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The first private company awarded a franchise to run an NHS hospital has made improvements in some clinical areas, but big financial challenges remain.

This update was prepared for the Public Accounts Committee. It outlines the government’s approach to tackling obesity in England.

This memorandum was prepared by the National Audit Office at the request of the Public Accounts Committee. It looks at the progress made since the government published its adult autism strategy in March 2010.

The NHS delivered a £2.1bn surplus in 2011-12 but there is some financial distress in NHS trusts with some very large deficits.

Diabetes care in the NHS is poor, with low achievement of treatment standards, high numbers of avoidable deaths and annual spending reaching an estimated £3.9 billion.

Since 2005, when the Department of Health introduced its National Service Framework for Long-term Conditions, people with neurological conditions have had better access to health services; but key indicators of quality have worsened. The Department does not know what the Framework and additional spending of nearly 40 per cent have achieved.

The Care Quality Commission had a difficult task in establishing itself and has not so far achieved value for money in regulating the quality and safety of health and adult social care in England.

This memorandum has been prepared for the Health Committee to support its review of public expenditure. It sets out how the NHS, supported by the Department of Health, plans to deliver efficiency savings of up to £20 billion by 2014-15.

Many NHS trusts need to tackle a range of financial, quality and governance issues if they are to meet the standards required of them to become self-governing foundation trusts by 2014. The Department of Health and the NHS will now have to decide how they will deal with those facing the most severe problems.