Finance, Commissioning and Contracting Handbook

NHS England | August 2019 | Finance, Commissioning and Contracting Handbook

NHS England have published the Finance, Commissioning and Contracting Handbook for the NHS England Comprehensive Model for Personalised Care. It aims to provide finance, commissioning and contracting staff with the information required to implement personalised care locally.

Finance, Commissioning and Contracting Handbook

How Does UK Healthcare Spending Compare With Other Countries?

This briefing provides an analysis of UK health care spending relative to comparable countries, such as the G7 group of large developed economies or member nations of the Organisation for Economic Co-operation and Development (OECD) | Office for National Statistics


It finds that the UK spent an average of £2,989 per person on health care in 2017 which is the median for OECD countries. However, of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).

Other key findings:

  • As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
  • The UK’s publicly funded NHS-based health system contributes to the UK having one of the highest shares of publicly funded healthcare (79%) in the OECD.
  • In 2017, the UK spent the equivalent of £560 per person on health-related long-term care, which was less than most other northern or western European countries, but a similar amount to France (£569) and Canada (£556).

Full document: How does UK healthcare spending compare with other countries?
An analysis of UK healthcare spending relative to comparable countries, using data produced to the international definitions of the System of Health Accounts.

Brexit: the implications for health and social care

Brexit has major implications for health and social care in England. In this ‘long read’, the Kings Fund looks at some of the latest developments that could impact the health and care system in England.


The deadline of 29 March 2019, set when Article 50 was triggered, is rapidly approaching but many important issues are still to be resolved. Brexit has already had an impact, especially on the recruitment and retention of EU nationals in some parts of the workforce which is contributing to shortages of key staff. In addition, the ongoing debate in parliament and uncertainty about whether a deal can be agreed mean considerable work has gone into preparations for a no-deal Brexit.

The Department of Health and Social Care has published guidance for organisations to prepare contingency plans and has established a national operational response centre to lead on responding to any disruption to the delivery of health and care services.

This long read, originally written by Helen McKenna and published on 13 December 2017, has been updated by Beccy Baird on 22 February 2019 and explores the following topics:

  • Staffing
  • Accessing treatment
  • Regulation
  • Cross-border co-operation
  • Funding and finance

Full detail at the Kings Fund

NHS financial sustainability 

National Audit Office | January 2019 |  NHS financial sustainability

The National Audit Office (NAO) has produced its annual report into the financial sustainability in the NHS. It concludes that the existence of  substantial deficits in some parts of the system, offset by surpluses elsewhere coupled with growing waiting lists and year-on-year increases in waiting times, does not paint a picture that is sustainable. 


The current funding flows in the NHS are complicated and do not support partnership working, integration and the better management of demand. Trusts also told the NAO that Sustainability and Transformation Fund payments made by NHS England have encouraged trusts to prioritise short-term gains over long-term sustainability which also resulted in reduced collaboration with other local bodies.

The NAO has made a number of recommendations to the Department, NHS England and NHS Improvement to ensure additional funding is spent wisely. This includes testing whether local plans to manage demand are realistic; ensuring key risks to delivery of the long-term plan are identified; and developing a sustainable long-term plan to support trusts in severe financial difficulty (Source: NAO).

Full report – NHS financial sustainability

Summary – NHS financial sustainability

ePub – NHS financial sustainability

NHS financial sustainability [press release]

How do you ensure robust system risk management arrangements?

HFMA |December 2018 | How do you ensure robust system risk management arrangements?

HFMA- the professional body for the healthcare finance profession- has issued its latest briefing in its series on system governance. The briefing explores how to support robust system risk management arrangements.

Each health and care system is different and one size does not fit all. However, there are some common essential ingredients to developing good system-wide finance and governance arrangements. This briefing considers the key challenges, shares experiences from across the country and draws out the top tips to help readers as they think about how to develop their own governance arrangements. governance elements
Image source:

The briefing is intended to be particularly helpful for health and care system leaders, finance officers, non-executive directors and lay members (Source: HFMA).

The briefing can be downloaded from HFMA

Of interest:

How do you align resource plans across the system?

How do you support effective system decision-making?

Mental health funding squeeze has lengthened waiting times, say NHS finance leads

The King’s Fund | December 2018 | Mental health funding squeeze has lengthened waiting times, say NHS finance leads

Eight out of ten NHS trust finance directors say that funding pressures have led to longer waiting times for people who need mental health treatment, according to The King’s Fund’s latest quarterly monitoring report.


New analysis for the report also shows that despite NHS England meeting its commitment to increase its investment in mental health, nearly a quarter of mental health trusts recorded a reduction in income between 2016/17 and 2017/18. An analysis of mental health trusts’ financial accounts carried out for the report found that, while mental health trusts as a whole reported an overall increase in funding, 21 per cent recorded a reduction in income last year, up from 13 per cent the previous year.

The report is published ahead of NHS England’s long-term plan, which was recently delayed amidst political turmoil over Brexit and is now expected early in the new year (Source: The King’s Fund).

Read the full press release from The King’s Fund