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CCGs face cutting services to plug sudden million-pound gaps in budgets



Exclusive CCG leaders are facing multi-million-pound shortfalls as specialised commissioning and social care take huge bites out of their budgets, putting their plans to improve patient care into doubt.

CCG leaders have said that their allocations have been reduced by up to £4m at a stroke, after funding was removed to cover specialist commissioning at hospitals and health and wellbeing boards ringfence funding for social care.

They told Pulse that money saved for non-recurrent spending in 2013/14 was being used to plug sudden gaps in funding, and the uncertainty could lead to plans to improve local services – such as end-of-life care and better integration of services – being abandoned.

The National Audit Office said earlier this month that the data supplied by PCTs regarding funding was inadequate, meaning CCG budgets did not necessarily reflect their spending, and budget allocations were not finalised until July in some cases.

CCGs are not responsible for the commissioning of specialised services, such as treatment for less common cancers and care for people with rare conditions.

But Dr Amanda Doyle, NHS Clinical Commissioners’ leadership group co-chair and chief clinical officer of Blackpool CCG, said budgets allocated to specialist commissioners have led to ‘wide discrepancies’ with many CCGs facing large shortfalls as a result.

‘In Blackpool, the process has meant that, with regard to our contract with Lancashire Teaching Hospitals for example, our allocation was reduced by approx. £5m to account for changes to specialist services definitions, but the contract value only reduced by about £900k, leaving us with more than £4m gap.

‘Overall, in Blackpool, this issue has left us with a more than £7m shortfall- and in the CCG with the worst life expectancy in the country this is funding that is desperately needed to address health inequalities.’

Dr Doyle said that CCGs all over the country are having to modify their plans drastically. She added: ‘There are discussions going on to try to rectify this. But in Blackpool, the shortfall will mean that the CCG´s plans for end-of-life care might be unable to go ahead. In addition, it will soak up the whole of our 2% non-recurrent allocation for the year which was to have been spent on pump-priming plans for integrated care.’

The National Audit Office said earlier this month that the data supplied by PCTs regarding funding was inadequate, meaning CCG budgets did not necessarily reflect their spending, and budget allocations were not finalised until July in some cases.

Dr Clare Highton, chair of NHS City and Hackney CCG, said her budget was suddenly reduced by £9m for specialist commissioning and £10m to fund social care by the health and wellbeing board.

She added: ‘There are still quite a few queries around where money went when the contract was novated. The biggest is the specialist commissioners’ money, although we may get this back depending on contract flows.’

Dr Elizabeth Johnston, chair of South Reading CCG, said: ‘The unpredictability is quite tricky to negotiate. A cold snap or a rise in influenza could change things.

‘It’s tight. And my concern is that we’re already 30% down on PCT running costs and there’s going to be a further reduction of 10% next year. The danger is that we’re forced just to concentrate our efforts on the acute stuff.’

A spokesperson for NHS England said: ‘The move from PCT contracts with providers into CCG and specialised commissioning activities has been particularly complex, and the estimated split which formed the basis of allocations issued in December 2012 has been under significant review and refinement since then.

‘We continue to work closely with providers using a set of defined “identification rules” to confirm and challenge the baseline budgets.’