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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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Upcoming budget will be big – and Starmer has some serious convincing to do as he fights for survival

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Upcoming budget will be big - and Starmer has some serious convincing to do as he fights for survival

Wednesday’s budget is going to be big.

It will be big in terms of tax rises, big in terms of setting the course of the economy and public services, and big in terms of political jeopardy for this government.

The chancellor has a lot of different groups to try to assuage and a lot is at stake.

“There are lots of different audiences to this budget,” says one senior Labour figure. “The markets will be watching, the public on the cost of living, the party on child poverty and business will want to like the direction in which we are travelling – from what I’ve seen so far, it’s a pretty good package.”

The three core principles underpinning the chancellor’s decisions will be to cut NHS waiting lists, cut national debt and cut the cost of living. There will be no return to austerity and no more increases in government borrowing.

Politics Live: Reeves’s ‘mansplaining’ claims are just a ‘smokescreen’, says shadow chancellor

What flows from that is more investment in the NHS, already the big winner in the 2024 Budget, and tax rises to keep funding public services and help plug gaps in the government’s finances.

More on Budget 2025

Some of these gaps are beyond Rachel Reeves’ control, such as the decision by the independent fiscal watchdog (the Office for Budget Responsibility) to downgrade the UK’s productivity forecasts – leaving the chancellor with a £20bn gap in the public finances – or the effect of Donald Trump’s tariffs on the global economy.

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Will PM keep his word on taxes?

Others are self-inflicted, with the chancellor having to find about £7bn to plug her reversals on winter fuel allowance and welfare cuts.

By not pulling the borrowing lever, she hopes to send a message to the markets about stability, and that should help keep down inflation and borrowing costs low, which in turn helps with the cost of living, because inflation and interest rates feed into what we pay for food, for energy, rent and mortgage costs.

That’s what the government is trying to do, but what about the reality when this budget hits?

This is going to be another big Labour budget, where people will be taxed more and the government will spend more.

Only a year ago the chancellor raised a whopping £40bn in taxes and said she wasn’t coming back for more. Now she’s looking to raise more than £30bn.

That the prime minister refused to recommit to his manifesto promise not to raise income tax, VAT or national insurance on working people at the G20 in South Africa days ahead of the budget is instructive: this week we could see the government announce manifesto-breaking tax rises that will leave millions paying more.

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Starmer’s G20 visit overshadowed by Ukraine and budget

Freeze to income thresholds expected

The biggest tax lever, raising income tax rates, was going to be pulled but has now been put back in neutral after the official forecasts came in slightly better than expected, and Downing Street thought again about being the first government in 50 years to raise the income tax rate.

On the one hand, this measure would have been a very clean and clear way of raising £20bn of tax. On the other, there was a view from some in government that the PM and his chancellor would never recover from such a clear breach of trust, with a fair few MPs comparing it to the tuition fees U-turn that torpedoed Nick Clegg’s Lib Dems in the 2015 general election.

Instead, the biggest revenue raiser in the budget will be another two-year freeze on income tax thresholds until 2030.

This is the very thing that Reeves promised she would not do at the last budget in 2024 because “freezing the thresholds will hurt working people” and “take more money out of their payslips”. This week, those words will come back to haunt the chancellor.

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Will this budget help lower your energy bills?

Two-child cap big headline grabber

There will also be more spending and the biggest headline grabber will be the decision to lift the two-child benefit cap.

This was something the PM refused to commit to in the Labour manifesto, because it was one of the things he said he couldn’t afford to do if he wanted to keep taxes low for working people.

But on Wednesday, the government will announce it’s spending £3bn-a-year to lift that cap. Labour MPs will like it, polling suggests the public will not.

What we are going to get on Wednesday is another big tax and spend Labour budget on top of the last.

For the Conservatives, it draws clear dividing lines to take Labour on. They will argue that this is the “same old Labour”, taxing more to spend more, and more with no cuts to public spending.

Having retreated on welfare savings in the summer, to then add more to the welfare bill by lifting the two-child cap is a gift for Labour’s opponents and they will hammer the party on the size of the benefits bill, where the cost of supporting people with long-term health conditions is set to rise from £65bn-a-year to a staggering £100bn by 2029-30.

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Why has chancellor U-turned on income tax rises?

Mansion tax on the cards

There is also a real risk of blow-up in this budget as the chancellor unveils a raft of revenue measures to find that £30bn.

There could be a mansion tax for those living in more expensive homes, a gambling tax, a tourism tax, a milkshake tax.

Ministers are fearful that one of these more modest revenue-raising measures becomes politically massive and blows up.

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This is what happened to George Osborne in 2012 when he announced plans to put 20% of VAT on hot food sold in bakeries and supermarkets. The plan quickly became an attack on the working man’s lunch from out-of-touch Tories and the “pasty tax” was ditched two months later.

And what about the voters? Big tax and spend budgets are the opposite of what Sir Keir Starmer promised the country when he was seeking election. His administration was not going to be another Labour tax and spend government but instead invest in infrastructure to turbocharge growth to help pay for better services and improve people’s everyday lives.

Seventeen months in, the government doesn’t seem to be doing things differently. A year ago, it embarked on the biggest tax-raising budget in a generation, and this week, it goes back on its word and lifts taxes for working people. It creates a big trust deficit.

Pic: PA
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Pic: PA

Government attempts to tell a better story

There are those in Labour who will read this and point to worse-than-expected government finances, global headwinds and the productivity downgrades as reasons for tax raising.

But it is true too that economists had argued in the run-up to the election that Labour’s position on not cutting spending or raising taxes was unsustainable when you looked at the public finances. Labour took a gamble by saying tax rises were not needed before the election and another one when the chancellor said last year she was not coming back for more.

After a year-and-a-half of governing, the country isn’t feeling better off, the cost of living isn’t easing, the economy isn’t firing, the small boats haven’t been stopped, and the junior doctors are again on strike.

Read more:
Reeves hints at more welfare cuts
Reeves vows to ‘grip the cost of living’

What tax rises could chancellor announce?

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Budget jargon explained

The PM told me at the G7 summit in Canada in June that one of his regrets of his first year wasn’t “we haven’t always told our story as well as we should”.

What you will hear this week is the government trying to better tell that story about what it has achieved to improve people’s lives – be that school breakfast clubs or extending free childcare, increasing the national living wage, giving millions of public sector workers above-inflation pay rises.

You will also hear more about the NHS, as the waiting lists for people in need of non-urgent care within 18 weeks remain stubbornly high. It stood at 7.6m in July 2024 and was at 7.4m at the end of September. The government will talk on Wednesday about how it intends to drive those waits down.

But there is another story from the last 18 months too: Labour said the last budget was a “once in a parliament” tax-raising moment, now it’s coming back for more. Labour said in the election it would protect working people and couldn’t afford to lift the two child-benefit cap, and this week could see both those promises broken.

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Can the Tories be blamed for the financial black hole?

Can PM convince his MPs?

Labour flip-flopped on winter fuel allowance and on benefit cuts, and is now raising your taxes.

Downing Street has been in a constant state of flux as the PM keeps changing his top team, the deputy prime minister had to resign for underpaying her tax, while the UK’s ambassador to the US, Peter Mandelson, was sacked over his ties to the Jeffrey Epstein, the late convicted paedophile. It doesn’t seem much like politics being done differently.

All of the above is why this budget is big. Because Wednesday is not just about the tax and spend measures, big as they may be. It is also about this government, this prime minister, this chancellor. Starmer said ahead of this budget that he was “optimistic” and “if we get this right, our country has a great future”.

But he has some serious convincing to do. Many of his own MPs and those millions of people who voted Labour in, have lost confidence in their ability to deliver, which is why the drumbeat of leadership change now bangs. Going into Wednesday, it’s difficult to imagine how this second tax-raising budget will lessen that noise around a leader and a Labour government that, at the moment, is fighting to survive.

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In Halifax’s night-time economy, no one is holding back over what is required in the budget

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In Halifax's night-time economy, no one is holding back over what is required in the budget

In the upstairs bar of a slick new brewery, the cheese-lovers of Halifax are paying “homage to fromage”.

It is one of the first events in the historic West Yorkshire town for the monthly cheese club and there is a decent turn-out.

Sky News visited Halifax's clubs, bars and restaurants to get an insight into people's priorities
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Sky News visited Halifax’s clubs, bars and restaurants to get an insight into people’s priorities

The night-time economy in Halifax is a useful measure of how the landscapes of our town and cities have changed
Image:
The night-time economy in Halifax is a useful measure of how the landscapes of our town and cities have changed

Discussion of Wednesday’s budget is not as popular as an accompaniment to the cheese as the selection of wines. But no one holds back on what is required of the chancellor.

Natalie Rogers, who runs her own small business with her partner, said there needs to be focus.

Small business owner Natalie Rogers wants to see more investment in local industries
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Small business owner Natalie Rogers wants to see more investment in local industries

“I think investing in small businesses, investing in these northern towns, where at one time we were making all the money for the country, can we not get back to that? We’re not investing in local industries.”

At the next table, with a group of friends, Ali Fletcher said there needs to be bigger targets.

“I think wealth inequality is a major problem. The divide is getting wider. For me, a wealth tax is absolutely critical. We need to address this question of ‘Is there any money left?’. There’s plenty of money, it’s all about choices that government make.”

More on Budget 2025

At this monthly cheese club, people told us about their priorities ahead of the budget
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At this monthly cheese club, people told us about their priorities ahead of the budget

The evening’s cheese tasting was being marshalled by Lisa Kempster. “The impression I get from talking to people is there’s a lot of uncertainty, but when you ask them what they’re uncertain about, they’re not really sure, there’s just a general feeling of uncertainty and being cautious.”

Ali Fletcher reckons wealth inequality is a major problem
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Ali Fletcher reckons wealth inequality is a major problem

Read more:
Budget will be big – and Starmer has some serious convincing to do
Reeves vows to ‘grip the cost of living’
What tax rises could chancellor announce?

This corner of Halifax, close to the town’s historic Piece Hall, is buzzing with clubs, bars and restaurants, trying hard to defy the crunch in the night-time economy. It is a useful measure of how the landscapes of our town and cities has changed.

“Whenever there’s a budget, for a few days afterwards, there’s a drop off in trade,” said Michael Ainsworth, owner of the Graystone Unity, a bar and music venue in the town.

“I accept the government needs to raise money but, in this day and age, there’s better ways to go about doing that, like closing tax loopholes for the huge businesses to operate up with banking arrangements outside the UK.”

Michael Ainsworth owns a bar and music venue and thinks the chancellor needs to close tax loopholes
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Michael Ainsworth owns a bar and music venue and thinks the chancellor needs to close tax loopholes

In the bar, a folk singer is going through a quirky and caustic set. In the basement, a punk band called Edward Molby is considerably louder.

On a sofa in the main bar, recent graduates Josh Kinsella and Ruby Firth, newly arrived in Halifax because of its more affordable housing, pinpoint what they want on Wednesday.

“Can we stop triple-locking the pensions, please? Stop giving pensioners everything. For God’s sake, I know they have hard times in the 70s and the 80s, but it just feels like we’re now paying for everyone else.”

Josh Kinsella and Ruby Firth feel there's too much focus on pensioners
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Josh Kinsella and Ruby Firth feel there’s too much focus on pensioners

Ben Randm is a familiar face at the bar and well known on the music scene with his band, Silver Tongued Rascals.

“Everyday people are seen as statistics, we’re always the afterthought. When the cuts are done, we’re always impeded and the ramifications that has for people’s livelihoods, for people’s mental health, for people’s passion and drive… it’s such a struggle.”

He, like many in the night-time economy sector, wants extra help for hospitality and venues that, he says, provide a vital community link.

Ben Randm who has his own band reckons everyday people are 'always the afterthought'
Image:
Ben Randm who has his own band reckons everyday people are ‘always the afterthought’

David Van Gestel chose Halifax to open the third branch of MAMIL, a bar in jokey honour of those cycling “middle-aged men in Lycra”. On a busy quiz night, he said venues had to provide something different to get people out of their homes.

“I think the government needs to start putting some initiatives in place. They talk about growth but the reality is that the only thing we’re seeing grow is our costs.”

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Eight men arrested after attempted murder of couple in their 60s in Newcastle

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Eight men arrested after attempted murder of couple in their 60s in Newcastle

Eight men have been arrested in connection with the attempted murder of a couple in Newcastle, police have said.

A man and a woman in their 60s were found with serious injuries inside a property in Durham Street in the city’s Elswick area at around 6.45pm on Friday.

The woman sustained serious head injuries and remains in hospital in a critical condition, while the man is in a stable condition.

A man in his 30s was initially arrested on suspicion of attempted murder, Northumbria Police said on Saturday, before announcing seven further arrests on Sunday. All eight men remain in custody.

Five of the men – two in their 20s, two in their 30s, and one in his 40s – have been arrested on suspicion of attempted murder.

A man in his 50s has been arrested on suspicion of conspiracy to murder, while two other men – one in his 40s and one in his 60s – have been arrested on suspicion of assisting an offender.

Detective Chief Inspector Mark Atherton, the senior investigating officer in the case, said: “Eight suspects are now in custody being questioned, and I would like to reassure our communities extensive inquiries into this serious incident have already been carried out.”

Police are urging anyone with information to come forward and have issued an appeal for people who saw a red Renault Twingo car, which was allegedly stolen.

The vehicle is believed to have been parked in the West End of Newcastle between 6.30pm and 8pm on Friday before being found in the Longbenton area on Saturday morning.

Read more from Sky News:
Murder victim named – as girl, 13, is bailed
Starmer wants Rayner back in cabinet

“We would like to thank everyone who has already come forward and as part of our investigation we are keen to hear from anyone who may have seen the Renault Twingo,” DCI Atherton said.

“Any information – no matter how insignificant it may seem – could prove vital to establishing exactly what happened that evening.”

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