NHS England » Financial performance update

Organisation objective

NHS Mandate from Government

Action required

The Board is asked to note the update on the month 12 financial outturn for 2023/24 for the NHS.

Month 12 financial outturn 2023/24

Headline revenue position

1. The figures in this report are based on the draft accounts position and are therefore subject to adjustment during the external audit period.

2. Table 1 below sets out the revenue expenditure position to the end of March 2024. The bottom-line position is shown on a non-ringfenced revenue departmental expenditure limit basis, which is the key measure for financial performance. The NHS has also complied with funding limits in all areas.

3. Overall, the total expenditure for the NHS of £171.0 billion is £30 million (0.01%) under plan. As set out in previous board reports there has been significant disruption to the plans set at the start of the year including:

industrial action where Government funding injected £1.7 billion to cover the disruption to services and costs of covering strikes
pay settlements averaging 5.5% for doctors and nurses which increased funding and costs by £2.9 billion and which was not included in planning figures
inflation which on a gross domestic product deflator measure averaged 6.5% compared to the Government’s funding assumption of 3.2% when setting the NHS budget. In practice non-pay inflation experienced by the NHS is higher for the basket of goods consumed. This has added cost pressures of around £1.4bn over the year compared to plans.

4. In that context systems are just over 1% adverse to the plans originally agreed at the start of the year. NHS England realised around £220 million of savings through the first year of its transformation programme that were rolled into allocations at the start of the year to be reinvested in frontline services. In addition, further savings in central costs have been realised during the year, along with tight management of centrally funded programmes and reserves to help cover the financial pressures in systems.

Month 12 financial outturn 2023/24 table

Table 1 - Financial outturn at month 12 2023 to 2024

Capital expenditure

5. Providers spent £7,263 million on capital schemes in the year to 31 March 2024 (excluding IFRS16 expenditure relating to lease assets), representing 99.9% of their full year budget (compared to 99.0% at the same stage last year). The Department of Health and Social Care (DHSC) provider capital budget for 2023/24 (excluding funding for leases) is set at £7,267 million against which providers delivered an underspend of £4 million.

6. IFRS16 capital expenditure by providers in the year to 31 March 2024 was £729 million against a DHSC budget of £837 million, an underspend of £107 million.

7. Through capital programmes this year we have completed 14 elective hubs, completed a further 9% of mental health dormitory eradication projects, and implemented electronic patient records in 11 trusts, plus completing a number of community diagnostic centres and progressing new hospital facilities.