Finance and Performance

Please use this page to read our Counter Fraud Statements and browse our Expenditure over £25K reports.

Please see our annual reports page for further information about our finances and expenditure.


Counter Fraud

The ICB is required by law to protect the public funds it administers. It may share information provided to it with other bodies responsible for auditing or administering public funds, or where undertaking a public function, in order to prevent and detect fraud.

We participate in the Cabinet Office’s National Fraud Initiative: a data matching exercise to assist in the prevention and detection of fraud. We are required to provide particular sets of data to the Minister for the Cabinet Office for matching for each exercise.

Data matching involves comparing computer records held by one body against other computer records held by the same or another body to see how far they match. This is usually personal information. Computerised data matching allows potentially fraudulent claims and payments to be identified.

Where a match is found it may indicate that there is an inconsistency which requires further investigation. No assumption can be made as to whether there is fraud, error or other explanation until an investigation is carried out.

The processing of data by the Cabinet Office in a data matching exercise is carried out with statutory authority under its powers in Part 6 of the Local Audit and Accountability Act 2014. It does not require the consent of the individuals concerned under data protection legislation or the General Data Protection Regulation (GDPR), however the Cabinet Office have set out how your data will be used and your rights.

For further information on data matching at the ICB please contact us.


Losses and Special Payments Guidance

The Losses and Special Payments guidance is prepared as procedural guidance for Integrated Care Boards (ICBs).

The purpose of this document is to establish best practice that can be incorporated into the ICB’s Standing Financial Instructions.

You can find the ICB’s Standing Financial Instructions within our Governance Handbook.

Read our Losses and Special Payment Guidance as HTML (below) or download as a PDF.

Version control

Document number: 1
Issue/approval date: 30/05/2022
Version number: 1.2
Status: approved
Next review date: 30/05/2024

Contents

1. Introduction and guidance statement
2. Scope
3. Definitions
4. Integrated care board reporting requirements
5. Roles and responsibilities

1 Introduction and guidance statement

1.1.1 The Losses and Special Payments guidance is prepared as procedural guidance for Integrated Care Boards (ICBs).

1.1.2 The purpose of this document is to establish best practice that can be incorporated into the ICBs Standing Financial Instructions.

1.1.3 It should be noted that the user of this procedural guidance should be compliant with the respective ICB SFIs. If there is a need to interpret or difficulty in application of this guidance, please send an email to the NHS England, head of assurance and counter fraud: england.assurance@nhs.net.

1.1.4 HM Treasury retains the authority to approve losses and special payments which are classified as being either:

  • novel or contentious;
  • contains lesson that could be of interest to the wider community;
  • involves important questions of principle;
  • might create a precedent; and/or
  • highlights the ineffectiveness of the existing control systems.

1.1.5 Therefore, HMT Treasury approval is required if a transaction exceeds the delegated authority, or if transactions will set a precedent, are novel, contentious or could cause repercussions elsewhere in the public sector.

1.1.6 Losses and special payments are therefore subject to special control procedures compared to the generality of payments, and, special notation in the accounts to bring them to the attention of parliament. The annual accounts reporting requirements are detailed herein.

1.1.7 For the avoidance of doubt, all cases relating to ICB losses and special payments must be submitted to NHS England for approval if the proposed transaction values exceed the delegated limits that are detailed below or satisfy the conditions in section 1.1.4:

Expenditure type: Delegated limit
All losses: up to £300k
Special Payments including Extra- Contractual/ Statutory/ regulatory/ compensation & Ex gratia: up to £95k
Special severance & Retention payments: £0
Consolatory payments: £500

1.1.8 Losses and/or special payments that indicate or give rise to suspicion of fraud or corruption, please follow the guidance as provided by your local counter fraud specialist.

1.1.9 In dealing with individual cases, ICBs must consider the soundness of their internal control systems, the efficiency with which they have been operated, and take any necessary steps to put failings right.

1.1.10 The outcome of the review of the case under consideration (1.1.9) must be clearly indicated when submitting cases to NHS England as part of the account’s consolidation process at yearend or as part of the approval process.

2 Scope

2.1.1 This procedural document is applicable to the following NHS bodies;

• Integrated Care Boards

3 Definitions
3.1.1 Unless a contrary intention is evident or the context requires otherwise, words or expressions contained in this document will have the same meaning as set out in HMT managing public money.

3.2 Losses

3.2.1 A loss refers to any case where full value has not been obtained for money spent or committed.

3.2.2 Examples of types of losses which cannot be treated as business as usual are cash losses, bookkeeping losses, fruitless payments and claims waived or abandoned.

3.3 Special Payment

3.3.1 Special Payments relate to the following;

  • any compensation payments;
  • extra-contractual or ex-gratia payments; and
  • any payment made without specific identifiable legal power In accordance with the National Health Service Act 2006, as amended by the Health and Care Act 2022.

3.4 Special Severance and retention payments

3.4.1 ICBs have not been delegated a limit to approve the special severance or retention payments. For detailed guidance, please refer to the special severance payments document as published on the NHSEI SharePoint finance library.

3.4.2 For clarity, any non-contractual special severance payments that are being considered for approval must be submitted to NHS England HR regional advisory teams prior to settlement.

3.4.3 The table below lists all the various expenditure classifications for losses and special payments and the applicable approvals if the final settlement sum exceeds the ICB delegated limit:

Category Classification Approval required from Further approvals Description of category
Fruitless Payment Loss Approval required from Further approvals Description of category
Bookkeeping Losses Loss Assurance team NHSE/DHSC/HMT Bookkeeping losses (un-vouched or incompletely vouched payments) including missing items or inexplicable or erroneous debit balances
Constructive loss Loss Assurance team NHSE/ DHSC/ HMT A constructive loss is a similar form of payment to stores losses and fruitless
payments, but one where procurement action itself caused the loss. For example, stores or services might be correctly ordered, delivered or provided, then paid for as correct; but later, perhaps because of a change of policy, they might prove not to be needed or to be less useful than when the order was placed
Administrative costs Loss Assurance team NHSE/ DHSC/ HMT An expense incurred in controlling and directing an organisation.
Claims Waived or Abandoned Loss Assurance team NHSE/ DHSC/ HMT Losses may arise if claims are waived or abandoned because, though properly made, it is decided not to present or pursue them
Extra- contractual payments Special Payment Assurance team NHSE/ DHSC/ HMT Payments which, though not legally due under contract, appear to place an obligation on a public sector organisation which the courts might uphold. Typically, these arise from the organisation’s action or inaction in relation to a contract. Payments may be extra-contractual even where there is some doubt about the organisation’s liability to pay, e.g. where the contract provides for arbitration, but a settlement is reached without it. A payment made as a result of an arbitration award is contractual
Extra-statutory Special Payment Assurance team NHSE/ DHSC/ HMT Payments which are within the broad intention of the statute or regulation but go beyond a strict interpretation of its terms.
Extra-regulatory payments Special Payment Assurance team NHSE/DHSC/HMT Payments which are within the broad intention of the statute or regulation but go beyond a strict interpretation of its terms.
Compensation payments Special Payment Assurance team NHSE/ DHSC/ HMT Payments made to provide redress for personal injuries, traffic accidents, and damage to property They include other payments to those in the public service outside
statutory schemes or outside contracts.
Special severance payments Special Payment NHSE Regional Director of Workforce and OD EHRSG DHSC GAC HMT Payments made to employees, contractors and others beyond above normal statutory or contractual requirements when leaving employment in public service whether they resign, are dismissed or reach an agreed termination of contract. Regional and further Approval is required regardless of the value of the non contractual pay package.
Ex gratia payments Special Payment Assurance team NHSE/ DHSC/ HMT Go beyond statutory cover, legal liability, or administrative rules, including payments;

  • made to meet hardship caused by official failure or delay;
  • out of court settlements to avoid legal action on grounds of official inadequacy; and,
  • payments to contractors outside a binding contract, e.g. on grounds of hardship
Retention payments Special Payment Regional Director of Workforce and OD None Payments, designed to encourage staff to delay their departures, particularly where transformations of ALBs are being negotiated, are also classified as novel and contentious. Such payments always require explicit Treasury approval, whether proposed in individual cases or in groups. Treasury approval must be obtained before any commitment, whether oral or in writing, is made.

3.5 Annual assurance statements

3.5.1 As part of the new compliance and control procedures over exit packages, ICBs must submit an annual assurance statement confirming the following:

  • details of all1 exit packages (including special severance payments) that have been agreed and/or made during the year;
  • that NHS England and HMT2 approvals have been obtained (in relation to non-contractual pay elements or amounts that exceed the ICB delegated limits) before any offers, whether verbally or in writing, are made; and
  • adherence to the special severance payments guidance as published by NHS England.

3.5.2 Further guidance will be provided to ICBs on this process.

3.6 Interpretation

3.6.1 Should any difficulties arise regarding the interpretation or application of any part of this losses and special payment guidance, the advice of the NHS England Head of assurance and counter fraud (england.assurance@nhs.net) must be sought before acting.

3.7 Delegation of Function, Duties and Powers

3.7.1 The ICB Constitution must have a governing body that makes provision for the appointment of the Audit Committee.

3.7.2 The ICB standing financial instructions should clearly indicate the role that the audit committee has in reviewing and approving losses and special payments.

3.7.3 The ICB standing financial instructions should indicate the delegated limits that have been agreed by the governing body for operational purposes.

4 Integrated care board reporting requirements

4.1 Capturing of losses and special payments

4.1.1 The ICB chief financial officer is responsible for ensuring that processes and procedures that facilitate the capturing and reporting of losses and special payments are in place and ensure that a losses and special payments register is maintained.

4.1.2 All losses and special payments for ICBs must be recorded in the register and reviewed as part of the internal controls process.

4.2 Parliamentary accountability and audit report

4.2.1 The ICB must maintain a losses and special payments register that provides the requested information to complete the NHS England group accounts.

4.2.2 It should be noted that ICBs do not have a mandatory requirement to produce a Parliamentary accountability and audit report as other entities that report directly to Parliament. However, it is a mandatory requirement that ICBs produce an audit certificate and report.

There will be a need to collect data for the NHS England consolidated account. NHS England will also use this information to complete the DHSC summarisation schedule for the DHSC consolidated account. Therefore, regardless of applicability of this report, all ICBs must ensure the summarisation schedule is completed.

4.2.3 If there are any individual cases or a group of losses or special payments that exceed or the aggregate value of £100,000, the related payment should be noted separately on the ICB yearend template completed for the NHS England group account.

5 Roles and responsibilities

5.1 Financial Control

5.1.1 Chief Financial Officer

5.1.2 It is noted and acknowledged that the roles and responsibilities for the chief financial officer vary in all the ICBs. The chief financial officer should implement a system of internal control that details the process for reporting losses, recording losses, monitoring and reporting the losses and special payments to the ICB’s audit committee based on existing reporting cycles.

5.1.3 The reporting cycle should also clarify the delegated sum that the chief financial officer can authorise as a loss or special payment. The delegated sum should be in line with the ICB escalation process for losses and special payments.


Footnotes

1. The assurance statement must include all exit packages, thus, contractual and non contractual.
2. This is only applicable to elements of the exit packages that are classified as non contractual


Capital Plans

Integrated Care Boards and Local Health and Care Systems are required by the Health and Care Bill to prepare and publish an annual plan for the use of system capital resources.  The plans have been prepared in collaboration with system partners and reflect plans submitted to and agreed by NHS England.

Introduction

Suffolk and North East Essex Integrated Care System (ICS) is one of six health systems operating in the East of England Region.  The Integrated Care Board (ICB) commissions services on behalf of a resident population of approximately 1.02million people living in Suffolk, excluding Waveney, and North East Essex (Colchester and Tendring district council areas).  From a socio-economic perspective the population includes significant diversity including areas of relative prosperity alongside the most deprived ward in England (Jaywick).

The system comprises four health service organisations:

    • NHS Suffolk and North East Essex Integrated Care Board (ICB)

    • East Suffolk and North Essex NHS Foundation Trust (ESNEFT)

    • West Suffolk NHS Foundation Trust (WSFT)

    • East of England Ambulance Service NHS Trust (EEAST)

The ICB ‘hosts’ the three provider organisations and is required by statute to publish a (system) joint capital plan for those hosted organisations.  Services are provided by other NHS organisations (most notably mental health services provided by Norfolk and Suffolk NHS Foundation Trust and Essex Partnership University NHS Foundation Trust), but these organisations are ‘hosted’ by ICBs in other systems, and their capital plans reflected in the Joint Capital Resource Plans of those organisations.  EEAST provides services to the entire East of England Region, but is hosted for historical reasons by the Suffolk and North East Essex system.

Vision and Aims

The SNEE Integrated Care Strategy has four collective ambitions.

Best health and wellbeing

What matters to me is that the ‘Best Health and Wellbeing’ is a genuine reality for me, because I am able to:

    • Be resilient through a sense of belonging, safety and purpose.

    • Live a healthy life in a healthy neighbourhood with a good home, good work or education, a good environment and a good local community.

    • Adopt and maintain healthy behaviours – I am able to be active, eat well, sleep well and maintain good mental wellbeing

    • Avoid needing treatment and care for physical or mental health conditions in the first place.

    • Prevent any condition from getting worse, by intervening early and/or slowing or reducing disease progression.

    • Be able to manage the impact of any lasting illness or condition for either ourselves or those who care for us avoid harmful substances.

    • Be protected from avoidable diseases.

Health equality

What matters to me is that I have ‘Health Equality’ – this means that I have the same opportunity of good health and wellbeing, dignity and respect regardless of:

    • My ethnicity, race or religion.

    • My age, gender or if I identify as LGBTQ+.

    • If I am living with a physical, sensory or learning disability.

    • My circumstances – if I am experiencing deprivation, homelessness or growing up in care.

    • If I live in a coastal, rural or traveller community.

Live well

What matters to me is that I can continue to ‘Live Well’ – this means that I am able to:

    • Start well – before conception, during pregnancy and birth, through childhood and into adolescence.

    • Be well – maintain good oral and dental health, good eye and ear health and good health for my gender.

    • Stay well – if I am living with cancer or any other long term condition, if I am living with obesity, if I require urgent or emergency care or if I am living with a disability.

    • Feel well – if I am living with a mental health problem or addiction, or if I am a survivor of trauma or abuse.

    • Age well – as I grow older, particularly if I am living with frailty or dementia.

    • Die well – for myself and those close to me when I reach the end of my life.

‘Can do’ health and care

What matters to me is that I am supported by a genuinely ‘Can Do’ Health and Care System that I can trust – this means that:

    • I am both listened to and heard.

    • I am treated with kindness, dignity, respect and compassion.

    • I can access support, diagnosis and treatment when I need to.

    • I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and personal goals.

    • When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place.

    • I have care and support that is co-ordinated and everyone works well together and with me.

Priorities

Joint Forward Plan priorities

The Joint Forward Plan (JFP) outlines demographics and population needs of the area in the context of the Essex and Suffolk Joint Strategic Needs Assessments (JSNAs) and also considers the following key drivers:

    • Demand for services.

    • Current capacity of services.

    • Current performance of services

    • Financial position.

The JFP identifies the vision, values, outcomes and purpose of the ICB before setting out its key priorities using the following six domains of the ‘Live Well’ model (see earlier).

Subsections within each of the Live Well domains outline key objectives, goals and metrics to achieve over the JFP timeframe of 2023 to 2028.

Within the Start Well domain, the JFP focuses on:

    • Maternity and Neonatal Care.

    • Children and Young People.

The Feel Well domain considers key metrics and ambitions for:

    • Mental Health including suicide.

    • The Be Well domain is centred on:

    • Healthy Behaviours.

    • Addictions.

    • Dental / Oral Health.

    • Eye Health.

    • Personalised Care.

Stay Well looks at a range of key care programmes including:

    • Primary Care.

    • Elective Care and Diagnostics.

    • Urgent and Emergency Care including community.

    • Cancer.

    • Diabetes.

    • Respiratory.

    • Cardiovascular Disease (CVD).

    • Stroke and Stroke Rehab.

    • Neuro Rehab.

    • Learning Disabilities and Autism.

The Age Well domain provides an insight on:

    • Ageing Well Programme.

    • Dementia.

    • Carers.

The Die Well domain encompasses key considerations for:

    • End of Life (EoL).

Estates Strategy

The estate is a key enabler and integral part of the system plan, supporting the ICB’s aspirations and the required outcomes. Where services are located, the choice of services offered and the environment in which care is delivered can enhance or reduce people’s personal health and wellbeing. Creating an estate where more people can access services at the right time, in the right place and be seen by the right person therefore supports people to improve their lives:

    • Providing ease of access to services that maintain health and wellbeing including acute, primary, community, mental health, voluntary, Social Care and leisure as close to home as possible.

    • Providing treatment in environments that ensure privacy and dignity are protected.

    • Taking views into account when an estates scheme is being developed.

    • Being confident that as our population increases over time and with an ageing population with complex health needs, the estate can meet the population needs.

    • Ensuring that our buildings are safe, efficient and well maintained.

    • Enabling appointments with health and care professionals in a timely manner using a method of their choice.

In working together as a system and thinking differently, there is the opportunity to use the large estate to support the transformation of services, bringing health and social care together for the community in a more integrated way and at the same time make cost savings and efficiencies

Governance

While Provider Trust Boards continue to operate as independent organisations, albeit with the statutory requirement to collaborate as a system, the ultimate system decision-making authority is the ICB Board.  The ICB Board approves the estates strategy for the wider health system. The ICB Board ultimately has the power to support, or not, any business cases that are beyond the delegated authority of individual provider organisations.  Applications for national programme capital resources routinely require ICB support.

The ICB Board receives guidance from multiple formal committees, notable in this case from the ICB Estates Committee and the ICB Finance Committee.  Provider organisations are represented on both committees.

Estates fits within the wider portfolio of the Director of People and Workforce.

CQC Rating

The Care Quality Commission has yet to assess and report on the ICB, either individually or as part of a wider system report.  The three hosted providers are all currently rated ‘Requires Improvement’.

Planned estates developments are key elements of the improvement plans of at least two of the system provider organisations.   As a RAAC (reinforced aerated autoclaved concrete) hospital West Suffolk is considered a national priority for the New Hospital Programme, although completion of this project is still several years away.  ESNEFT is in the latter stages of its acute configuration project.  The opening of the Essex and Suffolk Elective Orthopaedic Centre, will deliver a key milestone in the specialisation of services.

It should be noted that CQC ratings depend on a wide rage of criteria.  It could be argued that the planned development of HQ, training and EOC facilities by East of England (although still in the business case development phase) and the transition to hub-based estate may help with EEAST workforce issues that underpin the requires improvement CQC opinion.

Capital Allocations and Sources of Funding

Capital Allocations comprise two main components: system capital and strategic or programme capital.

System Capital Prioritisation Process

The allocation of system capital to hosted NHS organisations is determined by a locally agreed process.  The level of system capital provides for little more than the replacement of assets that have reached the end of their useful lives (and require replacement) and to address backlog maintenance.  With the exception of ring-fenced system capital (e.g. RAAC) which is allocated specifically to organisations, the balance of system capital is allocated via a process developed and approved in 2021/22 by the ICB’s predecessor organisations.  That process is driven by estimates of depreciation, thereby allocating capital to those organisations needing it to replace fully depreciated assets.

The 2024/25 a capital allocation includes a ‘bonus’ element for achieving 2023/24 revenue performance targets.  That element of the resource has been allocated in line with national principles, ie organisations failing to achieve their element of the system target are limited to a 50% share of the target.  At the time of production of this plan the system is waiting to receive the results of a further bonus system capital allocation based on Urgent Care Performance in Q4 2023/24.  In line with national policy any sums earned as part of this allocation will be allocated directly to the organisations earning that allocation.  It is likely that both acute providers in Suffolk and north east Essex will receive some additional system capital from this scheme.

The use of system resource is at the discretion of the provider organisations and their Boards.  The system capital allocation for 2024/25 is £55.193m subject to any further bonus capital award. To place that in context, the cost of backlog maintenance is currently estimated to be £249m.  West Suffolk Hospital at Bury St Edmunds, a reinforced aerated autoclaved concrete (RAAC) affected hospital accounts for over 40% of that total.  The replacement of West Suffolk Hospital is a national priority within the New Hospitals Programme.

Strategic Capital Prioritisation Process

Strategic Capital is normally allocated by an application process, with appropriate organisations invited to apply for capital that addresses specific national or regional objectives. Organisations apply for funding but require system support for that application to be successful.  The targeted areas for application are determined nationally, with organisations considering whether they wish to apply.

That decision making process is outlined in the below flowchart.

Strategic Capital Prioritisation Process Flowchart

Flowchart showing the decision-making process which governs which organisations are successful in their bids for capital funding.

Strategic Capital Prioritisation Process Flowchart: Text Description

Strategic Capital is normally allocated by an application process, with appropriate organisations invited to apply for capital that addresses specific national or regional objectives. Organisations apply for funding but require system support for that application to be successful.  The targeted areas for application are determined nationally, with organisations considering whether they wish to apply.

The decision making process comprises three separate stages, each with its own assessment criteria

Stage One Requirement: Is the project aligned to National, Regional and ICB objectives.

Proposals are tested against criteria to ensure that its objectives meet the strategic aims of the organisation.  These may be driven by National and/or regional and/or local targets.  It would be expected that the proposal would already be reflected in the Estates Infrastructure Strategy

Stage Two Requirement: Is the proposal deliverable, affordable and sustainable?

The proposal must be deliverable technically within a timeframe that is considered reasonable, including any restrictions on the access to capital (for example that it needs to be completed by a set date).  The project must be affordable in both capital and revenue terms. The project must also contribute to or meet NHS sustainability targets, including the requirement to achieve net zero carbon impact.

Stage Three Requirement: Capacity Gap Evaluation

The project must address current and projections of future demand.  In primary care this might, for example, take the form of increasing the capacity for offering more appointments, orby providing alternative care reduce the demand on appointment to achieve the same goal of reducing the gap between capacity and demand. The assessment will also need to take into consideration the impact of the availability of workforce.  Community care may address capacity shortfalls by supporting new ways of working that mitigate the challenges of recruiting certain workforce groups. Acute projects might be assessed against their impact on waiting lists.

Only if the proposed project evaluates favourably in all three stages will the ICB support the application for strategic capital.

Other capital sources: leased capital

In changes implemented in November 2023, NHS use of leases will in future need to be controlled in  at system level.  Leases are used widely across the NHS but nowhere more so than in the ambulance service, where the majority of the operational fleet is leased.  The system remains in discussion with NHSE regarding the setting of a reasonable target for leased capital that reflect the ambulance service’s reliance on leased capital.  Once addressed the system will establish a mechanism for the management of leases.  In the interim decisions continue to be made at organisational level.  In 2023/24, at a point at which system targets had not been set additional allocations were made in March 2024 to offset the overspend.  A similar process and allocation is likely to be required in 2024/25.

2024/25 Capital Schemes

There are a number of major capital schemes commencing, in progress or expected to complete in 2024/25 across the system.

ICB: ICB build or refurbishment schemes are expected across eight different GP/primary sites in 2024/25, with an in year aggregate cost of £1.780m, rising to £2.280m in 2025/6 when the largest of those schemes is due to complete.

ESNEFT:  2024/25 will see the completion and commissioning of the Dame Clare Marx elective orthopaedic centre, the largest such centre in Western Europe.  Whilst much of the project to date been funded from national project pots (Targeted Investment Fund elective funding/System transformation Programme capital), the latter stages (£3.28m) are funded from within the system capital allocation.  The electronic patient record replacement project is a huge undertaking for the next couple of years.  Most is funded from revenue resources, but this year’s programme includes £4.310m of national capital.  The largest new project in 2024/25 will see £18.038m of spend on the redevelopment of the Clacton Hospital site.  Other significant developments include community diagnostic facilities at Ipswich (£3.371m) and the development of a dedicated endoscopy unit at Colchester (£2.900m) which is currently under construction.

WSFT: 2024/25 will see further expenditure to maintain the structural integrity of the RAAC affected site.  Expenditure of £11.254m is expected on enabling works for its replacement; the new hospital project.  The other major development in 2024/25 is the completion and commissioning of the community diagnostic centre at Newmarket CDC, with in year expected spend of £8.291m.

EEAST: £36.116m is expected to be spent on new leases for ambulance fleet in 2024/25.  In addition, two ambulance hubs are expected to be developed: Bury St Edmunds leased at a cost of £7.503m and Ipswich, using STP wave 4 capital at a cost of £9.500m.  Serviced response points, also leased, to support the development of hubs accounts for a further £0.120m of expenditure.

The systems leasing plans are not compliant with a planning total provided by NHSE.  This was also the case for 2023/24, with solutions negotiated, involving additional resource, during the course of the year.  It is difficult to envisage given the high proportion of lease expenditure that relates to contractual commitments and specifically the dependence on leasing for the replacement of front-line ambulances, that a similar agreement will not be reached during 2024/25.

Business Cases in 2024/25

ESNEFT: At the time of writing there are no scheduled major capital business cases (ie that require national approval) in 2024/25.

WSFT: Work on the Trust’s outline business case for the replacement hospital will continue, although is expected that the case will not be submitted and approved until 2025/26.  Work will then commence on the development of the full business case.

EEAST: It is likely that the cases for the replacement of the Trust HQ, training and emergency operations centre (EOC), will be submitted, with the latter seeking to consolidate the existing centres at constrained sites at Bedford and Chelmsford. Cases may also be submitted for the continuation of the hub operational model, with new sites at Kings Lynn and Basildon.  The Trust may also, by virtue of the scale of the lease investment have to submit a case for the continued replacement of the operational fleet.

Cross System Working and Collaboration

Launched on 19th March 2024, there is currently a public consultation exercise being run that would if supported result in the transfer of elective orthopaedic activity from activity at West Suffolk and other neighbouring systems being transferred to the new elective orthopaedic centre at Colchester.  When open later this year the facility will offer state of the art facilities, with the potential for significantly reduced waiting times.

Risks

The level of capital investment needed to meet the system priorities is significantly greater than the capital which is available. Where additional national capital is made available this is inherently ringfenced to specific priorities. Capital investment requirements have been developed as part of the system estates infrastructure strategy which will feed in to the wider national NHS Estates strategy.

The inadequacy of the proposed cap on lease capital represents a significant risk to the delivery of the plan, and in longer term to the provision of safe health services.  The system is working with NHSE at a Regional level to find a permanent solution to this shortfall, noting that revenue support is available to support this business as usual, recurrent cost.

Other issues

Sustainability.  The NHS is committed to the delivery of zero carbon targets by 2035.  Carbon emissions are a key determinant in design solutions for new estate build.

Capital Plans 2024/25

CDEL ICB EEAST ESNEFT WSFT Total Key Projects
£000s £000s £000s £000s £000s
Provider Operational Capital 0 12,994 26,298 13,999 53,291 Backlog maintenance, site priorities, RAAC, equipment
replacement
ICB Operational Capital 1,907 0 0 0 1,907 GP Premises refurbishment/new build (8 locations)
Total System Capital Allocation 1,907 12,994 26,298 13,999 55,198
Provider Impact of IFRS 16 0 45,539 2,267 0 47,806 See narrative for detail
ICB Impact of IFRS 16 0 0 0 0 0
Provider New Hospital Programme 0 0 0 11,254 11,254 WSFT New Hospital enabling works
Provider Sustainibility and Transformation 0 9,500 18,038 0 27,538 Hub Deveopment (STP Wave 4 capital)
Partnership/Upgrades Programme
Provider National Programmes 0 0 0 0 0
Diagnostics 0 0 6,271 8,291 14,562 Newmarket Community Diagnostic Centre
Front Line Digitisation 0 0 6,220 0 6,220 Electronic Patient Record replacement project
Other Tech Funding 0 0 0 0 0
Elective Recovery 0 0 0 0 0
RAAC (included in system) 0 0 0 0 0
Provider Other (technical accounting) 0 4,209 2,736 0 6,945
Total System CDEL 1,907 72,242 61,830 33,544 169,523

Introduction

ICBs are required to publish an annual plan for the proposed use of capital resources, in line with a timetable determined by NHS England. Plans are required to cover all NHS hosted organisations within the ICS area. For Suffolk and North East Essex this includes:

  • NHS Suffolk and North East Essex Integrated Care Board (SNEE ICB)
  • East Suffolk and North Essex NHS Foundation Trust (ESNEFT)
  • West Suffolk NHS Foundation Trust) (WSFT)
  • East of England Ambulance Service NHS Trust (EEAST)

Capital Plans support the delivery of 2023/24 operational planning and strategic objectives. Key issues addressed in the development of this plan include:

  • Development of diagnostic capacity.
  • Development of elective capacity, whilst maintaining urgent care capacity.
  • Reconfiguration of services to support the delivery of clinically safe and affordable services.
  • Maintenance of a safe estate.

The plan identified in this paper comprises two key elements:
1) System Capital: also known as ‘business as usual’ capital. The system capital resource is determined at ICS level and allocated to organisations by the ICB in collaboration with hosted partner organisations.

2) Strategic or other (national) programme capital allocations. Allocations are determined by national programme teams, normally as a result of a bidding process submitted by provider organisations with the approval of the ICB.

The plan represents an initial or provisional plan that may be amended during the course of the year by additional allocations (see notes). The plan included in this paper is aligned to the (provider) Financial Planning Returns (FPR) and (system) Integrated Planning Returns (IPR) submitted on 4th May 2023.

SNEE ICB ESNEFT WSFT EEAST Total Notes
£000s £000s £000s £000s £000s
System Capital
System Capital: Ringfenced 0 0 8,400 0 8,400 1
System Capital: Discretionary 1,997 28,709 11,691 12,822 55,219 2
Sub-total 1,997 28,709 20,091 12,822 63,619
Memo (Over)/Under commitment 0 -1,211 -886 276 -1,821 3
System Capital 1,997 27,498 19,205 13,098 61,798
Strategic/Other Programme Capital
New Hospital 0 0 1,028 0 1,028 4
Electronic Patient Records 0 11,250 0 0 11,250 5
Acute Reconfiguration/Elective Capacity 0 40,395 20,000 0 60,395 6,7
Diagnostic 0 8,600 12,794 0 21,394 8
Other 0 5,319 0 26,551 31,870 9
Sub-total 0 65,564 33,822 26,551 125,937
Gross Capital Expenditure 1,997 94,273 53,913 39,373 189,556
Memo
Disposals 0 -1,948 -36 0 -1,984
Grants 0 -1,501 0 0 -1,501
Lease/PFI/other technical adjustments 0 -1,567 0 0 -1,567
Sub-total 0 -5,016 -36 0 -5,052
CDEL 1,997 89,257 53,877 39,373 184,504
IFR 1997 89257 53877 39373 184504

Notes

(1) System Capital Ringfenced. Although classified as system capital, an element of resource in this category is ring-fenced for use to replace Reinforced Aerated Autoclaved Concrete (RAAC) planks that form the roof of a significant element of the West Suffolk Foundation Trust site at Bury St. Edmunds. The replacement of RAAC planks is an ongoing project, likely to complete in 2024 and is a short-term measure designed to sustain a safe estate until such time as the construction of a replacement hospital in Bury St. Edmunds is complete. Bury St. Edmunds has been identified as a priority new build within the ‘40 new hospitals’ UK Government commitment.

(2) System Capital Discretionary. SNEE operates a Board approved policy for the allocation of discretionary system capital. In summary (to simplify); allocation is determined in two stages.

(a) A minimum capital allocation, determined by in year depreciation charges, with a view to ensuring that organisations are able to maintain the condition of the current estate/assets.

(b) Additional capital allocations (the balance) allocated on an equitable basis between provider unit in accordance with criteria determined by the ICB in conjunction with NHSE (patient safety, clinical quality etc.) These capital allocations are designed to address system development priorities.

In 2023/24 the ICB determined that the value of additional capital allocations was of a magnitude (small) that meant that a separate bidding/prioritisation/allocation process was not required. As a result, the additional allocation was apportioned in the same ratio as the minimum capital allocation.

Provider organisations as individual statutory organisations determine how this resource is allocated to individual projects. The organisational risk register is a key tool in the determinant of project priorities, to avoid interruption of service caused by asset failure. Priorities often change during the course of the year, as unforeseen asset replacement is identified. The close alignment of system capital allocations and depreciation charge figures means that there is little or no scope for enhancing or improving assets.

(3) NHS England allowed the submission of system capital plans that could be ‘over-committed’ by up to 5%, to reflect that capital slippage is commonplace. In the event that there are no further allocations of system capital in 2023/24 and depending on the financial performance against target of other systems, there maybe a need to reduce planned system capital expenditure by £1.821m (2.9%).

(4) West Suffolk Hospital at Bury St. Edmunds is a designated priority hospital within the Governments New Hospital initiative. The Trust is in the process of developing the business case required for approval before construction can begin in earnest. The capital plan includes a small national programme allocation to support elements of the project that can be capitalised before approval of the final business case. It is possible that significant additional allocation may be made available to WSFT prior to the end of this financial year to commence enabling work, subject to Treasury approval of the final business case.

(5) East Suffolk and North Essex NHS FT are developing the full business case for the replacement of their electronic patient record system (the outline business case has been approved). Although the full case has yet to be approved, it is expected that approval will be granted, with expenditure commencing in Q4 2023/24 and continuing and completing in 2024/25.

(6) East Suffolk and North Essex NHS FT submitted plans for reconfiguration of acute services shortly after its formation from the predecessor Colchester and Ipswich hospital Trusts. The development of an elective surgical hub at Colchester was a key element of that business case. In addition to reconfiguration funding, the Trust has successfully applied for Elective Recovery/Targeted Investment Fund (TIF) resource to enable the further expansion of the hub to increase elective capacity, in doing so creating the largest elective orthopaedic centre in Western Europe. Elements of both project and resource have been deferred from 2022/23, as global supply chain interruption (notable relating to steel) delayed construction. The development, which addresses multiple system priorities (sustainability of services, development of elective capacity, protection of non-elective capacity and financial viability) is due for completion early financial year 2024/25.

(7) West Suffolk Hospital NHS FT has submitted a business case, not yet approved, for the development of an elective surgical hub at Newmarket. The modular construction of the facility means that early approval of the case would enable construction in Q4 20223/24. The project was included in system plans under the guidance of the NHS England Regional Office. The project would bring further ring-fenced elective capacity, reducing the impact of increased non-elective activity notably in the winter months.

(8) Diagnostic Centres. The capital plan for East Suffolk and North Essex FT includes projects for the incremental development of the community diagnostic hub facility at Clacton, in addition to investment in PACS digital imaging and storage capacity across the Trust. The plan also includes the development of a community diagnostic Hub at Newmarket the business case for which has been approved; it would support the development of the elective surgical hub being at the same location. The plan may be amended to include the development of a further community diagnostic facility within Ipswich. A bid for resource was submitted after 4th May 2023. As approval is still pending it has been excluded from the current version of the plan.

(9) East of England Ambulance Service NHS Trust, Other. This category includes the routine reprovision, using lease facilities of the emergency and non-emergency ambulance service fleet.

Introduction

ICBs are required to publish an annual plan for the proposed use of capital resources, in line with a timetable determined by NHS England. Plans are required to cover all NHS hosted organisations within the ICS area for the year 1st April 2022 to 31st March 2023. For Suffolk and North East Essex this includes:

  • NHS Ipswich and East Suffolk Clinical Commissioning Group (IES CCG) 1st April 2022-30th June 2022
  • NHS North East Essex Clinical Commissioning Group (NEE CCG) 1st April 2022-30th June 2022
  • NHS West Suffolk Clinical Commissioning Group (WS CCG) 1st April 2022-30th June 2022
  • NHS Suffolk and North East Essex Integrated Care Board (SNEE ICB), 1st July 2022- 31st March 2023. (The small capital allocation and programme for the commissioning organisations noted above is combined).
  • East Suffolk and North Essex NHS Foundation Trust (ESNEFT)
  • West Suffolk NHS Foundation Trust) (WSFT)
  • East of England Ambulance Service NHS Trust (EEAST)

Capital Plans support the delivery of 2022/23 operational planning and strategic objectives. Key issues addressed in the development of this plan include:

  • Development of diagnostic capacity.
  • Development of elective capacity, whilst maintaining urgent care capacity.
  • Reconfiguration of services to support the delivery of clinically safe and affordable services.
  • Maintenance of a safe estate.

The plan comprises two key elements:

1) System Capital. Also known as ‘business as usual’ capital. The system capital resource is determined at ICS level and allocated to organisations by the ICB in collaboration with hosted partner organisations.

2) Strategic or other (national) programme capital allocations. Allocations are determined by national programme teams, normally as a result of a bidding process submitted by provider organisations with the approval of the ICB.

The plan represents an initial or provisional plan that may be amended during the course of the year by additional allocations. The plan included in this paper is aligned to the (provider) Financial Planning Returns (FPR) and (system) Integrated Planning Returns (IPR) submitted on 20th June 2022.

SNEE ICB ESNEFT WSFT EEAST Total Notes
£000s £000s £000s £000s £000s
System Capital
System Capital: Ringfenced 0 0 21,000 0 21,000 1
System Capital: Discretionary 1,787 23,619 9,250 10,618 45,274 2
System Capital 1,787 23,619 30,250 10,618 66,274
Strategic/Other Programme Capital
New Hospital 0 0 1,060 0 1,060 3
Acute Reconfiguration 0 48,090 0 0 48,090 4
Elective Recovery 0 17,258 0 0 17,258 5
Diagnostic 0 4,519 0 0 4,519 6
Ambulance Fleet Replacement 0 0 0 19,027 19,027 7
Other 0 11,621 1,891 0 13,512
Sub-total 0 81,488 2,951 19,027 103,466
Gross Capital Expenditure 1,787 105,107 33,201 29,645 169,740
Memo
Disposals 0 -2,048 0 0 -2,048
Grants 0 -3,369 0 0 -3,369
Lease/PFI/other technical adjustements 0 -423 0 0 -423
Sub-total 0 -5,840 0 0 -5,840
CDEL 1,787 99,267 33,201 29,645 163,900
IFR 1787 99267 33201 29645 163900

Notes

(1) System Capital Ringfenced. Although classified as system capital, an element of resource in this category is ring-fenced for use to replace Reinforced Aerated Autoclaved Concrete (RAAC) planks that form the roof of a significant element of the West Suffolk Foundation Trust site at Bury St. Edmunds. The replacement of RAAC planks is an ongoing project, likely to complete in 2024 and is a short-term measure designed to sustain a safe estate until such time as the construction of a replacement hospital in Bury St. Edmunds is complete. Bury St. Edmunds has been identified as a priority new build within the ‘40 new hospitals’ UK Government commitment. The Trust has applied for additional funding for the RAAC project to allow acceleration and earlier completion.

(2) System Capital Discretionary. SNEE operates a Board approved policy for the allocation of discretionary system capital. In summary (to simplify); allocation is determined in two stages.

(a) A minimum capital allocation, determined by in year depreciation charges, with a view to ensuring that organisations are able to maintain the condition of the current estate/asset base.

(b) Additional capital allocations (the balance) allocated on an equitable basis between provider unit in accordance with criteria determined by the ICB in conjunction with NHSE (patient safety, clinical quality etc.). These capital allocations are designed to address system development priorities.

In 2022/23 the ICB undertook a limited exercise with system partners to determine the priorities additional capital allocation budget as minimum capital allocation accounted for approximately 90% of the system capita allocation. The shortage of capital over several years resulted in the conclusion that patient safety/the need to accelerate asset replacement to prevent loss of capacity through breakdown was the primary determinant for resource allocation. Whilst individual projects were prioritised, the resultant allocation of capital remained close to the proportions of capital that would have been allocated if all system capital had been allocated on the basis of in year depreciation charge estimates.

Provider organisations as individual statutory organisations determine how this resource is allocated to individual projects. The organisational risk register is a key tool in the determinant of project priorities. Priorities often change during the course of the year, as unforeseen asset replacement is identified.

(3) West Suffolk Hospital at Bury St. Edmunds is a designated priority hospital within the Governments New Hospital initiative. The Trust is in the process of developing the business case required for approval before construction can begin in earnest. The capital plan includes a small national programme allocation to support elements of the project that can be capitalised before approval of the final business case.

(4) East Suffolk and North Essex NHS FT submitted plans for reconfiguration of acute services shortly after its formation from the predecessor Colchester and Ipswich hospital Trusts. The development of an elective surgical hub at Colchester was a key element of that business case. Significant elements of that project are scheduled to be undertaken in 2022/23.

(5) East Suffolk and North Essex NHS FT has successfully applied for Elective Recovery/Targeted Investment Fund (TIF) resource to enable the further expansion of the elective hub (4 above) to increase elective capacity, in doing so creating the largest elective orthopaedic centre in Western Europe.

(6) Diagnostic Centres. The capital plan for East Suffolk and North Essex FT includes projects for the initial stages of development of a community diagnostic hub facility at Clacton.

(7) East of England Ambulance Service NHS Trust. This category includes the routine reprovision, using lease facilities of the emergency and non-emergency ambulance service fleet.


Expenditure over £25K

Suffolk and north east Essex ICB

Ipswich and East Suffolk (Archive)

You can find reports of expenditure over £25K made by NHS Ipswich and East Suffolk CCG prior to June 2022 on the archived CCG website.


North East Essex (Archive)

You can find reports of expenditure over £25K made by NHS North East Essex CCG prior to June 2022 on the archived CCG website.


West Suffolk (Archive)

You can find reports of expenditure over £25K made by NHS West Suffolk CCG prior to June 2022 on the archived CCG website.

Page last modified: 6 September 2024
Next review due: 6 March 2025