Introductory guide to NHS finance

What is the introductory guide to NHS finance?

The HFMA’s introductory guide to NHS finance is a comprehensive guide of how the NHS finance regime works, as well as the wider landscape in which it operates. It is designed to give readers a solid grounding in – and practical understanding of – all key aspects of NHS finance and will provide contextual background that helps explain how the NHS has developed over the years.

The guide is a vital resource for anyone who wants to understand NHS finance and get the maximum value from NHS resources. It will be of interest to finance staff at all levels, non-executive directors, clinicians, budget holders and general managers. Indeed, anybody who wants to know more about how money works in the NHS; be they at the beginning of their career, moving to a new role, or just interested to understand the impact of recent changes.

A full list of chapters can be found below.

The guide has been produced with the support of One NHS Finance. It is freely available online.

Latest version

This is a time of considerable change across the NHS, and the guide has been updated to reflect policy and organisational changes that have taken place since the previous edition. Each chapter includes links and references to the key documents as well as to the latest issued guidance and directions. The closing chapter includes a comprehensive glossary of terms.

The HFMA is looking to continually improve and develop the guide, and if you have any comments, the HFMA team would like to hear from you – please email: [email protected].

How do I access the guide?

The guide is freely available as an electronic document online.

Unlike previous editions, the guide is not available as a printed publication. We have taken this approach to increase the availability of the guide and reduce the environmental impact of production/distribution.

Chapter list - updated January 2024

1. Introduction
2. Background and context – how we got to where we are today
3. NHS finance – the role of the centre
4. NHS finance – the role integrated care systems
5. NHS finance – the role of integrated care boards
6. NHS finance – the role of primary care
7. NHS finance – the role of secondary and tertiary care providers
8. NHS finance – the role of local authorities, health and wellbeing boards and HealthWatch
9. How the NHS is regulated
10. Governance – how NHS organisations are structured and run
11. How NHS bodies demonstrate financial accountability
12. How the NHS is financed
13. Revenue planning and budgeting
14. Capital funding, planning and accounting
15. Commissioning
16. How providers of NHS services are paid
17. Costing
18. Value and efficiency
19. NHS charitable funds
20. Health and social care in Northern Ireland
21. The NHS in Wales
22. The NHS in Scotland 
23. Glossary of terms