UK Inquiry Tracker

NHS financial sustainability

Public Accounts Committee Closed Inquiry

Opened: 31 Oct 2024 Closed: 16 May 2025 Parliament page

The scale of the challenge facing the NHS is unprecedented. Local NHS systems in England ended 2023/24 with a collective deficit of £1.4bn. NHS England (NHSE) received more than £4.5bn in extra funding in 2023/24, and reduced planned spending against its central budget by £1.7bn – but these actions did … Read more The scale of the challenge facing the NHS is unprecedented. Local NHS systems in England ended 2023/24 with a collective deficit of £1.4bn. NHS England (NHSE) received more than £4.5bn in extra funding in 2023/24, and reduced planned spending against its central budget by £1.7bn – but these actions did not prevent NHS systems’ deficits significantly increasing beyond what was planned at the start of the year. The NHS may be working at the limits of a system which might break before it is again able to provide patients with care that meets standards for timeliness and accessibility, according to the National Audit Office’s (NAO) July 2024 report . The NAO has warned that, with an ageing and increasingly sick population, either much future demand for healthcare must be avoided, or the NHS will need a great deal more funding, or service levels will continue to be unacceptable and may even deteriorate further. The Committee found in 2020 that the pandemic had highlighted the need for the NHS to fundamentally transform services to ensure that it could meet rising demand in the future while maintaining vital service standards. Committee reports on NHS bodies since 2011 have highlighted a range of challenges, including rising demand, lack of capital investment, trust deficits and workforce issues. Based on the NAO report, the Committee will hear from senior Department of Health & Social Care and NHSE officials, on subjects including: - Operational improvements identified by the NAO to help the NHS do more with the resources it has; - How NHSE supports NHS bodies that are struggling; and - Longer-term challenges to the NHS’ financial sustainability. Please note that the Committee is unable to consider or assist with individual cases. If you need help with an individual problem you are having, you may wish to contact your constituency MP . Please look at the requirements for written evidence submissions and note that the Committee cannot accept material as evidence that is published elsewhere. If you have evidence on these issues please submit it here by 23:59 on Thursday 14 November 2024. Show less

3 Recommendations

23 Conclusions

1 Report

1 Oral session

6 Letters

1 Event

Activity timeline 10 events

10 Sep
2025

Correspondence

Letter from the Permanent Secretary of the Department of Health and Social Care relating to the 5th Report of Session 2024-25, NHS financia…

4 Sep
2025

Correspondence

Letter to the Permanent Secretary of the Department for Health and Social Care relating to the Treasury Minute response follow up on NHS fi…

16 May
2025

Report published

Treasury minutes: Government response to the Committee of Public Accounts on the Fifth report from Session 2024-25

7 Apr
2025

Correspondence

Letter from the Interim Permanent Secretary of the Department of Health and Social Care relating to the delay to publication of Treasury Mi…

27 Mar
2025

Correspondence

Letter from the Interim Permanent Secretary of the Department of Health and Social Care and the Chief Executive Officer at NHS England rela…

10 Mar
2025

Correspondence

Letter from the Chief Financial Officer and Deputy Chief Executive at NHS England relating to the oral evidence session held on 25 November…

4 Feb
2025

Correspondence

Letter from the Interim Permanent Secretary of the Department of Health and Social Care relating to a follow up on the oral evidence sessio…

29 Jan
2025

Report published

5th Report - NHS financial sustainability

25 Nov
2024

Oral evidence

NHS financial sustainability

25 Nov
2024

Formal meeting (oral evidence session) · The Boothroyd Room, Portcullis House

NHS financial sustainability

Oral evidence sessions 1 session

25 Nov 2024

View on parliament.uk

NHS financial sustainability

Amanda Pritchard · NHS England Andy Brittain · Department of Health and Social Care (DHSC) Antonia Williams · HM Treasury Julian Kelly · NHS England Sir Chris Wormald KCB · Cabinet Office

Reports 1 report · click to expand

Title	HC No.	Published	Items	Response
5th Report - NHS financial sustainability	HC 350	29 Jan 2025	26	Responded

Recommendations & Conclusions

8 results

5 Recommendation Deferred

5th Report - NHS financial sustain…

Define government health prevention spending and increase flexible funding for local systems.

Given the constraints on public spending, it is highly likely that re- focusing attention from sickness to prevention cannot be achieved without re-allocating existing NHS funds in the same direction. Senior ICB leaders report a continued lack of progress with … Read more

Government Response

The government is considering defining health prevention spending, deferring to the upcoming 10 Year Health Plan and Spending Review Phase 2. It notes that 2025-26 planning guidance has removed many ringfences for local flexibility and NHS England will soon publish a revised oversight framework.

HM Treasury

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6 Conclusion Deferred

5th Report - NHS financial sustain…

Ensure greater NHSE funding for community services, preventing redirection to hospitals.

NHSE’s long-held ambition to move more care from hospitals to the community has stalled. There would have been more investment and progress in mental health and community services, particularly GP surgeries and dental services, in 2023–24 had NHSE not redirected … Read more

Government Response

The government is considering the recommendation, stating it will be addressed within the 10 Year Health Plan and multi-year Spending Review for decisions on shifting funding to community care. It highlights increased mental health spending in 2023-24 and the maintenance of Better Care Fund funding in 2025-26.

HM Treasury

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1 Conclusion Deferred

5th Report - NHS financial sustain…

Committee scrutinised NHS financial management and sustainability with key departments.

On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (DHSC), NHS England (NHSE), and HM Treasury (HMT) on the financial management and financial sustainability of the … Read more

Government Response

The government states it is working with NHS England to publish planning guidance earlier and aims to improve the planning process for future years. It defers further consideration of this recommendation to the upcoming 10 Year Health Plan.

HM Treasury

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19 Conclusion Deferred

5th Report - NHS financial sustain…

Government aims for three NHS shifts, balancing long-term transformation with current patient care.

DHSC described how the new government had set out three shifts that they want to see in the NHS: from analogue to digital; from treatment to prevention; and from acute to community. DHSC said that it wanted “to see those … Read more

Government Response

The government is considering measures for supporting the prevention shift in the context of the work of the 10 Year Health Plan and does not wish to pre-empt the content, but will consider defining health prevention spend as an enabler and will notify the Committee of the response when it is confirmed.

HM Treasury

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20 Conclusion Deferred

5th Report - NHS financial sustain…

Progress on health prevention hindered by acute care focus and reduced public health grants.

Senior ICB leaders reported to the National Audit Office a continued lack of progress with the government’s long-standing aim to move towards preventing ill health rather than treating it. One of the most important reasons cited by ICBs has been … Read more

Government Response

The government states that measures for supporting the prevention shift are being considered in context of the work of the 10 Year Health Plan.

HM Treasury

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21 Conclusion Deferred

5th Report - NHS financial sustain…

DHSC believes prevention requires cultural and legislative change, not solely additional resource allocation.

DHSC told us it did not view providing more resources, or redirecting them from elsewhere, as a substantive part of the solution to the lack of progress with prevention. Instead, it considers that a shift towards prevention might be achieved … Read more

Government Response

HM Treasury

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22 Conclusion Deferred

5th Report - NHS financial sustain…

Inadequate definition and tracking of prevention spending impedes accurate assessment of policy progress.

Currently, NHSE does not even track spend and activity on prevention by ICBs at local levels, due to unavailability of data and the lack of consistency about what counts as prevention spending. While DHSC funds some prevention activities that sit … Read more

Government Response

The government states that defining health prevention spend could enable a shift from sickness to prevention, and that this recommendation will be considered in the context of developing the 10 Year Health Plan.

HM Treasury

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24 Conclusion Deferred

5th Report - NHS financial sustain…

Overall NHS productivity remains low despite increased elective activity and community investments.

Despite carrying out 15% more elective activity than before the pandemic, the NHS is less productive overall once the activities of mental health trusts, community trusts and GPs are considered.42 NHSE told us that, while government has had a long-term … Read more

Government Response

NHSE, with DHSC, is focusing on enabling a greater shift from hospital to community – including considering how funding decisions over coming years can support this through the 10 Year Health Plan and the multi-year Spending Review. This recommendation is therefore under consideration and The Committee will be notified of the response when it is confirmed.

HM Treasury

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Government Response AI assessment · 25 of 3 classified

Accepted 10

Acknowledged 5

Deferred 8

Rejected 2

Total 3 recs + 23 conclusions

Correspondence 6 letters

10 Sep 2025 To committee Letter from the Permanent Secretary of the Department of Health and Social Care relating to the 5th Report of Session 2024-25, NHS financial sustainability, recommendations 2a, 3, 4, 5a, 5b, 6, and 7, 02 September 2025

Parliament page

4 Sep 2025 From committee Letter to the Permanent Secretary of the Department for Health and Social Care relating to the Treasury Minute response follow up on NHS financial sustainability, recommendations 3, 4, 7, 2a, 5a, 5b, and 6, 24 July 2025

Parliament page

7 Apr 2025 To committee Letter from the Interim Permanent Secretary of the Department of Health and Social Care relating to the delay to publication of Treasury Minute 5 NHS financial sustainability, 03 April 2025

Parliament page

27 Mar 2025 To committee Letter from the Interim Permanent Secretary of the Department of Health and Social Care and the Chief Executive Officer at NHS England relating to a follow up on questions raised in the oral evidence session held on 25 November 2025 on NHS Financial Sustainability, 18 March 2025

Parliament page

10 Mar 2025 To committee Letter from the Chief Financial Officer and Deputy Chief Executive at NHS England relating to the oral evidence session held on 25 November 2024 on NHS Financial Sustainability, 05 March 2025

Parliament page

4 Feb 2025 To committee Letter from the Interim Permanent Secretary of the Department of Health and Social Care relating to a follow up on the oral evidence session held on 25 November 2024 on NHS financial sustainability, 27 January 2025

Parliament page