Source · National Audit Office

NHS financial management and sustainability

Published: 5 Feb 2020 Recommendations: 5 Type: Value for Money NAO confirmed: 5

NAO report detail with recommendations, government responses, and any Public Accounts Committee follow-up.

nao.org.uk →

Recommendations

5 items

5 accepted 4 implemented 1 in progress

Rec	Recommendation	Addressee	Acceptance	Implementation
1	The Department and NHSE&I should redesign the financial architecture to promote the behaviours that will be needed to achieve The NHS Long Term Plan. It should draw on the lessons from previous schemes which have not worked, such as the use of punitively high interest-bearing loans to deter trusts from overspending. Ref Page 13, paragraph 24, point a · Implemented 06/2022	Department of Health and Social Care	Accepted	Implemented ✓ NAO
2	As part of these wider financial reforms to establish a more stable funding system, the Department should put in place an alternative support system to provide assistance to the most financially distressed organisations, stop issuing loans where there is no realistic prospect of those loans being repaid, and restructure the balance sheets of these trusts to address the accumulated debt that will not be repaid. Ref Page 13, paragraph 24, point b · Implemented 04/2020	Department of Health and Social Care	Accepted	Implemented ✓ NAO
3	The Department and NHSE&I should develop a better understanding of how much of the deficits in trusts in severe financial difficulties are down to structural issues that cannot be addressed by local health systems and develop a plan to address these structural issues and include this in any changes to payment systems. Ref Page 13, paragraph 24, point c · Implemented 06/2022	Department of Health and Social Care	Accepted	Implemented ✓ NAO
4	The Department and NHSE&I should develop a coherent long-term capital strategy, based on a long-term capital settlement, to support the development of The NHS Long Term Plan. This should include establishing a transparent, simplified, needs-based mechanism for prioritising, accessing and spending capital that better addresses high- and significant-risk backlog maintenance and supports place-based reform. Ref Page 13, paragraph 24, point d · Implemented Q1 2026/27	Department of Health and Social Care	Accepted	In progress ✓ NAO
5	NHSE&I should put in place a regulatory and oversight system that aligns with the responsibilities placed upon individual NHS bodies and their role within non-statutory sustainability and transformation partnerships and integrated care systems. This should clearly set out how roles and responsibilities sit between the national NHSE&I team, regional NHSE&I teams and local partnerships. Ref Page 13, paragraph 24, point e · Implemented 06/2021	NHS England and NHS Improvement	Accepted	Implemented ✓ NAO