Nottingham University Hospitals expects to need £45 million in cash support from NHS England this financial year after recording a £34.6 million deficit in its first four months.
Papers prepared for the Trust’s board meeting on Thursday 10 September show its financial position at the end of July was £17.7 million worse than planned.
NUH has board approval to submit a request for £16 million in deficit support in September. It forecasts needing a further £29 million between November and January to maintain minimum cash balances.
The papers warn that if its financial position deteriorates, or the request for support is partly or wholly unsuccessful, the Trust will have to delay non-statutory payments.
They do not specify which payments would be affected or confirm that NHS England has approved the funding.
The forecast £45 million requirement also assumes NUH delivers savings that release cash during the year and achieves its “most likely” forecast deficit position.
The Trust’s cash balance stood at £41.1 million at the end of July, down £39 million from £80.1 million at the start of the financial year.
The report attributes that reduction both to its deficit and to payments for capital projects carried forward from the previous year. The fall in cash therefore does not represent operating losses alone.
In July, NUH recorded a £1.9 million deficit, compared with a planned surplus of approximately £1.9 million, leaving the monthly position £3.9 million worse than planned after rounding.
Staffing costs were a significant contributor to the financial pressures. Pay expenditure over the first four months was £13.4 million above plan.
The papers identify industrial action costs, workforce costs associated with higher activity, shortfalls in planned savings, the continuing cost of additional capacity and funding shortfalls relating to the national pay award.
NUH has continued to use additional beds opened during winter to help manage pressure on emergency services.
The Trust also fell behind its savings programme. By the end of July, it had delivered £14.5 million in savings against a target of £18.7 million — a shortfall of £4.2 million.
July’s savings totalled £5.1 million against a monthly target of £7.3 million.
Patient-care income was £7.5 million below plan over the first four months. However, £4.7 million of that related to high-cost drugs and devices, where lower income was matched by lower expenditure because funding follows the cost incurred.
Other operating income was £5 million above plan, helping to offset some of the pressures. This included income from education and training, trading activities and research, although additional research income was fully offset by associated costs.
Agency spending was below both its spending ceiling and the previous year’s level.
NUH spent £3.1 million on agency staff between April and July, equivalent to 0.8 per cent of pay expenditure. That was £2.3 million less than during the same period a year earlier.
The report also says the Trust is working through a backlog of invoices. Its payment performance by value stood at 87.4 per cent, compared with 94.4 per cent by number of invoices.
Board members will consider the financial position alongside reports on emergency care pressures, corridor care and planned treatment waiting times.
The £45 million figure is the forecast cash support needed to maintain minimum balances during the remainder of the year. It is separate from the £34.6 million deficit already recorded between April and July.
