Understanding how NHS organisations manage their financial performance is critical. Drawing on the accounts data of all commissioning and provider bodies across the English NHS, this project aims to establish the Nuffield Trust as a centre of expertise in the analysis of spending and productivity.

The NHS in England is going through a period of unprecedented financial challenge. The difficult decisions facing health and social care services make it more crucial than ever to understand how the NHS spends money, and to identify areas of success and failure in financial performance.

This project looks to provide detailed annual analysis of NHS financial performance across acute hospitals (both NHS and foundation trusts), other providers, and commissioning bodies. The programme is supported by PwC and McKesson, it aims to establish the Nuffield Trust as a centre of expertise in the analysis of spending, budgets and productivity.

It will use past figures and provisional data to track the history of spending in recent years and productivity in the English NHS, and will assess the financial performance of trusts in aggregate, individually and by area.

We assess the overall financial position of the NHS in England and identify financial pressures

The questions this project will aim to answer include:

  • How have NHS organisations changed the way they invest, spend and employ in recent years?
  • Have government’ policies and budget priorities been able to influence patterns of spending?
  • Are changes in spending occurring which might have implications for maintaining and improving quality of care?
  • Are there current or emerging weaknesses in the financial position of trusts, and if so what are their underlying causes?

The research will be based on the detailed accounts submitted by NHS and Foundation trusts, primary care trusts (PCTs) and clinical commissioning groups (CCGs), to the Department of Health and Monitor (please note that SHAs and PCTs are formally abolished as of March 2013).

Although these accounts are consolidated annually and available to the public, the central bodies do not conduct detailed historical analysis.


Programme outputs

Into the red? The state of NHS finances

The report: Into the Red? The State of the NHS' Finances (published July 2014) examines financial performance commissioner’s income and expenditure and the experience of NHS providers of secondary care in the years 2010/11 to 2013/14. It explores patterns in PCT’s income and expenditure, looking at the experience of NHS providers of secondary care (NHS trusts and Foundation trusts).

At the time of publication, data from the latest audited accounts and provisional outturn data from NHS England, Monitor and NHS Trust Development Authority (NHS TDA) was included in the report.

It measures changes in spending, the use of non-NHS providers on different sectors and how these align with Government policies across NHS and foundation trusts. It identifies financial pressures and analyses deficits and surpluses from 2011 to 2014 by type of acute trusts and regions.

The anatomy of health spending 2011/12

The first output from this programme examines financial performance and productivity in the years 2003/04 to 2011/12. The anatomy of health spending 2011/12: a review of NHS expenditure and labour productivity (Nuffield Trust, March 2013) describes patterns in PCT and acute trust spending through the reforms of the Blair Government and the start of austerity.

It measures changes in spending on different sectors, and how these align with Government policies to bring care closer to patients. Across NHS and foundation trusts, it analyses deficits and surpluses across time and regions.

Project outputs

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