NHS might “break” before it can start operating well again, warns spending watchdog

Growing pressure on the NHS in England is so intense that the system could “break” before it can start to recover and provide a sufficient service for patients, the public spending watchdog has said.

Increasing numbers of NHS organisations are not breaking even in their finances, said the National Audit Office (NAO) in a report on the financial management of the NHS.1 Future demand for healthcare must be curtailed or more funding needs to be pumped into the NHS, it warned.

Most of the chief financial officers of integrated care boards who responded to the NAO’s survey (15 of 19) said that their board’s underlying financial position had worsened in 2023-24, and seven of the respondents said that it had deteriorated significantly.

NHS England’s resource expenditure was expected to be £153bn in 2023-24, said the report’s authors, but the estimated combined deficit for the same year among the 42 integrated care systems was £1.4bn, nearly double the planned deficit of £720m for the year.

The NHS’s financial position was getting worse because of a combination of longstanding and recent issues, the report said, including failure to invest in the estate, inflationary pressures, and the cost of post-pandemic recovery. Significant funding for covid-19 and large scale pandemic related activities had now stopped, but the NHS was still dealing with the pandemic’s legacy.

“When we consider how the health needs of the population look set to increase, we are concerned that 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,” the authors wrote.

The NHS had delivered record levels of activity in many areas last year, but performance was below what patients should expect and the timeliness of NHS treatment was poor, they added. In addition, NHS productivity had declined.

The NAO recommended that NHS England should complete its annual planning processes with integrated care systems “well in advance” of the start of each financial year, and more needed to be done to intensify efforts to prevent more serious ill health to help manage current and future demand.