Health care surveys

This quarter’s report is based on an online survey of 85 NHS trust finance directors and 27 clinical commissioning group (CCG) finance leads (covering 32 CCGs).

Respondents were asked about their organisation’s forecast end-of-year financial situation for 2017/18 and the financial outlook for their local health economy over the past and forthcoming financial year; the state of patient care in their area; the financial situation looking ahead to 2018/19; the key organisational challenges facing trusts and CCGs; and workforce issues. We also asked respondents about the NHS’s ability to meet A&E (accident and emergency) milestones as set out in the 2017/18 Mandate document.

1. Forecast end-of-year financial situation 2017/18

  • In our recent survey, 44 per cent of trust finance directors forecast their organisation would end 2017/18 in deficit (Figure 5). 79 per cent of trust finance directors reported that their forecast position for 2017/18 would depend on significant financial support (Figure 7). Furthermore, 47 per cent of providers expecting to receive Sustainability and Transformation Fund monies still forecast a deficit by the end of the year.

  • 63 per cent of respondents receiving interim financial support from the Department of Health were either fairly or very concerned about being able to meet the total repayment requirements of the loan (Figure 8).

  • We also asked trusts to provide details of their agreed control totals for 2017/18. Of the 76 trusts that have agreed control totals (or that are in the process of agreeing control totals), 12 per cent forecast a worse end-of-year position against their control total. Furthermore, 37 per cent of all providers were either fairly or very concerned about meeting their agreed control totals in 2017/18 (Figure 11).

  • 41 per cent of all CCGs forecast a surplus for 2017/18, and 16 per cent were expecting to overspend (Figure 6). Furthermore, 53 per cent of all CCGs expect to delay or cancel spending plans to support their finances in 2017/18 (Figure 9). The potential threat to the commissioner portion of the risk reserve (ie, the 0.5 per cent of CCG budgets that are held back and uncommitted to in-year spending) is underlined by the fact that 38 per cent of CCGs are relying on their share being returned to them, rather than being used to support provider deficits (Figure 9). 44 per cent of all CCGs were fairly or very concerned about meeting their control total for 2017/18 (Figure 12).

  • 81 per cent of CCG respondents were considering extending the number of low-value treatments and prescriptions that will not be funded, and 67 per cent were considering extending waiting lists or reducing activity for certain elective specialties (Figure 10).

NHS Trusts
Figure 5: What is your organisation’s forecast end-of-year financial position?

Respondent comments

  • “This is on the basis of the plan but there are emerging risks that could influence this.”

    Mental health and community provider, in surplus
  • “This is our control total and haven't officially reforecast. Being honest at the moment the more likely place is to be in deficit.”

    Acute and community foundation trust, in surplus
  • “Planned deficit to support agreed investment from balance sheet reserves. Forecast deficit now over and above this.”

    Social enterprise, in deficit
  • “In line with control total although there are some major risks to achievement.”

    Specialist foundation trust, in deficit

QMR 1-4 based on a panel of 50 trust finance directors.

CCG Leads
Figure 6: What is your organisation's forecast end-of-year financial position?

Respondent comments

  • “The achievement of the forecast year-end position relies on mitigating actions to generate savings of over £2.5 million. The surplus to be delivered is historic brought forward.”

    Break even
  • “Taking into account approved in-year draw down, the in-year position is classed as break even.”

    In surplus
  • “We are currently forecasting hitting our target surplus requirement as set by the business rules, this however is getting increasingly difficult to achieve and as the year progresses this may change. We are essentially using non-recurrent monies to achieve this, for the first time our CCG is using non-recurrent funding to balance the recurrent position.”

    In surplus
  • “We are recognising a high degree of risk of non-achievement of this position, with a move into deficit.”

    Break even

27 CCG finance leads answered this question for the 32 CCGs they cover collectively. CCGs only surveyed since their establishment in April 2013.

NHS Trusts
Figure 7: What is your forecast 2017/18 end-of-year outturn likely to depend on:
44 Financial support from the Sustainability and Transformation Fund
37 Use of trust reserves
19 Other financial support (eg. additional PDC support, loans, etc)
14 Delay or cancellation of capital spending
9 Delay payment to suppliers
18 None of the above

Respondent comments

  • “It will depend on commissioners being reasonable and trying to support the trust. In the past few years they have been very aggressive with challenges we do not think are appropriate.”

    Acute, in deficit
  • “Cancelling cap ex, loans and delaying payments to suppliers are required to manage the cash position rather than the I&E [income and expenditure] forecast.”

    Acute foundation trust, in deficit
  • “Also, revaluation of investment assets, which are technical and not real benefits.”

    Acute, in deficit
  • “Receipt of all four quarters full STF funding is fundamental to delivery of control total plan but is likely to be compromised by ability to deliver internal CIPs and impact on income from CCG QIPP schemes.”

    Acute and community provider, in deficit
  • “Achievement of control total. We already have long-term loans (NB not 'interim financial support') from both ITFF [Independent Trust Finance Facility] and a commercial lender.”

    Specialist foundation trust, in deficit
  • “Massive risks around: agency usage, operational performance, CCG challenges, drug costs, winter, flu. If medical patients take surgical beds out then forget the finance plan.”

    Acute, in deficit

Only foundation trusts are allowed to retain surpluses. Respondents were allowed to select more than one form of additional financial support.

NHS Trusts
Figure 8: If you are in receipt of interim financial support via a loan from the Department of Health, how confident are you that you will be able to meet the total repayment requirements of the loan (without taking a further loan to support repayment)?
2 Very confident
3 Fairly confident
5 Uncertain
3 Fairly concerned
14 Very concerned

Respondent comments

  • “Only for cashflow to cover deficit.”

    Acute, fairly confident
  • “Not YET in receipt anyway!”

    Acute, not applicable
  • “Cash flow is a growing issue.”

    Specialist foundation trust, fairly concerned
  • “There is no cash left in the system.”

    Acute, very concerned
  • “Loans will never be repaid – impossible.”

    Acute and community, very concerned

27 respondents (for whom the question was applicable).

CCG Leads
Figure 9: What is your forecast 2017/18 end-of-year outturn likely to depend on:
17 Delay or cancellation of spending
12 Release of the 0.5 per cent risk reserve
5 Draw down of surpluses from previous years
1 Financial support from NHS England
7 None of the above

Respondent comments

  • “Also dependent upon NHS England not clawing back ‘unplanned’ prescribing benefits but leaving CCG with unplanned cost pressures such as ‘no cheaper supply obtainable’ prescribing pressure.”

    In surplus
  • “As well as non-recurrent flexibilities.”

    Break even
  • “Delivery of QIPP phased into final six months of year.”

    In surplus
  • “Will improve if 0.5 per cent risk reserve is released into the financial position.”

    In deficit

27 CCG finance leads answered this question for the 32 CCGs they cover collectively. Respondents were allowed to select more than one form of additional financial support.

CCG Leads
Figure 10: What, if any, of the following actions will your organisation consider taking in 2017/18?
22 Extending the number of low-value
treatments and prescriptions
that will not be funded
18 Extending waiting lists or reducing activity
for certain elective specialties
14 Extending the use of patient characteristics
and eligibility criteria - such as smoking or body
mass index as criteria for accessing care
12 Placing more limits on access
to services such as IVF
8 Other

Respondent comments

  • “Getting a bit late for these changes to impact in 2017/18.”

  • “Disinvestment in services.”

  • “Decisions may be made on these during 2017/18, benefit would accrue in 2018/19.”

  • “Rightcare initiatives, prescribing and pass through drugs and devices efficiencies.”

  • “Avoiding growth in activity levels and significant prescribing savings.”

Respondents were allowed to select more than one option.

NHS Trusts
Figure 11: How confident are you that organisation can meet its control total for the year ahead?

Respondent comments

  • “This year is looking hugely challenging. Our contract is unaffordable, CIPs are slipping, staff shortages are crippling (operationally and financially) and CQUIN monies are being top sliced. Cash is also a concern – not helped by the fluid nature of timing of STF monies. PDC dividends are removed from our bank accounts directly on particular dates – can the Treasury not afford us the same courtesy when the money comes the other way.”

    Acute, very concerned
  • “Current concern about being defunded for 0.5 per cent CQUIN ‘reserve’. This would reduce our income, and we would struggle to hit our control total in these circumstances. This in turn would lead to failure to receive sustainability and transformation funding, further reducing our overall surplus.”

    Mental health, fairly confident
  • “Pressure from agency staff rates and activity.”

    Mental health and community, uncertain
  • “Internal risks and issues re consequences of commissioner financial pressures.”

    Acute and community teaching hospital, uncertain
  • “Loss of services via tender will adversely impact our ability to meet the control total.”

    Mental health and community provider, very concerned
  • “Depends on executing a gain on sale of a property.”

    Specialist foundation trust, uncertain
  • “Cash is also a big issue as CCGs are not paying their bills and raising more and more challenges.”

    Acute, very concerned
  • “No chance!”

    Acute and community, very concerned

76 respondents (for whom this question was applicable).

CCG Leads
Figure 12: How confident are you that your organisation can meet its expenditure control total for 2017/18?
2 Very confident
10 Fairly confident
6 Uncertain
6 Fairly concerned
8 Very concerned

Respondent comments

  • “Overspends relate to non-elective and Continuing Health Care. Primary care prescribing is particularly complex due to national policy on shortages in drugs which has resulted in significant price increases.”

    Very concerned
  • “Large number of risks around increasing GP referrals.”

    Uncertain
  • “We have sufficient flexibilities to meet this year, however the recurrent underlying position is worse.”

    Very confident
  • “Interdependency with trust recovery plans remains the biggest uncertainty.”

    Uncertain

27 CCG finance leads answered this question for the 32 CCGs they cover collectively.

2. Cost improvement (CIP) and quality, innovation, productivity and prevention (QIPP) programmes (2017/18)

  • The average cost improvement programme (CIP) target for trusts for 2017/18 is 4.4 per cent, ranging from 1 per cent to 8 per cent of turnover (Figure 13).

  • The average quality, innovation, productivity and prevention (QIPP) target for CCGs for 2017/18 is 3.8 per cent, ranging from 1 per cent to 6 per cent of allocation (Figure 13).

  • 47 per cent of all NHS trust finance directors were either fairly or very concerned about achieving their savings plans this year (Figure 14).

  • 59 per cent of all CCG finance leads were fairly or very concerned about achieving their plans this year (Figure 15).

NHS TrustsCCG Leads
Figure 13: Trusts and CCGs CIP/QIPP targets for 2017/18
NHS Trusts
Figure 14: How confident are you of achieving your CIP target?

Respondent comments

  • “CIP confident but additional QIPP more at risk.”

    Community, fairly confident
  • “Predominantly based around income generation through trading services so is variable.”

    Mental health social enterprise, fairly confident
  • “Reliance on non-recurrent savings.”

    Community NHS trust, fairly confident
  • “Majority of plans in place – plans to cover gap being devised – mobilisation delays mean lower than required in-year benefit.”

    Mental health and community, fairly concerned
  • “Slippage on programme covered by over-delivery elsewhere.”

    Mental health, uncertain
  • “We are reliant on a considerable amount of non-recurrent funding generated from within the trust.”

    Mental health foundation trust, fairly concerned
  • “Non-recurrent measures hoping to reduce corporate costs via restructure if can afford in 2017/18 to maintain underlying recurrent CIP.”

    Community and mental health foundation trust, uncertain

QMR 1-4 based on a panel of 50 finance directors. QMR1 and QMR5 excluded as wording of responses not compatible with other quarters' data.

CCG Leads
Figure 15: How confident are you of achieving your QIPP target?

Respondent comments

  • “We will not meet all of our QIPP.”

    Very concerned
  • “Delivered approx 3 per cent last year (with a number of non-recurrent schemes), never delivered QIPP in excess of that 3 per cent before…”

    Very concerned
  • “Will not meet our QIPP targets.”

    Very concerned

27 CCG finance leads answered this question for the 32 CCGs they cover collectively. CCGs only surveyed since their establishment in April 2013.

3. The state of patient care

  • 51 per cent of finance directors and 59 per cent of CCG finance leads felt that patient care has worsened in their local area in the past year (Figures 16 and 17).
  • The number of trust finance directors and CCG finance leads reporting that patient care had worsened in their local area in the past year remained high throughout 2016/17, and into 2017/18 when compared to previous years.
NHS Trusts
Figure 16: Thinking about the NHS in your local area, in the past 12 months, do you think it has got better, worse, or stayed the same in terms of patient care?

Respondent comments

  • “Out-of-hospital care concerns.”

    Unknown, worse
  • “Demand rising, resource and staffing availability falling.”

    Community NHS trust, worse
  • “The CCG is limiting elective services provided and seeking to increase waiting lists to reduce activity.”

    Acute, worse
  • “Waiting times universally worse.”

    Acute, worse
  • “Commissioners tendering and removing services at full cost leaving providers with stranded costs.”

    Community trust, worse
  • “Real improvements in quality, safety and patient and staff experience.”

    Acute foundation trust, better
  • “Shortages now starting to bite.”

    Community provider – social enterprise, worse
  • “2016/17 was delivered both as an organisation and as local health economy via non-recurrent measures, many of which were one offs.”

    Acute and community provider, worse
  • “Clear evidence of tendering reducing access to services.”

    Acute teaching, worse
  • “Medical staff and lack of primary care resources are as extreme as they have ever been against rising emergency pressures.”

    Acute, worse

Question not asked before QMR6.

CCG Leads
Figure 17: Thinking about the NHS in your local area, in the past 12 months, do you think it has got better, worse, or stayed the same in terms of patient care?

Respondent comments

  • “Staff shortages and budget squeezes.”

    Worse
  • “Systemic failure to manage demand, poor performance indicators, availability of workforce.”

    Worse
  • “Increasingly difficult to fill vacancies, particularly GPs.”

    Worse
  • “Care has stayed the same, but pressures have increased (demand for services, financial, targets).”

    The same
  • “Pressures in primary care remain concerning although performance/satisfaction levels holding up.”

    The same

CCGs only surveyed since their establishment in April 2013.

4. Organisational challenges

  • For trust finance directors, delayed transfers of care continued to be their main concern. As in the previous QMR, staff morale was the second highest concern for finance directors, with A&E returning to the top three concerns, followed closely by bed occupancy (Figure 18).

  • For CCG finance leads, the four-hour A&E waiting time standard continued to be their main concern for a fourth QMR in a row. Their second biggest concern was pressures on general practice, introduced as an option in QMR23. They also continued to be concerned about delayed transfers of care and the cancer treatment waiting times standard (Figure 19).

NHS Trusts
Figure 18: Which aspects of your organisation's performance are giving you most cause for concern at the moment?

Note: Respondents asked to choose their top three concerns. Figures expressed as a percentage of the total number of concerns in each survey. A new option, bed occupancy, was introduced in QMR21.

CCG Leads
Figure 19: Which aspects of your organisation's performance are giving you most cause for concern at the moment?

Respondents asked to choose their top concerns. Figures expressed as a percentage of the total number of concerns in each survey. New options have recently been added, implementation/delivery of The five year forward view for mental health (introduced in QMR21), and pressures on general practice (introduced in QMR23).

5. Waiting time standards

  • As a condition of receiving sustainability and transformation funding, trusts are expected to develop credible plans for maintaining the delivery of core standards for patients, including the A&E four-hour performance standard.

  • We asked trust finance directors how confident they were in their organisation’s ability to deliver on the A&E four-hour performance standard by March 2018. Worryingly, 57 per cent of all trust finance directors (Figure 20) were either fairly or very concerned that their organisation will not be able to deliver this performance standard by March 2018. At the same time, 74 per cent of CCG finance leads felt fairly or very concerned that the organisations from which they commission services would not be able to deliver this performance standard by March 2018 (Figure 21).

  • The 2017/18 NHS Mandate set out that total delayed transfers of care (attributable to the NHS, adult social care or both) should be reduced by September 2017 to 3.5 per cent of occupied hospital beds. Following this announcement, just under 13 per cent of trust finance directors said they felt fairly or very confident about their organisation meeting the planned trajectory for reducing delayed transfers of care by September (Figure 22). At the same time, 56 per cent of all CCGs finance leads were fairly or very pessimistic about providers achieving their planned trajectories by September (Figure 23).

NHS Trusts
Figure 20: How confident are you that your trust will meet the 95 per cent A&E four-hour performance standard by March 2018?
3 Very confident
10 Fairly confident
7 Uncertain
5 Fairly concerned
22 Very concerned

Respondent comments

  • “Concerned that pressure to achieve A&E may impact on elective programme which is needed to deliver financial performance.”

    Acute teaching provider, fairly confident
  • “Paradoxically, if the finances have already gone south, then we will probably spend everything we can to hit 95 per cent. But we already in low 90 per cents so not that great a leap for us.”

    Acute, uncertain
  • “Currently at 91–92 per cent but hard to see why it would get much better over winter.”

    Acute/community teaching hospital, fairly concerned
  • “Not a snowball’s chance in hell!”

    Acute, very concerned

47 respondents (for whom the question was applicable).

CCG Leads
Figure 21: How confident are you that the trusts you commission services from will meet the 95 per cent A&E four-hour performance standard by March 2018?
0 Very confident
1 Fairly confident
6 Uncertain
8 Fairly concerned
12 Very concerned

Respondent comments

  • “It is almost certainly not going to happen.”

    Very concerned
NHS Trusts
Figure 22: The 2017/18 NHS Mandate set out that total delayed transfers of care (attributable to the NHS, adult social care or both) should be reduced by September 2017 to 3.5 per cent of occupied hospital beds. How confident are you that your organisation will meet (or has met) your planned trajectory for reducing delayed transfers of care by September?
2 Very confident
7 Fairly confident
17 Uncertain
14 Fairly concerned
29 Very concerned

Respondent comments

  • “Local authority cutting provision.”

    Community, very concerned
  • “As we are an acute trust we are left with DTOC patients we can’t control them.”

    Acute, very concerned
  • “Reduced by 50 per cent over the past 12 months but from a very poor position.”

    Acute foundation trust, fairly concerned
  • “Local authority not signing up to the target as part of the 'new' money it has received.”

    Acute and community foundation trust, very concerned
  • “No chance.”

    Acute, very concerned
  • “Good progress but still many issues, including affordability.”

    Acute/community teaching hospital, uncertain
  • “System working is still poor.”

    Acute and community, very concerned

69 respondents (for whom the question was applicable).

CCG Leads
Figure 23: The 2017/18 NHS Mandate set out that total delayed transfers of care (attributable to the NHS, adult social care or both) should be reduced by September 2017 to 3.5 per cent of occupied hospital beds. How confident are you that the organisations from which you commission services from will meet (or has met) their planned trajectories for reducing delayed transfers of care by September?
1 Very confident
3 Fairly confident
8 Uncertain
11 Fairly concerned
4 Very concerned

Respondent comments

  • “Coming down but a long way to go, need for internal processes in acute to change.”

    Very concerned
  • “Low levels of DTOC to start with. Bigger issue is bed occupancy at 95 per cent plus. First benefits in efficiency will be used to lower bed occupancy not deliver financial savings – impact on delayed transfers is uncertain.”

    Very concerned

6. Workforce

  • 65 per cent of all trusts were planning to increase the number of permanent nursing staff in the next six months (Figure 24).

  • Shortages in the number of staff being trained was the top reason NHS trust finance directors gave for experiencing difficulties in recruiting and/or retaining sufficient nursing staff; this was followed closely by morale/work–life balance and the pay restraint affecting the public sector. It is worth noting that for those to whom this question was applicable, only one respondent did not have any difficulties in either recruiting or retaining sufficient nursing staff (Figure 25).

NHS Trusts
Figure 24: Is your organisation planning to increase the number of permanent nursing staff in the next six months?
53 Yes
29 No

Respondent comments

  • “Filling vacant posts currently being done by overtime, bank and agency.”

    General acute, yes
  • “In terms of those employed but not more posts. We have 15 per cent vacancies.”

    Integrated care, yes
  • “Very unclear where these additional nurses will come from.”

    Acute, yes
  • “Subject to ability to recruit – acuity of patients driving need for safe staffing numbers.”

    Acute, yes
  • “Need to control costs, principally by reducing agency staff.”

    Specialist foundation trust, no

82 respondents (for whom the question was applicable).

NHS Trusts
Figure 25: If you are experiencing difficulties in recruiting and/or retaining sufficient nursing staff to fill available posts, which factors have had the most significant impact?

Respondent comments

  • “Other trusts are paying golden handshakes to attract nursing which is increasing the supply issue.”

    Small acute trust
  • “The delay in obtaining visas has also been a real problem for us. Many candidates have gone elsewhere in the interim.”

    Acute
  • “We were assigned far fewer visas than we requested and told we can only apply for more when we have a small number of visas left, the time lag will significantly impact our international recruitment programme.”

    Acute teaching provider
  • “Skills shortage, levels of pay and benefits, the changing nature and intensity of the work and the agency alternative (higher pay, greater flexibility and less responsibility).”

    Mental health and community

Note: Of the 82 respondents for whom the question was applicable, one respondent selected 'no difficulties in recruiting or retaining nursing staff'. Respondents allowed to select more than one option. Figures expressed as a percentage of the total number of mentions for all options.

7. Looking ahead...

  • When asked for their views about the financial state of their wider local health and care economy over the next 12 months, 86 per cent of trust finance directors and 85 per cent CCG finance leads were fairly or very pessimistic (Figures 26 and 27).

  • 58 per cent of NHS trust finance directors were very or fairly pessimistic about balancing their books in 2018/19 (Figure 28).

  • 44 per cent of CCG finance leads were very or fairly pessimistic about achieving financial balance in 2018/19 (Figure 29).

NHS Trusts
Figure 26: Overall, what do you feel about the financial state of the wider health (and care) economy in your area over the next 12 months?

Respondent comments

  • “Level of non-recurrent support required belies the underlying picture. Level of optimism in demand reduction proposals not backed up by credible plans. Level of effective collaboration is decreasing due to application of pressures on individual organisational results.”

    Acute, very pessimistic
  • “Finance and activity pressures at the same time as building STPs [sustainability and transformation partnerships] and ACSs [accountable care systems].”

    Mental health and community, fairly pessimistic
  • “To achieve control total we will have to do more work which will bust CCG.”

    General acute, very pessimistic
  • “A combination of growing provider, commissioner and council financial pressures with no obvious solutions.”

    Acute/community teaching hospital, very pessimistic
  • “For the first time both providers and commissioners in financial difficulty.”

    Acute and community provider, fairly pessimistic
  • “Social care cuts are frightening. Health visiting and school nursing as we know it will no longer exist. Councils face nightmarish decisions.”

    Community and mental health foundation trust, fairly pessimistic

Question not asked before QMR3. QMR 1-4 based on a panel of 50 finance directors.

CCG Leads
Figure 27: Overall, what do you feel about the financial state of the wider health (and care) economy in your area over the next 12 months?

Respondent comments

  • “Expect 2018/19 to be even more difficult.”

    Very pessimistic
  • “CCG positions, until recent years holding relatively steady, have been hit very hard by changes to the tariff reducing the savings requirement. The reality of NHS spending is that the embedded efficiency requirement has to come from frontline costs as this is where the money is spent.”

    Very pessimistic
  • “Every year the opportunities for financial savings are diminishing and becoming more difficult to identify and challenging to deliver.”

    Fairly pessimistic
  • “Pressures on social care budgets continue to take their toll on NHS delivery.”

    Fairly pessimistic

CCGs only surveyed since their establishment in April 2013.

NHS Trusts
Figure 28: Looking ahead, how confident are you that your organisation will achieve financial balance in 2018/19?
0 Very confident
12 Fairly confident
24 Uncertain
9 Fairly concerned
40 Very concerned

Respondent comments

  • “The need for further efficiencies is a challenge, along with managing demand without spending above funded levels.”

    Mental health and community, uncertain
  • “Local system pressure/financial deterioration. Uncertainty re Autumn Statement and likelihood of pay award increase but how funded?”

    Mental health and community, uncertain
  • “Pay awards prospect most concerning given two-year tariff and CCG financial position (which we view jointly as STP [sustainability and transformation partnership] problem).”

    Community and mental health foundation trust, uncertain
  • “Will achieve control total, but will remain in deficit.”

    Acute, very concerned
  • “Only with more non-recurrent stuff and STF [Sustainability and Transformation Fund].”

    Acute, very concerned
CCG Leads
Figure 29: Looking ahead, how confident are you that your organisation will achieve financial balance in 2018/19?
1 Very confident
2 Fairly confident
15 Uncertain
9 Fairly concerned
5 Very concerned

Respondent comments

  • “Again this will only be on a non-recurrent basis and unless there is a change to funding policy 2018/19 will be the last year when we have any non-recurrent flexibility to support the bottom line.”

    Fairly confident
  • “My organisation will not achieve financial balance in 2018/19, this is already a certainty.”

    Very concerned
  • “Unless funding is diverted to the STP [sustainability and transformation partnership].”

    Very confident
  • “A lower QIPP target predicted but will have exhausted all ‘menu of opportunity’ options.”

    Fairly concerned

27 CCG finance leads answered this question for the 32 CCGs they cover collectively.