On 29 January 2025, the Health and Social Care Committee held an evidence session about the work of NHS England (NHSE).

Amanda Pritchard, Chief Executive Officer of NHSE; Julian Kelly, Deputy Chief Executive Officer & Chief Financial Officer of NHSE; and Duncan Burton, Chief Nursing Officer for England and Executive Director of NHSE attended the session.

Health and Social Care Committee members questioned witnesses on their response to findings in the recent report by the Public Accounts Committee (PAC) on NHS financial sustainability, which was a key topic during the session.

The PAC report concluded that there is a lack of fresh thinking and decisive action within NHSE and the Department of Health and Social Care (DHSC).

It also underlines that NHSE and DHSC blame the NHS’ “poor financial position” on external factors, such as the covid-19 pandemic and inflation, but states that there are some well-known issues that are within officials’ control.

“For example, DHSC and NHSE have repeatedly failed to provide information about budgets in good time to local NHS systems and indeed in some cases not until months after the start of the financial year,” the report states. “This disregard for basic principles of sound financial planning is hampering NHS systems’ ability to deliver services for their local areas.”

The report makes recommendations to the UK Government based on its three big shifts within the health and social care sector: from hospital-based to community care; from analogue to digital; and from treating ill health to prevention.

These suggestions include ensuring that NHSE spends more funding, year on year, in the community and giving local systems the required flexibility and autonomy to direct funds in the right areas.

However, the NHSE responded, stating that the report features a “flawed” understanding of how the NHS and the government’s financial processes work and that it contains some factual inaccuracies.

At the Health and Social Care Committee evidence session, Layla Moran MP, Chair of the Committee, directed some questions to Amanda Pritchard about the PAC report and NHSE’s response.

“NHS England is absolutely not complacent about productivity, and it is completely wrong to suggest otherwise,” Amanda said at the session.

She noted that while NHS productivity is now improving ay double the rate it was pre-covid, there is still a gap from where the NHS is now to where it was pre-covid.

“Far from being complacent about that, we have been repeatedly open about the challenges and our plans to address them, whether that is in committee appearances, in the media or in every public board meeting that we have. We will be publishing further improvement measures in planning guidance tomorrow—or hopefully tomorrow.”

Contrary to the PAC’s claim, Amanda affirmed that there is “no shortage of fresh thinking in the NHS”. She added that the upcoming NHS 10-year plan will be key to driving forward innovation, but that nobody is waiting for the plan in order to start with delivering reform. She pointed to the recent elective care reform plan as an example, where care will be delivered closer to home in community diagnostic centres.

On earlier budget allocations, Amanda exclaimed that everyone in the NHS would like to see earlier budgets, as it is better for NHS staff to know their budget allocations and operational priorities for the financial year ahead as soon as possible. However, she said that while the NHS tries to give early informal indications of what people should expect, the NHS needs to know what its budget is to be able to give a budget.

“It is worth saying that NHS England’s planning guidance for the NHS, alongside ICB financial allocations, is subject to cross-government clearance, and that is an important principle,” Amanada said at the evidence session.

“It is important because the NHS budget is billions of pounds and therefore—understandably—has to be subject to proper engagement with ministers. That is not just in the Department of Health; that has to be across government, because these are really difficult decisions for government. But as soon as we have had cross-government clearance, we have released planning guidance that same day—certainly in the last two years—and we plan to do so again, hopefully tomorrow.”

Layla also noted that NHSE saying that the PAC’s report is full of factual inaccuracies is a “bold claim”.

Amanda stated that NHSE will write to the PAC to go through the factual issues. She also committed to writing to the Health and Social Care Committee as well when NHSE formally responds to the PAC on its factual inaccuracies.

Reacting to the evidence session, Layla Moran MP said: “Following today’s report by the Public Accounts Committee, this morning’s evidence session was an opportunity for NHS leadership to prove their drive and dynamism.

“Regrettably, we were left disappointed and frustrated.

“We had hoped for a sharpness in witnesses’ responses but were exasperated by the lengthy and diffuse answers that were given to us and will be writing to them to seek the clarity that we expected to hear in the evidence session.”