National Health Service Finances

Briefing Paper

The National Health Service is one of Britain’s most popular institutions. It is also a very large institution, spending over £100billion a year and employing over a million people. However, the organisation of the National Health Service is often seen to be complex, its financial management arrangements difficult to understand and the financial challenges that it faces numerous. It is often said that the National Health Service is in ‘crisis’. The purpose of this briefing paper is to provide an overview of the finances of the National Health Service in England and of the financial challenges that are faced and to provide some commentary.

The briefing paper includes sections on:

  • Health Service Structures in England (National Health Service England, Clinical Commissioning Groups, Health & Wellbeing Boards, Public Health England, Vanguards, Regulation, Primary & Secondary Care)
  • National Health Service Trusts (Foundation Trusts, Acute Trusts, Ambulance Trusts, Mental Health Trusts)
  • Example: Cumbria Partnership National Health Service Foundation Trust Accounts
  • Funding National Health Service England
  • Comparative Spending
  • Demand for Health Care and the Need to Spend
  • Integration with Public Health and Adult Social Care
  • Challenges for the National Health Service (Brexit and International Relations, Inflation and Supplies from outside the United Kingdom, Recruitment and Retention)

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While it is usual to refer to the ‘National Health Service’ there are, in fact, four different National Health Services in the United Kingdom; with the United Kingdom government managing National Health Service England and the devolved administrations in Northern Ireland, Scotland and Wales managing the National Health Service in those countries. There are therefore differences between the four jurisdictions. Funding is linked in that the expenditure on National Health Service England by the United Kingdom government feeds into the ‘Barnett formula’ that determines funding for the devolved administrations that they can use to fund the National Health Service in those areas.

Pinderfields Hospital, Wakefield, West Yorkshire.



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