Conclusion 1

The NHS had not made the transformation required to meet rising demand before the COVID-19 pandemic. We have reported on the financial and service sustainability of NHS bodies every year since 2011, and have consistently highlighted a range of challenges faced by the NHS, including rising demand, lack of capital investment, tackling trust deficits and workforce issues. The NHS has failed to get a grip on these challenges. The NHS did not achieve the vision of its last long-term plan, the Five-Year Forward View for the five years to 2020–21 including moving more care out of hospitals. This plan was superseded by the NHS Long Term Plan in 2019. Although the NHS delivered increased activity in 2018–19, patient waiting times continued to slip and variations in financial performance continued to grow.