Nottinghamshire Healthcare NHS Foundation Trust ended the last financial year with a £53.7m deficit, board papers show.
The trust, which provides mental health, community health and forensic services across Nottinghamshire and beyond, reported the position in papers prepared for its public Board of Directors meeting on 28 May.
The papers state that the trust recorded an £8.2m income and expenditure deficit in March alone, bringing the year-to-date deficit to £45.5m. Against its original break-even plan, this represented a £53.7m adverse variance by the end of March 2026.
A separate report from the trust’s Finance, Cash and Performance Committee said the £53.7m deficit was in line with forecasts agreed externally, but described it as “nevertheless a disappointing result” which left a significant underlying and structural deficit going into 2026/27.
The committee said it continued to take only “limited assurance” because of the scale of the ongoing deficit, the financial challenges facing the trust in the current year and beyond, and continued slippage in recovery plans.
Board papers say the trust will need to rely on external cash support in the immediate future. The committee reviewed cash flow projections for the year ahead and agreed that a further application for cash support would be needed to cover the first five months of 2026/27.
The trust’s financial position is linked in the papers to a range of pressures, including the cost of independent sector beds, temporary workforce costs, inflationary supplier and contract costs, and expenditure continuing to outpace available funding.
The issue of independent sector beds is a recurring theme in the board pack. Performance papers say ongoing reliance on private and subcontract beds continues to affect quality, patient experience and financial performance, with reduced inpatient capacity and patient flow creating pressure across the wider system.
At the end of March, the trust had 83 patients in private beds, including 59 acute patients and 24 psychiatric intensive care unit patients. The papers also state that 13 trust patients were inappropriately out of area at the end of March, with the target of having no patients in inappropriate care settings missed throughout 2025/26.
The trust has reported some progress in reducing costs. Board minutes from March state that there had been a 34% reduction in bank and agency spend and a 27% reduction in independent sector bed usage since April 2025.
However, papers for the May meeting show the financial pressure has continued into the new financial year. At the end of April 2026, the trust reported a £5.9m deficit for the month, which was £1.3m worse than plan. The principal causes included independent sector bed pressures, while pay controls were said to be having a positive effect but not enough to offset the scale of underlying cost pressures.
The trust has submitted a two-year medium-term financial plan which aims to move towards break-even over two years. However, the committee said more detail was needed on efficiency plans and the assumptions underpinning the 2026/27 financial plan.
The papers state that early delivery of recovery actions and efficiencies will be critical to improving the trust’s financial trajectory.
