Board papers published ahead of Nottingham University Hospitals NHS Trust’s meeting on Thursday 8 January show the organisation is £35.5 million worse than plan year-to-date, with leaders warning that a break-even financial position is no longer achievable in 2025/26.
The position is set out in the Integrated Performance Report covering month eight of the financial year, to the end of November 2025. In that month alone, the trust recorded a £10.5 million adverse position against plan.
The year-to-date figure includes £22.4 million of non-recurrent deficit support, reflecting the level of external funding required to maintain services while demand pressures remain high.
The report makes clear that the Trust Board approved a Financial Recovery Plan in November, but none of the scenarios presented — including “best case” options — deliver the original break-even position submitted earlier in the year. As a result, NUH is now working with NHS England to agree a revised year-end outturn and an underlying exit trajectory beyond 2025/26.
Despite the scale of the challenge, the board papers also highlight a number of areas where performance has been stronger than expected.
Agency expenditure remains significantly below national ceilings, with agency spend accounting for just 0.9 per cent of total pay in November. Year-to-date agency costs are reported as £15.6 million below the indicative national cap and lower than the same period last year.
The trust has also delivered £7.1 million of efficiency savings against a £6.3 million plan at month eight, although this has been offset by under-performance in other areas, leaving an overall efficiency shortfall year-to-date.
Pay pressures remain the single largest driver of the adverse position. The report identifies a £30.6 million overspend on pay, largely driven by a £17.7 million efficiency shortfall, £2.6 million linked to industrial action, and £9.6 million in unplanned costs associated with operational pressures. These include additional staffing to support emergency department handovers, the opening of escalation wards, and growth in substantive staffing.
Non-pay costs are also £23.8 million worse than plan, reflecting inflationary pressures, under-delivery of non-pay efficiency schemes, and higher activity-related healthcare purchase costs. Some of these pressures, such as high-cost drugs and devices, are offset by matched income.
The trust’s cash position remains fragile, although temporarily supported by national funding. NUH ended November with a cash balance of £5.9 million, following the receipt of £26.9 million of Public Dividend Capital cash support from NHS England. A further £20 million of a £41 million December request was approved, with a larger £70 million Quarter 4 request now incorporated into planning assumptions.
While the forecast year-end cash balance is £14.2 million, the report stresses this is largely due to the timing of capital funding drawdowns and does not represent an improvement in the underlying revenue position. The trust is also using unspent capital cash to support day-to-day salary and supplier payments.
Board papers note that creditor payment performance remains below national standards, although some improvement was seen in November following additional cash support, allowing the trust to reduce backlogs with key suppliers.
Overall, the report presents a picture of a trust under sustained financial pressure, driven by demand and operational challenges, but one that continues to maintain services, limit agency reliance and engage with NHS England on a longer-term recovery plan.
Trust leaders will ask the board to receive and discuss the report, noting both the scale of the challenge and the areas where performance has remained resilient.
