Difficulties have already emerged with CCG finances. A recent HSJ article pointed out that whilst Andrew Lansley had last year insisted that CCGs would not inherit any legacy debt from PCTs and that they would operate with a clean balance sheet, just a few months into the new system NHS England finance director Paul Baumann has warned “a quarter of CCGs are having real difficulty making ends meet, with little or no reserves to fall back on”, and that some CCGs also have “a significant underlying deficit to deal with”. CCGs have also complained about being informed at short notice that their 2013-14 budgets were smaller than expected, or that they were responsible for services that they had not anticipated. Mr Baumann said that these issues came about due to the complexity of disaggregating primary care trusts’ budgets. He added: “It is massively complex and frankly we’ve all been surprised [at] the difficulty getting that tied down.”
Another HSJ article explains that Department of Health records show that CCGs may have inherited unfunded liabilities for hundreds of millions of pounds worth of continuing healthcare claims made before they came into being. Clinical commissioners had warned last year that PCTs should not be allowed to record significant contingent liabilities in their final year. Whilst contingent liabilities will not necessarily translate into actual costs, any unfunded costs shouldered by CCGs would potentially be controversial as the government has repeatedly insisted the new commissioners will not be responsible for resolving their predecessors’ legacy debts. Some commissioners have issued warnings about the impact contingent liabilities could have on their finances.
According to Pulse, CCG leads are facing multi-million shortfalls as specialized commissioning and social care take large amounts out of their budgets, putting in doubt plans to improve patient care. CCG leaders 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 being abandoned. Pulse explains that one in ten trusts and CCGs are predicting that they will be deficit by the end of the financial year, according to the King’s Fund latest Quarterly Monitoring Report. Only one in ten NHS finance directors believe their chances of meeting the target is better than 50/50, with 56% identifying a high or very high risk that the target will not be met. Another survey by Primary Care Commissioning and Capsticks, a healthcare law firm, found that more than a third of commissioning groups (36%) who responded to the survey said they were ‘extremely concerned’ or ‘very concerned’ about the challenge facing their organisation in achieving financial balance. This figure rose to more than 80% if those citing ‘moderate concern’ were included.