12 Some NHS providers are in surplus and some NHS providers are in deficit and have had to borrow to fund capital plans. In 2018-19, 124 out of 230 NHS providers (54%) delivered a surplus, which improves providers' cash balances. The current capital regime means that the availability of cash, and ability to spend capital without approval from the Department (for example, in those trusts delivering surpluses and foundation trusts), does not necessarily match where there are the most urgent capital needs. Therefore, unlike providers with healthy cash balances, NHS providers in deficit are likely to resort to borrowing funds to meet their revenue and capital spending plans (paragraph 3.3).
13 NHS providers have increasingly sold their assets to fund day-to-day activities. Government policy encourages public sector entities to sell assets where they no longer serve a public purpose. NHS providers can sell assets such as land to finance capital investment, and profits made can fund day-to-day spending. The overall proceeds from asset sales rose by 99% (from £222 million to £441 million) between 2016-17 and 2018-19. During this time the proportion of profit made on these sales also increased, which assists the revenue position, and meant that not all of these asset proceeds have been available to reinvest into capital (paragraph 3.4).
14 NHS providers owe the government £10.9 billion in interim revenue and capital debt. Cash shortages affect the ability of NHS providers to invest in new capital assets. Another source of funding is loans from the government. In 2018-19, the total outstanding debt from interim loans reached £10.9 billion (paragraph 3.6).