Financial management in the NHS: seventeenth report of session 2006-07, report, together with formal minutes, oral and written evidence

Spending on the NHS is the fastest growing area of public expenditure, with a budget for 2004-05 of £69.7 billion, rising to £76.4 billion in 2005-06 and £92.6 billion in 2007-08. Despite the increased resources, the NHS reported an overall deficit of £251 million (including Foundation Trusts) in 2004-05, the first time since 1999-2000 that the NHS as a whole had overspent. In 2005-06, the overall deficit increased to £570 million, with a rise in both the number of NHS organisations (Strategic Health Authorities, Primary Care Trusts, NHS Trusts and NHS Foundation Trusts) reporting a deficit and the proportion of those bodies reporting a deficit. Following on from a report (HC 1059-I, session 2005-06; ISBN 9780102938159) published in June 2006, jointly prepared by the National Audit Office and the Audit Commission, the Committee's report examines three main issues: the factors that led to the deficits, the impact on the organisations involved, and the steps taken to recover the deficits. Amongst its findings, the Committee concludes that there are a number of reasons why NHS bodies are in deficit, with most organisations in deficit tending to have had a deficit the previous year. Bodies already in deficit looking to turn their financial position around can be disadvantaged as they are expected to recover that deficit in the next financial period. The NHS has been under significant financial pressure to meet the costs of national pay initiatives which the Department of Health had not fully costed, and as some NHS bodies have coped better than others in managing these cost pressures, this indicates that the standard of financial management expertise varies across the NHS, as does the level of clinical engagement in financial matters.