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NHS financial management and sustainability


The NAO’s report ‘NHS financial management and sustainability’ found that deterioration in the financial performance of NHS providers shows few signs of improving. The report highlights that the overall deficit for all providers and CCGs fell slightly in 2018-19, but the combined deficit in the 10 worst performing trusts grew.  More trusts were in deficit on 31 March 2019 than on 31 March 2018, with the gap in financial performance between the best- and worst-performing trusts (with the largest surplus and the largest deficit) increasing from £218 million to £282 million.

The report also finds that the NHS is treating more patients, but waiting times standards are not being met and the absolute number of people on the waiting list continues to grow. 

Trusts are becoming becoming increasingly dependent on one-off savings to deliver efficiency targets, and financially distressed trusts are increasingly relying on short-term loans from the Department with little or no prospect of paying them back. By 31 March 2019, outstanding debt issued by the Department to these trusts was £10.9 billion, up from £8.0 billion on 31 March 2018. The NAO found that this is not an acceptable or sustainable approach to the financial management of major public bodies, and the Department is reviewing options to address this issue.

The report concludes that ongoing workforce issues and funding uncertainties for capital, training, public health and social care, all pose significant risks to the success of the NHS Long Term Plan. 

Public Accounts Committee hearing:

On Friday 22 May 2020 the Committee will question officials from the Department for Health and Social Care, NHS England, and NHS Improvement, on the findings of the two reports. The Committee will ask questions about the impact year-on-year transfers from capital and revenue are having on patient care, and how the Department’s capital budget is earmarked against specific investment priorities and risks. The Committee will also question officials on the disparity in financial health at a local level, growing waiting lists, and staffing shortages.  

The Committee will also ask officials about potential impact of the NAO’s findings in the context of the Department’s response to COVID-19.

Ahead of the evidence hearing on 22 May, the Committee invites written submissions on any of the issues and questions raised above. Please submit your evidence here by Friday 15 May 2020.

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Contact us

  • Email:
  • Phone: 020 7219 3273 (General enquiries). For all media inquiries please contact Jessica Bridges Palmer / 07917488489
  • Address: Public Accounts Committee, House of Commons, London, SW1A 0AA