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:
“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.
“The target was never particularly ambitious,” says the Institute for Fiscal Studies (IFS) about Labour’s plan to add two million extra NHS appointments during their first year in power.
In February, Health Secretary Wes Streeting announced they had achieved the feat early. He recently described the now 3.6m additional appointments achieved in their first eight months as a “massive increase”.
But new data, obtained by independent fact checking charity Full Fact and shared exclusively with Sky News, reveals this figure actually signalled a slowing down in new NHS activity.
There was an even larger rise of 4.2m extra appointments over the same period the year before, under Rishi Sunak’s government.
The data also reveals how unambitious the target was in the first place.
We now know two million extra appointments over the course of a year represents a rise of less than 3% of the almost 70 million carried out in the year to June 2024.
In the last year under Mr Sunak, the rise was 10% – and the year before that it was 8%.
Responding to the findings, Sarah Scobie, deputy director of independent health and social care think tank the Nuffield Trust, told Sky News the two million target was “very modest”.
She said delivering that number of appointments “won’t come close to bringing the treatment waiting list back to pre-pandemic levels, or to meeting longer-term NHS targets”.
The IFS said it was smaller than the annual growth in demand pressures forecast by the government.
What exactly did Labour promise?
The Labour election manifesto said: “As a first step, in England we will deliver an extra two million NHS operations, scans, and appointments every year; that is 40,000 more appointments every week.”
We asked the government many times exactly how it would measure the pledge, as did policy experts from places like the IFS and Full Fact. But it repeatedly failed to explain how it was defined.
Leo Benedictus, a journalist and fact-checker at Full Fact, told Sky News: “We didn’t know how they were defining these appointments.
“When they said that there would be more of them, we didn’t know what there would be more of.”
Image: Leo Benedictus
Even once in government, initially Labour did not specify their definition of “operations, scans, and appointments”, or what the baseline “extra” was being measured against.
This prevented us and others from measuring progress every month when NHS stats were published. Did it include, for instance, mental health and A&E appointments? And when is the two million extra comparison dating from?
Target met, promise kept?
Suddenly, in February, the government announced the target had already been met – and ever since, progress on appointments has been a key boast of ministers and Labour MPs.
At this point, they did release some information: the definition of procedures that allowed them to claim what had been achieved. They said the target involved is elective – non-emergency – operations excluding maternity and mental health services; outpatient appointments and diagnostic tests.
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Why has Starmer axed NHS England?
However, we still did not have a comprehensive baseline to measure the two million increase against.
The government data instead relied on a snapshot: comparing the number of appointments carried out from July to November 2024 with the number from July to November 2023, and adjusted them for the number of working days in each period.
This did not tell us if the NHS had already been adding appointments under the Conservatives, and at what pace, and therefore whether this target was a big impressive ramping up of activity or, as it turns out, actually a slowing down.
Since then, a number of organisations, like Full Fact, have been fighting with the government to release the data.
Mr Benedictus said: “We asked them for that information. They didn’t publish it. We didn’t have it.
“The only way we could get hold of it was by submitting an FOI request, which they had to answer. And when that came back about a month later, it was fascinating.”
This finally gives us the comparative data allowing us to see what the baseline is against which the government’s “success” is being measured.
A Department of Health and Social Care spokesperson said: “On entering office last July, the secretary of state [Wes Streeting] was advised that the fiscal black hole meant elective appointments would have to be cut by 20,000 every week.
“Instead, this government provided the extra investment and has already delivered 3.6 million additional appointments – more than the manifesto commitment the British public voted for – while also getting more patients seen within 18 weeks.
“In the nine months since this government took office, the waiting list has dropped by over 200,000 – more than five times as much as it had over the same period the previous year – and also fell for six consecutive months in a row.”
Image: Health Secretary Wes Streeting. Pic: PA
We put this to Jeremy Hunt, Rishi Sunak’s chancellor during his last two years as prime minister, and health secretary for six years under David Cameron and Theresa May.
He said: “What these numbers seem to show is that the rate of appointments was going up by more in the last government than it is by this government. That’s really disappointing when you look at the crisis in the NHS.
“All the evidence is that if you want to increase the number of people being treated, you need more capacity in the system, and you need the doctors and nurses that are there to be working more productively.
“Instead what we’ve had from this government is the vast majority of the extra funding for the NHS has gone into pay rises, without asking for productivity in return.”
Image: Jeremy Hunt speaks to Sky’s Sam Coates
Edward Argar, shadow health secretary, accused the government of a “weak attempt […] to claim credit for something that was already happening”.
“We need to see real and meaningful reform that will genuinely move the dial for patients,” he added.
Is the NHS getting better or worse?
New polling carried out by YouGov on behalf of Sky News this week also reveals 39% of people think the NHS has got worse over the past year, compared with 12% who think it’s got better.
Six in 10 people say they do not trust Keir Starmer personally on the issue of the NHS, compared with three in 10 who say they do.
That is a better rating than some of his rivals, however. Just 21% of people say they trust Nigel Farage with the NHS, and only 16% trust Kemi Badenoch – compared with 64% and 60% who do not.
Ed Davey performs better, with 30% saying they trust him and 38% saying they do not.
Ms Scobie of the Nuffield Trust told Sky News “the government is right to make reducing long hospital treatment waits a key priority […] but much faster growth in activity is needed for the NHS to see a substantial improvement in waiting times for patients.”
The government is correct, however, to point out the waiting list having dropped by more than 200,000 since it’s been in office. This is the biggest decline between one July and the following February since current waiting list statistics were first published under Gordon Brown.
The percentage of people waiting less than 18 weeks for treatment is also falling for the first time, other than a brief period during the pandemic, for the first time in more than a decade.
The latest figures show 6.25m people waiting for 7.42m treatments (some people are on the list for more than one issue). That means more than one in 10 people in England are currently waiting for NHS treatment.
There continues to be a fall in the number who have been waiting longer than a year. It’s now 180,242, down from almost 400,000 in August 2023 and over 300,000 in June 2024, the Conservatives’ last month in power.
But that number is still incredibly high by historical standards. It remains over 100 times higher than it was before the pandemic.
The government has a separate pledge that no more than 8% of patients will wait longer than 18 weeks for treatment, by the time of the next election. Despite improvements in recent months, currently more than 40% wait longer than this.
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.
Sir Keir Starmer’s claim he is U-turning on cutting winter fuel payments for pensioners because he now has the money is not “credible”, Harriet Harman has said.
The Labour peer, speaking to Sky News political editor Beth Rigby on the Electoral Dysfunction podcast, said the prime minister made the move as it was so unpopular with voters.
He and his ministers had insisted they would stick to their guns on the policy, even just hours before Sir Keir revealed his change of heart at PMQs
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Winter fuel payment cuts to be reversed
Baroness Harman said: “It’s always been contested and always been unpopular.
“But the final straw that broke the camel’s back was the elections. The council elections and the Runcorn by-election, where the voters were saying, ‘this is not the change we voted for’.
“At the end of the day, you cannot just keep flying in the face of what voters – particularly if they’re people who previously voted for you – wanted.”
Baroness Harman is unconvinced by Sir Keir’s claim he can U-turn because there is more money due to good economic management by the government.
“I don’t think that’s credible as an argument,” she said.
“It really is the fact that voters just said ‘this is not the change we voted for, we’re not going to have this’.”
The challenge for the government now, she said, is deciding who will get the allowance moving forward, when they’ll get it, and when it will all be announced.
The Institute for Fiscal Studies has looked into the government’s options after Sir Keir Starmer said he is considering changes to the cut to winter fuel payment (WFP).
The government could make a complete U-turn on removing the payment from pensioners not claiming pension credit so they all receive it again.
There could be a higher eligibility threshold. Households not claiming pension credit could apply directly for the winter fuel payment, reporting their income and other circumstances.
Or, all pensioner households could claim it but those above a certain income level could do a self-assessment tax return to pay some of it back as a higher income tax charge. This could be like child benefit, where the repayment is based on the higher income member of the household.
Instead of reducing pension credit by £1 for every £1 of income, it could be withdrawn more slowly to entitle more households to it, and therefore WFP.
At the moment, WFP is paid to households but if it was paid to individuals the government could means-test each pensioner, rather than their household. This could be based on an individual’s income, which the government already records for tax purposes. Individuals who have a low income could get the payment, even if their spouse is high income. This would mean low income couples getting twice as much, whereas each eligible house currently gets the same.
Instead of just those receiving pension credit getting WFP, the government could extend it to pensioners who claim means-tested welfare for housing or council tax support. A total of 430,000 renting households would be eligible at a cost of about £100m a year.
Pensioners not on pension credit but receiving disability credits could get WFP, extending eligibility to 1.8m households in England and Scotland at a cost of about £500m a year.
Pensioners living in a band A-C property could be automatically entitled to WFP, affected just over half (6.3m).
Chancellor Rachel Reeves has committed to just one major fiscal event a year, meaning just one annual budget in the autumn.
Autumn budgets normally take place in October, with the last one at the end of the month.
If this year’s budget is around the same date, it will leave little time for the extra winter fuel payments to be made, as they are paid between November and December.
Business Secretary Jonathan Reynolds told the Electoral Dysfunction podcast the economy will have to be “strong enough” for the government to U-turn on winter fuel payment cuts.
He also said the public would have to wait for the budget for any announcement.
Before that, there had been calls for festivals to reconsider booking the band over their political stances, and several have done, which prompted artists like Brian Eno, the Mystery Jets and CMAT to sign an open letter accusing Westminster and the British media of a campaign to “remove Kneecap from the public eye”.
They put their names to wording that said “in a democracy, no political figures… have the right to dictate who does and does not play at music festivals.”
So what’s the reality like for artists who are outspoken at a time when the world is so divided?
As some of the biggest names in music gathered in London for the Ivors, an annual celebration of songwriting, Self-Esteem – aka Rebecca Lucy Taylor – said the level of scrutiny can be “terrifying”.
‘The problem with the internet’
She told Sky News: “The problem with the internet is you say one thing, which gets scrutinised, and then you shit yourself, you really do… then you’re advised not to. And then you’re like ‘don’t advise me not to!’
“You second-guess anything you want to say any more… but any time I do that, I think ‘well that’s why you’ve got to say it then’.”
She said it can be frustrating that focus turns on to pop stars’ opinions instead of “the people doing the bad things”.
Former Little Mix singer Jade said: “To be a pop artist these days, it’s not just about music, it’s: ‘What’s your political stance?’
“I’ve always been quite vocal about those things, but in doing so you have even more of a scary spotlight on you, constantly assessing what your thoughts are as a human…it is scary.”
Trinidad-born London artist Berwyn, whose songs depict his struggles with UK immigration, says: “Silencing freedom of speech… is a road we don’t want to walk down.
“I’m not a politician, this is a very complicated issue, but I do absolutely believe in a human’s right to express themselves freely.”
But is that freedom of speech dependent on what side you’re coming from?
Image: Berwyn speaking to Sky News
‘Unethical investments’
Soon, an event called Mighty Hoopla will take place at Brockwell Park as part of its programme of six festivals this summer.
Artists performing at that are coming under increased pressure from pro-Palestine groups to quit because it’s owned by a company called Superstruct, which has links to an American investment firm called KKR.
Critics argue that any KKR-affiliated events should be a red flag to artists as campaigners claim it “invests billions of pounds in companies” that do things like “develop Israeli underground data centres”, and they say it has shares in companies that “advertise property on illegally occupied land in the West Bank”.
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Mighty Hoopla itself has said while it “cannot control investments made in our parent companies”, it wants to “state its clear opposition to KKR’s unethical investments”.
And Superstruct – which puts on over 80 festivals around the world – says while horrified by the crisis in Gaza: “We are aware that there is a significant amount of debate… around our festivals.
“Our owners, made up of our promoters and several investment firms, support us to achieve the highest standards… fans and artists rightly expect.”
They insist that operationally, Superstruct is independently run and all its “revenue and profits… remains entirely within our business… towards the ongoing development… of our festivals.”
Even deciding where to perform can have political connotations for musicians these days.
As Tom Gray, a founding member of the rock band Gomez, now chair of the Ivors, explains: “The amount of commercial interest required to get a young artist into the public eye means they have to keep their head down a lot and that’s a terrible shame.
“It’s not just artistic expression, but personal human expression is one of the fundamental things that allows people to feel they have agency.”