Troubling misalignment on NHS funding fuels short-termism and distrust

Responding to the Department of Health and Social Care Accounts 2022-23, Nuffield Trust Senior Policy Analyst Sally Gainsbury said:

"Today’s accounts for the year that ended in March 2023 are further evidence of the gap between the NHS as ministers would like it to be funded and the actual costs the health service faces.

"The headline figure is that the DHSC overspent the budget set for it by Parliament by just under £1bn, but in fact, the accounts reveal a somewhat more precarious situation as that figure is flattered by the inclusion of a £700m underspend on a technical accounting budget.

“Further still, the accounts show the NHS in England also kept hold of £1bn of funding the Treasury did not believe it had earned, as the funding was tied to the achievement of elective recovery targets, which the NHS missed.

“All in all, this suggests the DHSC spent around £2.7bn more than the Treasury had given it permission to spend in 2022-23.

“The misalignment between the growing costs the NHS faces this year and next and what ministers deem to be sufficient funding is troubling. There are doubtless improvements to be made about the way the NHS uses its resources and opportunities to increase the number of patients it treats. But those improvements will not be squeezed out of a health system that constantly has to go back to the Treasury and Parliament multiple times a year to seek top ups to an unrealistically low budget.

"Failure to properly fund the existing and unavailable cost pressures it faces today fuels short termism and distrust that are unlikely to result in a more sustainable health and social care system."