The NHS had a surplus of £2.1 billion as a whole in 2012-13, figures from the National Audit Office (NAO) show.
The research said financial performance for the NHS appears stronger in 2012-13 than it did in 2011-12, although it has suffered a period of period of little to zero growth in funding for NHS services over the last two years and a period of significant structural change. However, there are signs of "increasing pressure" it added.
The NAO's research also identified a "substantial gap" between the trusts with the largest surpluses and those with the largest deficits.
When primary care trusts (PCTs) and strategic health authorities are also included, there is a similar variation between local health economies. The NAO found some regions were in overall surplus, while others were not. The differences are most marked in London, where PCT clusters in parts of west London had some of the largest surpluses, whereas outer north-east London had one of the largest deficits.
As in 2011-12, NHS trusts in difficulty once again relied on cash support from the Department of Health or non-recurrent local revenue support from strategic health authorities and primary care trusts.
The report warned it is hard to see how this approach would be a sustainable way of reconciling growing demand with the scale of efficiency gains required within the NHS, and that, without major change affecting some providers, the financial pressure on them would only get more severe.
At the end of 2012-13, there were still 100 NHS trusts that had not achieved foundation trust status. The NHS Trust Development Authority no longer expects all NHS trusts to achieve the original target of gaining foundation trust status by March 2014. Nonetheless, the risk that NHS trusts will not maintain their planned trajectory to foundation trust status increased substantially in 2012-13. The risks are greatest among acute trusts.
