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Full report: Funding healthcare: Making allocations to local areas

Prioritising the financial stability of local health economies has resulted in the Department of Health and NHS England making very slow progress towards allocating local commissioners of healthcare their fair share of funding, according to the National Audit Office.

A total of £79 billion has been allocated to local commissioners in 2014-15, equivalent to £1,400 per person. Following the reforms to the health system in 2013, the three different sets of commissioners (clinical commissioning groups, NHS England area teams and local authorities) receive separate funding allocations to commission services for their local populations.

Yesterday’s report says that the approach of the Department and NHS England to allocating funding is generally sound. Decisions are informed by independent, expert advice and are increasingly transparent. However, the tighter financial position in recent years has made it difficult for the Department and NHS England to allocate funding in a way that achieves the twin aims of fairness and financial stability.

There is wide variation in the extent to which the funding received by local commissioners differs from their target allocations, which are based on relative need. In 2014-15, over three-quarters of local authorities, and nearly two-fifths of clinical commissioning groups, are more than five percentage points above or below their fair share of funding per person. Funding for clinical commissioning groups varies from £137 per person below target to £361 per person above target.

The Department’s and NHS England’s decisions about how quickly to move commissioners towards their target funding allocations are not based on evidence. The decisions are essentially a matter of judgement about the changes that local health economies can tolerate without being financially destabilised and about the effects of organisations not receiving their target allocations. Exploratory analysis by the National Audit Office suggests that local bodies may be able to tolerate changes in funding that are more significant that those currently allowed.

There is a clear relationship between the financial position of clinical commissioning groups and their distance from target funding allocations. Of the 20 groups with the tightest financial positions at 31 March 2014, 19 had received less than their target allocation. And, of the 20 groups with the largest surpluses, 18 had received more than their target allocation.

Local populations are taken into account when calculating target funding allocations, and NHS England has taken steps to address the risk that population changes may jeopardize financial stability. NHS England uses GP lists to estimate population size. Although this makes target allocations more responsive to changing needs, there is limited assurance about the accuracy of the data, with a tendency for lists to be inflated.

“Funding allocations have reflected, among other factors, a desire not to upset local health economies by taking funding away or even by increasing it by less than inflation. This has significantly slowed progress towards a fair distribution where funding fully reflects need across the country.The Department and NHS England need to consider carefully whether this approach is fast-moving enough to sustain hard-pressed local areas in the next few years.”

Amyas Morse, head of the National Audit Office, 11 September 2014

Notes for Editors

£79.1bn  Total funding allocated to local healthcare commissioners, 2014-15

£1,371 Average funding per person for locally commissioned healthcare, 2013-14

-£137 to +£361
Range in how far clinical commissioning group allocations are from their fair share of funding per person, 2014-15

1.2 per cent Annual increase in funding for health after inflation in the four years to 2014-15

£64.3 billion
Funding allocated to clinical commissioning groups, 2014-15

£1,076 to £1,845 Estimated range in funding per person for locally commissioned healthcare, 2013-14

£0.37 billion Used to move under-target commissioners towards their fair share of funding, 2014-15

19 Of the 20 clinical commissioning groups with the tightest financial positions at 31 March 2014 had received less than their fair share of funding

1. Press notices and reports are available from the date of publication on the NAO website, which is at www.nao.org.uk. Hard copies can be obtained by using the relevant links on our website.
    
2. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Amyas Morse, is an Officer of the House of Commons and leads the NAO, which employs some 820 employees. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of £1.1 billion in 2013.