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NHS foundation trusts need to get better control over contract and agency staffing costs and increase their efficiency savings, says Monitor.

The health regulator’s comments come as the foundation trust sector as a whole is projecting a deficit of £271 million at the end of financial year 2014/15. This comprises a gross deficit of £531 million at 60 trusts (£115 million worse than planned), offset by a £260 million surplus at 87 trusts (£136 million worse than planned).

The increased strain on foundation trusts (which make up two-thirds of all NHS trusts) is shown by the sector’s failure to achieve a number of key national waiting times targets on A&E, routine surgery and cancer services between July and September 2014. Nevertheless, foundation trusts still treated 200,000 more patients than they did a year ago.

David Bennett, Chief Executive of Monitor, said:

This is proving to be a tough year for many foundation trusts. Funding is rising, but not as quickly as costs are increasing. These are driven by higher demand for healthcare, reflecting an ageing population and more people suffering complex conditions, and also higher staffing levels.

Nevertheless, trusts can and need to deliver greater efficiencies while also planning for more significant change over the next 2 to 5 years, so that they can continue providing the quality services that patients value.

A report to Monitor’s board on the performance of the foundation trust sector over the 6 months ended 30 September 2014 found:

• the sector reported a deficit of £254 million compared with a planned deficit of £59 million
• 81 foundation trusts reported a deficit of which 80% were acute trusts
• the combined deficit of the 81 trusts was £396 million, offset by 66 trusts making a surplus of £142 million
• trusts spent £831 million on contract and agency staff, double the £377 million they had planned
• trusts made £492 million worth of cost savings, which is £126 million less than planned
• trusts spent £854 million on items such as new facilities and estates, which is £357 million less than planned
• 2.7 million patients received emergency care and more than 490,000 received non-emergency inpatient treatment, an increase of 124,000 and 6,000 respectively compared with the same period last year
• 19,000 patients received inpatient cancer treatment, an increase of 1,000 compared with the same period last year, but the sector failed to treat 15% of them within 62 days of referral by a GP
• the foundation trust sector as a whole breached the target to treat 90% of admitted patients within 18 weeks of referral
• 27 trusts (18% of the sector) were subject to enforcement action by Monitor because of governance and performance concerns