Trusts in deficit

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Part of The NHS in a nutshell

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  • Posted:Thursday 29 November 2018

Data: Data refers to number of trusts in existence on 31 March each year ie, changes to the number of trusts during the year due to mergers, separations, or dissolutions are not counted.

Source: The King's Fund analysis of data from Monitor, NHS Trust Development Authority and Department of Health (2009/10–2011/12), National Audit Office (2012/13–2015/16), NHS Improvement (2016/17, 2017/18, 2018/19).


NHS Improvement report quarterly financial data for 234 NHS trusts and foundation trusts providing ambulance, hospital, community and mental health services in England. 

In 2010/11, just 5 per cent of these providers overspent their annual budgets. By 2015/16, two-thirds of trusts (66 per cent) were in deficit as the slowdown in NHS funding took its toll. 

The 2015 Spending Review provided additional funding for the NHS in the form of a £1.8 billion annual ‘Sustainability and Transformation Fund’. This funding contributed to a fall in deficits, but 44 per cent of trusts still overspent their budgets in 2017/18, with acute hospitals accounting for just under 90 per cent of all providers in deficit. The NHS provider sector as a whole ended 2017/18 with a deficit of £960 million.

The national planning guidance for the NHS states that £2.45 billion of funding support will be available to NHS trusts in 2018/19 through a ‘Provider Sustainability Fund’ which will replace the Sustainability and Transformation Fund. This guidance also states an ambition that the NHS provider sector will financially balance in 2018/19.

However, at the halfway point in 2018/19 NHS trusts are forecasting to end the year £558 million in deficit. 

For an in-depth analysis of NHS finances, see our  Quarterly monitoring reports


2018/19 data refers to the planned number of providers in surplus/deficit, based on data from the first six months of the 2018/19 financial year.