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UK Health Security Agency’s financial controls remain unacceptably weak

10 May 2024

  • PAC urges Government to reduce clinical harm as warnings reiterated on lack of preparation for future pandemics

The Department of Health and Social Care (DHSC) and the UK Health Security Agency (UKHSA) are getting the basics unacceptably wrong in their financial management and accountability for public spending – for the second year running. In a report published today, the Public Accounts Committee (PAC) finds that weaknesses in UKHSA’s financial controls mean it remains impossible to establish if taxpayers’ money has been spent to the purposes intended by Parliament.

The PAC urgently recommended in 2023 that UKHSA ensure robust financial controls and processes were put in place with a clear plan for its accounts. The Government agreed with this recommendation, but UKHSA’s financial accounting remains fundamentally weak and unable to be properly audited. This is due both to spillover effects from the state of last year’s accounts, and to government mistakenly failing to tell auditors in time about changes made to forecasts for COVID vaccine demand, underpinning several significant sums in UKHSA’s accounts.

The report also finds that £2.6bn was paid out to claimants in 2022-23 for clinical negligence by government, which has no effective plan to minimise these costs. Each claim is a tragedy for the people involved, and the report calls on government to reduce clinical harm. Cash payments were made for negligence in maternity and neonatal services worth £1.1bn that year, equivalent to an eye-watering third of the NHS’ total budget for these services.  The cost of clinical negligence to the NHS in England relative to the population served is significantly higher than those of similar health and social care systems. In 2018-19, it was higher than the combined equivalent costs in the health systems of Australia, Canada, New Zealand, and Sweden.

The PAC is also disappointed that, four years after the pandemic began, government still does not have a plan for stockpiling inventory, including PPE, for future pandemics. The Committee previously recommended government should work out what items and quantity of PPE it needs to hold as a stockpile, and develop and implement a clear, cost-effective plan for such a stockpile in preparation. The Government has not done so, meaning it risks disposing of items that could form part of the nation’s strategic stockpile for future crises.

Chair's comment

Dame Meg Hillier MP, Chair of the Committee, said:

“The proper safeguarding and robust accounting of how taxpayers’ money is spent is not an optional extra. The fact that UKHSA’s accounts have been unable to be properly audited for two years in a row – a very rare occurrence for a public body – is deeply concerning.

But our report also raises wider issues speaking to the DHSC’s grip on spending, and illustrate ongoing and tragic failures experienced by people using the health service. The Government is spending billions on clinical negligence claims. An effective plan to reduce these costs would be an effective plan to reduce clinical harms, but such a plan does not yet exist.”

Further information

Image: Parliamentary copyright