NHS England: Where's the money going?

NHS England won't publish data on where it spends its money, including to private companies. What happened to the promised transparency?

Tamasin Cave
11 November 2014

The new NHS is big on transparency.  Tim Kelsey, the senior official overseeing care.data and all things digital in the NHS yesterday announced that transparency is “the most important innovation in health”, adding rather dramatically: “The closed world is the enemy of good care." Jeremy Hunt has said greater openness makes the NHS ‘safer for patients’.

NHS England chief, Simon Stevens, has gone as far as claiming that NHS England “has set new standards for openness and transparency in all of its operations, compared with what went before.”

The rhetoric is clear. But how transparent is the new NHS? Not very, it turns out.

NHS England is one of the only (if not the only) government body that does not regularly publish how it spends our money. Given that they are stewards of the NHS's £95 billion budget, this matters.

We know that roughly two thirds of its budget goes to local groups to buy care, with the rest spent centrally by NHS England on mainly specialised and primary care services. But unlike other government agencies, NHS England has never published details of where its money is going.

Since May 2010, government departments and their agencies have published monthly reports on all their spending over £25,000. This was so we could all become 'armchair auditors' and hold the government to account for how it spends taxpayers money.

This meant that we could see, for example, the amount of money the Department of Health paid to management consultants; how much was finding its way to companies with strong political links; and whether unpopular policies were draining resources.

Other NHS bodies, like the regulator Monitor, Public Health England, and the Health and Social Care Information Centre regularly tell us how they are spending our money. But, in the two years since it was established, NHS England has never once published this data.

When questioned about this anomaly, NHS England initially pointed to its accounts (a different set of figures, which do not give a breakdown of how it spends its budget). Its press office then said it was ‘working towards’ publishing its receipts, and that these would be available in September. This then slipped to ‘by the end of October’. Bonfire night has now come and gone and still no sign.

We are repeatedly warned about the NHS’s dire financial situation – of hospitals facing bankruptcy, services being rationed, and the need for massive savings to be made if the NHS is to survive. But first, we need to see that the stewards of the NHS budget are spending with care and where it matters. 

A petition has been launched (by Spinwatch on 38Degrees) to encourage Simon Stevens to follow through on his promise of transparency and make public how it spends our money. Sign it here.

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