Kent and Medway Integrated Care Board has revised its year-end forecast from breakeven to a £198m deficit, with just two months remaining in the financial year, triggering leadership changes and an externally commissioned review.
The system, led by Kent and Medway Integrated Care Board, attributes the deterioration to the failure of back-loaded cost improvement programmes to materialise, compounded by the expected loss of £49.3m in deficit support funding.
In response, the ICB has undertaken a detailed review of system finances and, jointly with NHS England, commissioned a “drivers of the deficit” assessment from Ernst & Young. The board has also replaced its chief finance officer and is planning to appoint a system financial recovery director. A paper to the ICB’s board describes a £148.3m “materialised risk”, with a significant element linked to one of its acute providers, Medway NHS Foundation Trust. The trust’s forecast deficit has risen sharply from £4.9m to £47.2m, including £16.5m in lost deficit support funding. The ICB said a £9.6m deterioration within a single week of an earlier forecast was “evidence of weak financial controls and forecasting”.
The revised position places Kent and Medway among a growing number of systems reporting large late-year deficits, even as national leaders maintain that overall performance remains ahead of last year. The board paper also highlights continuing discussions with Kent County Council over a “technical financial matter”, the value of which has not been disclosed. The dispute, it notes, “compromises a sustainable system approach to delayed discharges”.
As recently as November, the board had been advised of a £48m deficit, £11.7m worse than plan, but there was confidence at that stage that substantial cost improvement programmes would deliver later in the year. That confidence has since ebbed as delivery failed to accelerate.
An ICB spokesperson said the board had been clear for some time that the breakeven position was at risk. While mitigations were identified earlier in the year, these “were not being delivered at the pace and impact required” as 2025–26 progressed, contributing to the sharp deterioration. Additional support has now been brought in to develop “a credible, deliverable and sustainable financial plan for 2026–27”.
“A deficit of this size is clearly very serious,” the spokesperson said. “We are working closely with NHS England to understand the implications and agree the next steps. No decisions have been made on repayment profiles or timescales. Our priority is to ensure services for the people of Kent and Medway remain safe, sustainable and focused on patient need.”
Chief finance officer Ivor Duffy has left the organisation, with Jonathan Wilson joining last week. Mr Wilson was previously CFO at Hertfordshire and West Essex and has held senior finance roles at Moorfields Eye Hospital, Homerton University Hospital and the Royal National Orthopaedic Hospital. In board papers, chief executive Adam Doyle thanked Mr Duffy for his “steadiness, professionalism and dedication” during a period of mounting financial pressure.
