressively to advance their objectives and undermine ours.”

Read more:
Anybody working for Iran in UK must register or face jail, government announces

As part of that address, Jarvis highlighted the National Security Act 2023, which “criminalises assisting a foreign intelligence service”, among other things.

So it was notable that this was the act used in one of this weekend’s investigations.

The suspects were detained under section 27 of the same act, which allows police to arrest those suspected of being “involved in foreign power threat activity”.

Those powers are apparently being put to use.

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Pictured: Boy killed in Gateshead industrial estate fire – 14 children arrested on suspicion of manslaughter

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Pictured: Boy killed in Gateshead industrial estate fire - 14 children arrested on suspicion of manslaughter

Tributes have been paid to 14-year-old Layton Carr who died in a fire at an industrial estate.

Eleven boys and three girls, aged between 11 and 14 years, have been arrested on suspicion of manslaughter after the incident in Gateshead on Friday. They remain in police custody.

Drone view showing the aftermath of a fire at Fairfield industrial park at Bill Quay, Gateshead
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Police were alerted to a fire at Fairfield industrial park in the Bill Quay area

Firefighters raced to Fairfield industrial park in the Bill Quay area shortly after 8pm, putting out the blaze a short time later.

Police then issued an appeal for a missing boy, Layton Carr, who was believed to be in the area at the time.

In a statement, the force said that “sadly, following searches, a body believed to be that of 14-year-old Layton Carr was located deceased inside the building”.

Layton’s next of kin have been informed and are being supported by specialist officers, police added.

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Teenager dies in industrial estate fire

A fundraising page on GoFundMe has been set up to help Layton’s mother pay for funeral costs.

Organiser Stephanie Simpson said: “The last thing Georgia needs to stress trying to pay for a funeral for her Boy Any donations will help thank you.”

One tribute in a Facebook post read: “Can’t believe I’m writing this my nephew RIP Layton 💔 forever 14 you’ll be a massive miss, thinking of my sister and 2 beautiful nieces right now.”

Another added: “My boy ❤️ my baby cousin, my Layton. Nothing will ever come close to the pain I feel right now. Forever 14. I’ll miss you sausage.”

A third said: “Rest in peace big lad such a beautiful soul taken far to soon my thoughts are with you Gee stay strong girl hear for u always.”

Read more from Sky News:
Eight arrests in connection with two terrorism operations
Compensation scheme scrapped for child sexual abuse victims

Detective Chief Inspector Louise Jenkins, of Northumbria Police, also said: “This is an extremely tragic incident where a boy has sadly lost his life.”

She added that the force’s “thoughts are with Layton’s family as they begin to attempt to process the loss of their loved one”.

They are working to establish “the full circumstances surrounding the incident” and officers will be in the area to “offer reassurance to the public”, she added.

A cordon remains in place at the site while police carry out enquiries.

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