Nottinghamshire mental health hospitals 'likely' unable to afford key priorities as dire finances revealed

The trust which runs Nottinghamshire's mental health services may not be able to afford some of its key priorities after the perilous state of its finances was revealed. Nottinghamshire Healthcare NHS Foundation Trust, which runs Highbury Hospital and a network of other mental health facilities across the county, has been put into special measures after its latest board meeting in March forecasted a deficit of £23 million - which was nearly twice what it had previously agreed with local NHS leaders.

NHS England has placed the troubled care provider into the most serious level of its 'oversight framework', as it has “very serious, complex issues manifesting as critical quality and/or finance concerns that require intensive support”. The trust's own documents outlined the provider's financial position was of "considerable concern", with board members being told this was due to high spending on agency staff and incredibly expensive private sector mental health beds.

The trust and Nottingham and Nottinghamshire's Integrated Care Board, which sets local aims for the NHS and allocates resources, will now get "intensive support to use all their levers to address the often complex, historical problems they face", according to NHS England. Alison Wyld, executive director of finance and estates at Nottinghamshire Healthcare, said: “As a trust we are fully committed to making the sustained improvements in quality necessary to exit the National Oversight Framework Segment 4.

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"We have confidence in our financial recovery plan to help us achieve this and reduce our spending, so we can protect our clinical services and continue to provide safe, quality care to our patients. The board is committed to delivering long term financial sustainability for our trust.

"The core focus for this is to reduce the number of people from Nottingham and Nottinghamshire who are receiving inpatient care outside of the area, as well as successfully reducing our reliance on agency staffing. We know that improvements in these two areas will also result in an increase in quality of care for people using our services.”

Board documents outlined staff were worried the trust's poor reputation was a factor in its problematic retention rates and subsequent reliance on agency workers. In recent papers the trust explained it had cut agency spending from its peak amount, but was still spending above its target.

The trust has been heavily criticised over its involvement in Nottingham attacks killer Valdo Calocane's treatment by his victims' families. In a special review, carried out by the Care Quality Commission (CQC) after concerns were raised about failures in Calocane's care, the healthcare regulator found mental health patients and members of the public were put at risk due to poor access to care in Nottinghamshire.

There have also been concerns raised about the quality of care at specific facilities like Highbury Hospital in Bulwell, where Calocane had been a patient, and Millbrook Mental Health Unit in Sutton-in-Ashfield. The latter has been undergoing an extensive refurbishment to replace its old dormitory layout, but issues like building defects and failed electrics have delayed its completion and significantly increased costs, trust documents said.

A NHS England improvement director will be allocated to manage progress at the trust, with it receiving extra support while it remains in the Recovery Support Programme. The trust will need to develop and agree an improvement plan that aims to address its key issues.

Stuart Poynor, director of finance at NHS Nottingham and Nottinghamshire, said: “The financial position for NHS organisations nationally is currently very challenging due to a number of pressures including increasing demand, costs of agency staff and inflationary costs. Financial targets were agreed by each organisation as part of a review with NHS England regional and national finance colleagues in the autumn.

“We will continue to work with all NHS organisations in the area to support them to deliver their financial plans in 2024/25 alongside a series of service improvements that are required. Our key focus will be around delivering the best value services for the resources we have available.

"The whole system's financial position is discussed on a weekly basis with NHS chief executives in the area as we work together to implement plans which ensure the whole system moves to a sustainable financial position.” Nottingham Hospitals Trust, which runs Queen's Medical Centre and City Hospital and is a similarly bleak financial position, has put a number of staff at risk of redundancy after its own potential £69 million budget gap was revealed.