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Survey of Medical Directors in NHS trusts in England funding difficulties

• Half of respondents work for an acute trust, with a further quarter working for a PCT (table 1)
• Three quarters of respondents report that their trust is facing a funding shortfall in the current financial year (table 2). The predicted shortfall ranges from £0.2million to £25 million, with the mean predicted shortfall of £6.2 million (figure 2).
• More than a third of respondents report that earlier apparent/actual funding agreements with the PCTs have been changed at short notice in this financial year (table 3). This appears to be more likely in acute and community health trusts (figure 3). The reasons for this largely relate to funding shortfalls, cutbacks and pressures, often at the SHA level.
• A third of respondents report that their trust is intending to reduce services as a result of any shortfall (table 4). Intended reductions in services includes bed closures, staff redundancies and recruitment freezing, reduced elective services, ward closures, withdrawal of staff development and training, reduction in patient transport services and overall service reconfiguration.
• Almost half of respondents report that their trust is intending to freeze recruitment as a result of funding shortfalls and a quarter report that their trust is considering staff redundancies (table 5). The impact of recruitment freeze is more likely to be experienced by PCTs (figure 5). In half of cases, medical staff are likely to be included in any recruitment freezes, but are less likely to be part of any redundancies (table 6). In most cases respondents are unable to identify exact post which may be affected by potential recruitment freezes and redundancies, although some consultant and senior medical posts are likely.
• Whilst a quarter of respondents rate the financial health of their trust as being ‘poor’ (1) the mean rating was the middle ‘average’ score (3) (table 7 and figure 6). Almost two-thirds of respondents rate the financial health of their PCT at the lower end of the scale (mean rating=2) (table 8 and figure 7).

Table 2 - Whether your trust is facing a funding shortfall in the current financial year (2005-6)

	Frequency	Percent
Yes	83	72.8
No	29	25.4
Don't know	2	1.8
Total	114	100.0
No reply	6
Total	120

Figure 1 Whether your trust is facing a funding shortfall in the current financial year (2005-6) by type of trust (%)

Figure 2 Predicted shortfall by the end of the year (£millions) (%)

Table 3 - Whether earlier apparent/actual funding agreements with Primary Care Trusts been changed at short notice in this financial year

	Frequency	Percent
Yes	42	37.8
No	59	53.2
Don't know	10	9.0
Total	111	100.0
No reply	9
Total	120

Figure 3 - Whether earlier apparent/actual funding agreements with Primary Care Trusts been changed at short notice in this financial year by type of trust (%)

Table 4 - Whether your trust is intending to reduce services as a result of any shortfall

	Frequency	Percent
Yes	41	37.6
No	58	53.2
Don't know	10	9.2
Total	109	100.0
No reply	11
Total	120

Figure 4 - Whether your trust is intending to reduce services as a result of any shortfall by type of trust (%)

Table 5 - Impact of funding shortfalls on staff recruitment and retention

	Frequency	Percent
Freeze on recruitment
Yes	52	47.3
No	53	48.2
Don't know	5	4.5
Total	110	100.0
No reply	10
Total	120
Considered redundancies
Yes	30	26.8
No	73	65.2
Don't know	9	8.0
Total	112	100.0
No reply	8
Total	120

Figure 5 - Impact of funding shortfalls on staff recruitment and retention by type of trust (%)

Table 6 - Whether recruitment freezes or redundancies are likely to include medical staff

	Frequency	Percent
Recruitment
Yes	23	47.9
No	15	31.3
Don't Know	10	20.8
Total	48	100.0
No reply	4
Total	52
Redundancies
Yes	4	14.3
No	20	71.4
Don't Know	4	14.3
Total	28	100.0
No reply	2
Total	30

Table 7 - Rating of the financial health of your trust

	Frequency	Percent
1 - Poor	26	23.4
2	20	18.0
3	30	27.0
4	26	23.4
5 - Excellent	9	8.1
Total	111	100.0
No reply	9
Total	120

Table 8 Rating of the financial health of your Primary Care Trust

	Frequency	Percent
1 - Poor	38	35.2
2	28	25.9
3	25	23.1
4	14	13.0
5 - Excellent	3	2.8
Total	108	100.0
No reply	12
Total	120

Figure 6 - Rating of financial health of your trust (%)

Figure 7 - Rating of the financial health of your Primary Care Trust (%)