Health service leaders in Birmingham have issued a stark warning that they may fail to meet their crucial 'break even' financial target by the end of the current fiscal year.
Mounting Financial Pressure
The NHS Birmingham and Solihull (BSOL) Integrated Care Board recorded a deficit of £45.9 million by November 2025 (Month 8 of the financial year). This figure is more than £32 million worse than the forecast for this point and represents a further deterioration of £7.2 million compared to the previous month's position.
Board members were told that increasing deficits mean the forecast break-even point by the end of March 2026 is now at significant risk. Paul Taylor, chair of finance and performance, acknowledged the challenge, stating: "We've been forecasting a break even position across Birmingham and Solihull since the start of the year. There is a risk we won't get to a break-even position by the end of the year."
Pay Costs and Recovery Efforts
The primary driver of the overspend is pay. The overall wage bill is currently £37.2 million over budget. This consists of:
- £23.8 million over budget for substantive staff.
- £18.8 million over budget for bank staff.
Some progress has been made, with savings of almost £5.5 million achieved by cutting agency and other pay costs. However, efficiency savings are currently £19.8 million behind their year-to-date plan, though the Financial Recovery Board is actively working to improve this.
Major Trust Concerns and the Final Quarter
University Hospitals Birmingham NHS Foundation Trust (UHB) is the biggest single concern for the BSOL system. Its current finances show a deficit of £36,941,000 – nearly £24 million worse than forecast. UHB is now working directly with NHS England to tackle the issue and mitigate risks.
Paul Athey, chief finance officer, highlighted the critical nature of the coming weeks: "Month 9 is the key month. There is a reasonable expectation from NHS England that the number you put down at Month 9 is the number you will hit." He added that some provider trusts, which had previously been optimistic about managing risks, are now reassessing their ability to do so, particularly given "quite stretching efficiency targets in the last quarter of the year."
Mr. Taylor emphasised the narrowing window for action, noting: "As we get closer to the end of the year, we get less time to forecast and more time to act and therefore there is very little wriggle room." The coming month will be decisive in determining whether the Birmingham and Solihull NHS can steer its finances back on track.
