NHS provider trusts in England are in
the midst of the worst deterioration in their financial health in
a decade, with trusts in the North West and Midlands recording
the deepest overspends last year. In 2023-24 the sector as a
whole reported a £1.2bn overspend, leaving it in as precarious a
position it was in immediately prior to the
pandemic.
That's according to a new Nuffield Trust analysis
of the financial health of the NHS trust sector, which makes up
three-quarters of NHS day to day spending. The analysis, shared
exclusively with the Financial Times, shows that NHS trusts in
areas of greatest deprivation saw the worst deterioration in
2023-24 compared to the previous year, and that the underlying
gap between stable incomes and outgoings across the provider
sector was at least £4.5bn.
While overall deficits are not as high
as the record deficits of 2015/16, when overspends concentrated
in the acute hospital sector led to a £2.2bn shortfall, this time
they are spread across almost all provider types, including
acute, ambulance and mental health trusts. The Nuffield Trust
says this suggests a wider financial problem for policymakers to
tackle in the forthcoming spending
review.
Key findings from the analysis
include:
-
When the effects of an accountancy
change are removed, NHS providers ended the 2023-24 financial
year £1.2bn overspent, doubling the level of overspend the
previous year, after modest surpluses in 2020/21 and
2021/22
-
Acute hospital trusts still report
the deepest revenue deficits (overspends of 1.2% of revenues
overall), but the steepest declines since 2019/20 have been
in specialist, ambulance and mental health trust sectors,
with the latter two falling into the red after previously
reporting surpluses
-
Regionally, the deepest deficits
are in the North West (2.2% of revenues) and the Midlands
(1.5% of revenues) which, along with the North East and
Yorkshire have also seen the steepest declines in financial
health since 2022/23.
-
While not directly comparable with
full-year figures, the latest NHS England board report
revealed a £1.6bn deficit in the trust sector by the end of
December, suggesting the situation has worsened over this
financial year.
Commenting on the data, Nuffield Trust Senior Policy
Analyst Sally Gainsbury said:
“These findings reveal just how
fragile the financial health of the NHS is, which should sound
alarm bells over the Government's promise of extensive reforms
but with no new money to pay for
them.
The Government says it wants to shift
care out of hospital but also dramatically reduce waiting times.
With over 6 million people on an NHS waiting list – many of them
needing treatment in a hospital – it is not realistic to assume
expenditure on acute hospitals can just be switched to expand
other services such as community and mental health care. Those
services do need to be adequately resourced, but the funding for
that cannot be found by robbing Peter to pay
Paul.
“Particularly concerning is the
finding that NHS Trusts serving the most deprived populations
have been experiencing the steepest deterioration in their
financial health. It is well known that people living in poverty
have poorer health, more complex conditions and die younger. A
strategy that targets investment in these areas, rather than
allowing it to flow away from them, is needed to reverse these
worrying trends.”
Ends.
Notes to Editors
