Conclusion 12

In 2018–19, the 10 trusts with the worst financial results reported a combined deficit of £844 million, representing 31% of the combined total of all trusts reporting a deficit, up from £758 million in 2017–18. The financial performance of these trusts each year has continued to deteriorate over several years. The NAO highlighted that the underlying reasons for deficits in these trusts are not always fully understood.24 NHSE&I did not clarify how it will better understand the underlying issues and address them, but said that it has been discussing with trusts and local health systems about what further support could be provided to see those deficits reduce.25 15 Qq 23, 52, 58, 73; Department of Health and Social Care, The Exercise of Commissioning Functions by the National Health Service Commissioning Board (Coronavirus) Directions 2020, 20 March 2020 16 NHS Providers’ written evidence 17 Q52 18 C&AG’s Report NHS financial management and sustainability, paras 14, 22, 3.14–3.15 and Figures 6 and 7 19 Qq 38, 48 20 C&AG’s Report NHS financial management and sustainability, para 13 21 Q19 22 NHS providers’ written evidence 23 Q19 24 Q48; C&AG’s Report NHS financial management and sustainability, paras 14, 2.7 25 Qq 19, 48 NHS capital expenditure and financial management 11 Ensuring timely access to services