The NAO has reported on the financial sustainability of the NHS in England for many years. Our last report, published in February 2020, concluded that the short‑term fixes put in place to manage resources in a constrained financial environment were not sustainable. It said that to bring about lasting stability the NHS needed a financial restructuring programme, not just a recovery programme.


This report will examine the extent to which the NHS in England is managing its resources well day-to-day, while also looking at the steps it is taking to enable longer-term financial sustainability. Issues we will consider include:

  • whether the NHS is living within its means following the COVID-19 pandemic
  • NHS England’s systems and processes for financial management
  • NHS England’s use of resources to recover NHS services
  • the Department of Health & Social Care and NHS England’s strategy to improve longer-term NHS financial sustainability

If you would like to provide evidence for the study or further information, please email the study team on, referencing the study title in the subject line. The team will consider your message, but please note that due to the volume of information we receive we may not respond to you directly.

NAO Team

Director: Tim Phillips
Manager: Katie Sargeant