Select committee: Public Accounts Committee
Conclusion 23
5th Report - NHS financial sustainability
Published 29 Jan 2025
Addressed to HM Treasury
Public Accounts Committee NHS financial sustainability All items in this report Report on parliament.uk ↗ Inquiry on parliament.uk ↗
Conclusion (the committee's words)
Local areas would value more flexibility about where they can direct their resources to achieve greatest impact, including how they fund measures to prevent ill health. ICBs were supposed to have greater autonomy in determining how to allocate resources locally compared to their predecessor bodies, including freedom to shape future local health services. However, there is widespread agreement that NHSE’s approach to planning and governance, in particular the all-encompassing nature of its top-down guidance, has meant negligible autonomy in the real world for local health systems.40 NHSE told us there are certain prevention programmes, such as for diabetes prevention or targeted lung health checks, where it made sense to fund activities nationally rather than giving local areas discretion over whether to deliver those services.41 Moving care from hospital to community
From: Public Accounts Committee, 5th Report - NHS financial sustainability (HC 350), 29 January 2025
Government response
Latest Treasury Minutes progress report to the Committee of Public Accounts on the Fifth Report of Session 2024-26
The government responded to the whole report on 4 June 2026.
Treasury minutes: Government response to the Committee of Public Accounts on the Fifth report from Session 2024-25
Published 16 May 2025.
Summary written by Accountability Index from the government's response. It is not the government's own words.The government agrees with several of the Committee's recommendations, including on earlier planning guidance, productivity and capital-to-revenue switches, is still considering others, and disagrees with the recommendation on paperless providers.
- On planning, the government agrees that guidance should be issued earlier, with a target implementation date of December 2025. NHSE and DHSC are working so guidance is published "ideally before Christmas".
- On the ten-year plan, prevention spending definitions and community funding, the government "is considering" the recommendations and says it will notify the Committee of its response "when it is confirmed".
- The government agrees that NHSE should set out its productivity actions (target: Autumn 2025). It says the plan for productivity improvements from 2026-27 "will be set out following Phase 2 of the Spending Review".
- The government disagrees with the recommendation on paper reduction, saying it "does not agree that providers should be fully paperless" as some patient communications must be sent by letter. It expects trusts and ICBs "to restrict fax machine use".