Review of Staffordshire and Stoke-on-Trent Integrated Care Board’s 2025/26 savings plans

In March 2025, Staffordshire and Stoke-on-Trent Integrated Care Board approved its 2025/26 financial plan, which required one of the largest system-wide savings in England. Commissioned by Stoke-on-Trent City Council, this review examines the implications of these savings for local services, and particularly examines concerns about potential cost-shifting to councils and rising unmet need.

SSOT NHS system’s total saving requirement for 2025/26 was £277m, to fill a budget shortfall primarily driven by demand for health care growing at a faster rate than funding, and relatively high costs, particularly for acute care. The health economy also received additional funding during the pandemic from NHS England which meant it was viewed as ‘over-funded’ and as such received a lower level of funding growth in 2025/26 than the England average. 

The total £277m savings requirement was split almost equally between the ICB as the commissioner of NHS health care and the health system’s three NHS providers. This report focuses predominantly on the ICB’s share of savings, and finds the largest portion (in the region of £60m) of these were planned to come from the ICB withdrawing from funding services and interventions it no longer views as legitimate health care expenditure. 

The largest single programme of savings within that group relates to NHS continuing health care (CHC), a national legal framework through which the needs of (typically) elderly and disabled people are assessed to determine whether responsibility for funding their social care (as well as health care) needs sit with the NHS. Decisions under the CHC framework have stark financial consequences, as when a patient is assessed as ineligible for CHC, the costs of their social care fall either to their local authority, or to their household. 

SSOT’s CHC savings involve both reducing the numbers of people found eligible for CHC as well as reducing the intensity and extent of services and expenditure items included in CHC care packages. 

Nationally, there is very significant variation in the rate of CHC eligibility between ICB areas, with only some of this variation explained by population age and deprivation. SSOT has historically had a higher-than-average rate of CHC eligibility after adjusting for age and deprivation. However, by the middle of 2025, SSOT’s CHC eligibility rate was within the expected range, suggesting the ICB now has limited scope for reducing eligibility further.

A smaller portion of the ICB’s total savings were planned to be made through reducing specific elective procedures carried out in independent sector providers. These savings mainly related to hip, knee and cataract surgery procedures where NHS patients receiving these treatments in private facilities experienced much shorter waiting times than patients requiring other procedures not typically treated in the independent sector. While the ICB’s savings will lead to longer waiting times for some patients, this may be necessary in order to rebalance provision and investment more equitably, particularly for patients with multiple conditions or who are deprived and are much less likely to be treated in the independent sector.

The ICB planned to find in the region of a further £50m in savings through administrative efficiencies and by holding down the prices it pays to providers outside of the SSOT health system below the rate of inflation. These are known as ‘tariff efficiencies’ and are required by national guidance. 

The health system’s own three NHS provider trusts were also expected to absorb some of the cost of inflation this year, and were tasked with finding inthe region of £29m cost savings to off-set unfunded inflation in their contracts with SSOT ICB, again reflecting national policy. These savings requirements were particularly challenging for the health system’s main acute care provider, University Hospitals North Midlands NHS Trust, as they came on top of a substantial underlying gap between its income and expenditure. Original plans for the year alluded to this gap being closed through a significant reduction in staffing numbers at the trust, but that has not been implemented, and the savings have instead been made non recurrently, which means much of the gap between its recurrent income and expenditure will be carried into 2026/27.

The review concludes that the SSOT health system is likely to meet its financial plan for 2025/26, but the level of non-recurrent savings required to do this will mean its financial challenges will continue into 2026/27. A substantial component of its recurrent savings result from a redrawing of the boundary around what is viewed as ‘health care’, which risks leaving some needs unmet – particularly the needs of those who are economically deprived. This reflects a dynamic also seen nationally and highlights the need for local authorities and a broader range of public and third sector services to work together to agree how limited resources can best be prioritised.