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Also available is the joint report from the National Audit Office & the Audit Commission "Financial management in the NHS" (HC 1092-I, ISBN 0102938156) arising from their work on the NHS accounts
This joint report was prepared by the National Audit Office and the Audit Commission, and contains the findings from the NAO's audit of the NHS summarized accounts and the Audit Commission's appointed auditors' work on the 2003-04 accounts of individual NHS organizations. The report outlines the financial issues facing individual NHS organizations, with an overview of the effects of these issues at national level and how this will affect the national health economy. In 2003-04 the NHS spent a total of £63 billion, with expenditure costs in the NHS rising by 7.3 per cent each year. This will increase the costs to £76 billion for the 2005-06, and £93 billion for 2007-08 periods. Alongside this increasing expenditure, the Government has set out various reform plans, including the establishment of the NHS Foundation Trusts, new staffing contracts, the development of the information technology infrastructure, and the way hospitals are funded. In the Summary of the financial performance for 2003-04 period, the number of bodies failing to achieve a financial balance had increased, along with an increase in the number of bodies with significant financial deficits. In all, 106 NHS bodies failed to achieve an in-year financial balance, and 14% of the Primary Care Trusts failed to keep expenditure within their resource limit, also a small number of NHS bodies are struggling to manage large deficits. The report advocates four key themes for the improvement of financial management: the role of the Board - who should display better oversight and improve their financial acumen; forecasting - NHS bodies should continually test whether cost savings programmes are realistic, and take account more effectively for risk factors in their financial planning, as well as set realistic budgets at the beginning of the year; earlier preparation of accounts - improvements in financial reporting, and the provision of financial information throughout the year should closely reflect the standard and range of information required in the annual accounts; transparency - that boards, managers, stakeholders would benefit from clarity in the way the accounts are organized, and that the amount of financial support received by the trusts should be clearly stated. With the introduction of Payment by Results and the use of independent healthcare providers the income received by NHS Trusts is no longer certain. So overall improvements in their financial forecasting and modeling, with NHS Trusts in particular developing their commercial financial skills, would be beneficial especially if they intend to become foundation trusts.
This report examines in detail the 2004-05 revenue situation of NHS organisations and considers key financial management and reporting issues facing the NHS both currently and in the future. Jointly prepared by the National Audit Office and the Audit Commission, the report incorporates the findings of their audit work on the NHS summarised accounts, the consolidated account of NHS foundation trusts, the Department of Health's resource account and the accounts of individual NHS organisations, as well as the unaudited NHS revenue out-turn for 2005-06 as reported by the Department of Health and Monitor. Findings include that in 2004-05, the Department reported a deficit across the NHS as a whole for the first time since 1999-2000, with an aggregate overspend for all NHS bodies of £251.2 million, with 171 out of 615 bodies recording a deficit or overspend, with 68 out of 259 NHS trusts failing to break even, and with 90 out of 303 primary care trusts exceeding their revenue resource limits.
This NAO report is based on an examination of the 23 summarised accounts for the NHS in England for the year 2002-03, covering strategic health authorities, NHS and primary care trusts, charitable trusts, special health authorities and the Dental Practice Board. Unqualified audit opinions are given on all of the underlying organisations, except seven special health authorities and the Dental Practice Board where the audit opinion has been qualified on the grounds of regularity. It is found that these eight bodies failed their statutory duty to remain within resource limits set for them by the Secretary of State. Overall, in 2002-03, the Department of Health successfully met its target of ensuring that financial balance was achieved in aggregate across the 607 individual NHS organisations, and the NHS as a whole reported an underspend of pound]96 million. However, the report highlights the fact that 51 (or eight per cent) of organisations suffered significant deficits (the biggest of which amounted to nearly pound]45 million) which, if not matched by surpluses elsewhere, may put at risk the achievement of overall financial balance of the NHS.
In continuation of HC no. 742 of session 2006-07
In continuation of HC no. 1092-II of session 2005-06