The finances at Nottingham's hospitals are a 'very serious cause for concern', according to hospital bosses.
Senior figures on the board of directors of Nottingham University Hospitals NHS Trust (NUH), which runs the QMC and City Hospital, said "very tight controls" remain in place in order to reduce a deficit.
The trust employs around 15,000 people and receives just under £1 billion in funding each year.
But its finances for the current financial year - which ends in April - are in a deficit of £40.3m.
This is £17m away from the targeted deficit in its 2018/19 financial plan.
Bosses say their failure to balance the books is because they have saved £5m less than planned. However, it has managed to save £35.1m over the last 11 months.
Winter pressures, fewer elective surgeries and staff costs have all also contributed to the £17m shortfall.
A dressing and a pin were left inside two patients following surgery at Nottingham's hospitals
To tackle the crisis, the hospital has put in place a "vacancy pause" with the exception of key front-line staff.
It has also put plans in place to control pay as well as reviewing and scrutinising non-critical spending.
The performance report presented at the board meeting says that failures to achieve the control total will lead to the need for the trust to access cash through unplanned borrowing, which will potentially be at a higher rate of interest than planned borrowing levels.
Rupert Egginton, NUH’s chief financial officer, outlined the factors which have contributed to the deficit.
These include the reduction in planned 'elective' operations - planned operations result in a greater contribution of money compared to emergency care.
The winter period was also expensive due to the hospital opening 113 extra beds as well as employing extra staff to manage the beds which has put pressure on the planned budget.
On top of this, bosses said the plan they signed up for was too ambitious. The next year's plan will be more realistic.
He said: “At month 11 (February), we have a £40.8m deficit and are £17m away from our challenging 18/19 financial plan despite actions taken to strengthen controls across the Trust.
"We have been unable to deliver our forecast levels of non-emergency care and earn the income we planned due to the ongoing pressures on our emergency pathway, even though we opened over 100 additional beds over winter to ensure the safety of our patients.
Hucknall doctors surgery with 12,000 patients told it will stay open after new provider is found
"We have a well-developed recovery plan in place to return the best possible results for the year. Additional actions we have taken in recent months include controlling our pay spend, stopping all but essential non-pay and discretionary spend and driving further improvements to clinical efficiency and productivity.
"We have saved £35.1 million against our £41 million savings requirement for the year, which is slightly behind plan. We are on track to deliver the year-end position that we have submitted to our Regulator, which is a £43.8 million deficit; £18.9 million adverse to our original plan.
"It is critical that we get off to the best possible start to 19/20, which will be even more challenging, with the tightened controls remaining in place to ensure delivery against our agreed financial plan.
"We continue to publish our financial results monthly on our website and via social media.”
