NHS capital expenditure and financial management Contents


The challenges presented by the COVID-19 pandemic have been severe and immense. Staff at the Department of Health & Social Care (the Department) and the NHS, including staff across the wider social care sectors, have worked incredibly hard to help the country deal with this crisis. We would like to place on record our thanks to all those involved for their collective effort in rising to these challenges.

As the response to COVID-19 continues, we are extremely concerned by the widely reported shortages of personal protective equipment (PPE) faced by NHS and care workers during the COVID-19 pandemic. Although the Department says it is committed to building up PPE stocks to meet longer-term demand, we are not convinced that it is treating the matter with sufficient urgency or that the procurement is robust enough. The Government needs to have a clear understanding of what is needed and how to distribute it—particularly in the more fragmented care sector. Our predecessor committee raised similar concerns about plans to ensure access to medicines and equipment in the social care sector in the event of a no deal Brexit. We intend to look at this in more detail in the coming months.

As part of the preparation for COVID-19 “to protect the NHS and save lives” the Government provided significant additional funding to the NHS, including writing off £13.4bn of loans. But this, and funding for specific staffing and other support, does not address the underlying issues of the NHS’s financial sustainability which we have been highlighting for some years.

As the NHS prepares to introduce more routine and planned services again, it does so in the context of a range of pre-crisis performance measures that it was struggling to meet. For example, on financial performance, all NHS trust and NHS foundation trust (trust) resulted in a combined net deficit of £827 million for 2018–19. Within patient services, performance against the 18-weeks waiting times standard in 2018–19 was at its worst since 2009–10, and the number of people on the waiting list had increased to an historical high of 4.23 million at the end of March 2019. The pandemic has highlighted the need for the NHS to continue its efforts to fundamentally transform services to ensure that it can meet rising demand in the future while maintaining vital service standards. In order to get to that position, the NHS needs to have a coherent plan for how it will function after the peak of the COVID-19 crisis.

The COVID-19 crisis should not be used as an excuse not to address long-standing issues which we have highlighted in our previous reports such as workforce shortages, coherent and aligned capital investment strategies, tackling trust deficits and at the same time, remaining ready to deal with any future peaks in the pandemic.

We will be closely watching the day to day financial performance of the NHS as well as its COVID-19 preparedness to ensure that both sets of expenditure are properly accounted for.

Published: 8 July 2020