At the direction of the Secretary of State for Health and Social Care, NHS England have been taking a very aggressive approach to reducing the funding deficit that the majority of NHS trust's currently have. These deficits arise because the level of funding provided to trusts falls below their costs. Cheshire and Merseyside has one of the largest funding deficits in the country and consequently has been specifically targeted by NHS England.

As reported in NHS Board minutes "the appointment of a system improvement director – Mandy Nagra – signals an explicit
financial turnaround process for both the [Cheshire and Mersey Integrated Care Board] and the wider system. There has been the introduction of "Expenditure assurance panels removing local decision making".

The impact of this has been stark, there have been redundancy programmes, recruitment freezes and virtual overtime bans in some services. This has resulted in severe reductions in the numbers of admin and clerical staff and in some hospitals such severe reductions in cleaning staff that floors in non-clinical areas are only being cleaned once every 6 weeks - with other staff including doctors being expected to clean in between.

This is not only creating more pressure for already overworked doctors and other NHS staff but is having a direct impact on patient services. The latest move by the ICB has been to severely reduce the rates of overtime pay for resident and SAS doctors. This has been imposed across Cheshire and Merseyside at a time when there is already a high vacancy rate (with effective recruitment freezes in place) and without any meaningful consultation with staff or risk assessment having taken place.

Although, we agree that the NHS needs to operate as efficiently as possible and are committed to working with trusts to achieve this, the level of funding cuts being imposed and the manner in which they are being enforced is in our view, simply not deliverable without severely harming patient care. Indeed, not only does it seem that the ICB and NHS England have not learned from the Francis report, they are repeating those mistakes on an even larger scale.

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