NHS England reported a full-year 2025/26 system deficit of £813m including deficit support funding, falling to £563m once withheld support and delegated specialised commissioning were counted 1. A system here means an integrated care system, one of the regional bodies that holds the NHS budget for a population and divides it between hospitals, community services and primary care. Fifteen finished the year in deficit, down from seventeen the year before.
Then the distribution. The five worst systems accounted for 88% of the entire deficit 2. Take those five out and the rest of the NHS in England is close to balance. That concentration is the finding, and it inverts how the number is usually read. A sector total that improves year on year can coexist with a small number of places where waiting lists lengthen, vacancies go unfilled and capital projects stall, because the money to close a large local gap has to come from somewhere inside that same local budget.
This run also settled a question the register did not have an answer to: how often this ledger reports. NHS England publishes a "Month N financial position" long-read each month, tied to a dated board or committee paper, with the year-end figure landing roughly nine weeks after the financial year closes 3. The next figure to watch is the first monthly position for 2026/27, due around August.
