Value for Money
NHS Financial Management and Sustainability
Recommendations (6)
Source: NAO Recommendations Tracker
NHS England and NHS Improvement
Rec 1
Partially Accepted
Implemented
DHSC, NHSE and ICSs need to intensify their efforts to manage current and future demand for healthcare by preventing more serious ill health.
This should include:
? work to improve understanding of what ICBs and providers have had success doing so far, and how much is spent on prevention outside national programmes;
? an agreed definition of what counts as prevention to help track spending over time and to identify whether funding is being used in the most effective way; and
? greater collaboration across government, including work to identify options to address the wider determinants of poor health.
Department of Health and Social Care
Rec 2
Accepted
Work in Progress
NHSE needs to deliver on its commitments to increase NHS productivity. It should identify the factors that have limited growth in productivity both before and since the pandemic and develop plans to tackle them. It should work with ONS to agree an official measure of healthcare productivity that captures the full value of activity the NHS currently performs, including care outside hospital settings and prevention activities.
Department of Health and Social Care; HM Treasury
Rec 3
Accepted
Work in Progress
NHSE needs to complete its annual planning processes with ICSs well in advance of each financial year starting. All key players, including NHSE, DHSC and HM Treasury, have roles to play to enable planning guidance to be provided in a timely manner and should work together to facilitate this, agreeing and adhering to an annual deadline for publishing the guidance. NHSE should work with ICBs and providers to identify opportunities to start the planning process earlier.
Department of Health and Social Care
Rec 4
Accepted
Work in Progress
NHSE and DHSC should revisit their understanding of the reasons some ICBs and other NHS bodies have persistent underlying weaknesses that lead them to struggle with their finances. They should then develop a plan to remove these barriers.
NHS England and NHS Improvement
Rec 5
Accepted
Implemented
To facilitate greater efforts at medium- and longer-term financial planning, DHSC and NHSE should propose to HM Treasury ways to deploy more health funding on a longer timeframe than annual allocation and planning cycles allow. Remedies could include greater flexibility between funding pots, multi-year allocations to provide certainty over longer periods (as the government has done in the past), and more discretion for ICBs and providers to direct national funding towards local priorities.
NHS England and NHS Improvement
Rec 6
Accepted
Implemented
As part of the next spending review, DHSC and NHSE should identify and explain to HM Treasury what further capital investments across government could have the greatest impact on NHS productivity and preventing serious ill health. As part of this assessment, they should determine the opportunity costs of not making this investment, including the potential impact in future years on NHS services, employees, and patients.