Auditor’s Annual Report 2025/26

1. Introduction

Our Auditor’s Annual Report (AAR) summarises the work that we completed for West Midlands Ambulance Service University NHS Foundation Trust (the Trust) for the year ended 31 March 2026.

The Trust is responsible for keeping proper accounts and proper records in relation to the accounts and for maintaining an appropriate system of internal control. It is also responsible for the preparation of annual accounts for each financial year. Such accounts must present a true and fair view and comply with the requirements of enactments that apply to them.

2. Executive summary

Results from the audit of the financial statements

We completed our audit of the financial statements and issued our unqualified audit opinion on 22 June 2026. See section 3 for more details.

We also completed component auditor procedures, in line with the National Audit Office group auditor instructions. We had no matters to report from this work.

Results on our work on other matters and the Annual Governance Statement

We completed our review of other matters and the Annual Governance Statement in line with our issuing of the audit opinion on 22 June 2026.

Results from our work on VFM arrangements

Under the Code, we are required to consider whether the Trust has put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2026.

Our conclusions are summarised below. See sections 4-8 for more details.

The Trust is also responsible for putting in place appropriate arrangements to secure the economy, efficiency and effectiveness in its use of resources and to maintain an effective system of internal control that supports the achievement of their policies, aims and objectives whilst safeguarding and securing value for money from the public funds at their disposal.

The scope of our work is set in accordance with the National Audit Office’s Code of Audit Practice (the Code) and the International Standards on Auditing (ISAs) (UK). Our work is planned to provide a focused and robust audit. We are responsible for and are required to provide an independent opinion as to whether the financial statements:

• give a true and fair view of the financial position of the Trust at the year end and of the Trust’s expenditure and income for the year then ended;
• have been properly prepared in accordance with international accounting standards as interpreted and adapted by the Department of Health and Social Care’s Group Accounting Manual; and
• have been prepared in accordance with the requirements of the National Health Service Act 2006.

We are also responsible for:

• reviewing the Annual Governance Statement to ensure it complies with the guidance issued;
• ensuring the parts of the Remuneration and Staff Report to be audited have been properly prepared; and
• reviewing the Trust’s arrangements in place to secure economy, efficiency and effectiveness in its use of resources. The Code requires us to report on the Trust’s arrangements under three specified reporting criteria:
  • Financial sustainability – how the Trust plans and manages its resources to ensure it can continue to deliver its services;
  • Governance – how the Trust ensures it makes informed decisions and properly manages its risks; and
  • Improving economy, efficiency and effectiveness – how the Trust uses information about its costs and performance to improve the way it manages and delivers its services.

We carried out our work in accordance with our Audit Plan that we issued to the Trust on 18 March 2026.

Value for Money (VFM) arrangements – Summary of conclusions

Green rating signifies – No significant weaknesses in arrangements identified and no recommendations made

3. Audit of the financial statements

Audit opinion on the financial statements

The scope of our work is set in accordance with the Code and the International Standards on Auditing (ISAs) (UK). We are required to provide an independent opinion as to whether the financial statements:

• give a true and fair view of the financial position of the Trust at the year end and of the Trust’s expenditure and income for the year then ended;
• have been properly prepared in accordance with international accounting standards as interpreted and adapted by the Department of Health and Social Care’s Group Accounting Manual; and
• have been prepared in accordance with the requirements of the National Health Service Act 2006.

There were no significant issues arising from our audit work again this year. However, we did identify that during 2025/26, the Trust had released its annual leave accrual brought forward from 2024/25, totalling £3.4m, through the Statement of Comprehensive Income. In our view this was not in accordance with accounting standards (namely IAS 19) which require entities to recognise a liability for annual leave earned but not taken at the reporting date. Based on the accrual made in the last three years, we estimated that, had an annual leave accrual been recognised on 31 March 2026, it would have been approximately £3.794m. This was not material to the accounts, but its impact would have been to reduce the Trust’s reported surplus of £0.345m to a deficit of £3.449m.

We gave an unqualified opinion on the Trust’s financial statements on 22 June 2026.

Other matters

We are required to give an opinion on whether the other information published in the Annual Report is materially inconsistent with the financial statements or the knowledge obtained by us in the course of our audit.

We are required to consider whether the Annual Governance Statement does not comply with the guidance issued by NHS England or is misleading or inconsistent with the information of which we are aware from our audit.

We have nothing to report in this regard.

We are required to give our opinion on whether the parts of the Remuneration Report and the Staff Report to be audited have been properly prepared in accordance with international accounting standards in conformity with the requirements of the Accounts Directions issued under Schedule 7 of the National Health Service Act 2006.

We issued an unqualified opinion in this regard on 22 June 2026.

Audit certificate

At the end of the audit, we are required to certify the completion of the audit. The effect of this certificate is to close the audit and marks the point when the auditor’s responsibilities in respect of the audit of the period covered by the certificate have been discharged.

The National Audit Office has highlighted to auditors that further work may be needed over and above that set out in their Group Instructions issued on 1 April 2026. As a result we cannot formally conclude the audit and issue an audit certificate for West Midlands Ambulance Service University NHS Foundation Trust for the year ended 31 March 2026 until we have confirmation from the National Audit Office that no additional work will be required in respect of the Consolidated NHS Provider Accounts exercise that auditors must undertake.

More detailed findings can be found in our Audit Completion Report which was reported to the Audit Committee on 22 June 2026.

4. Value for Money

Under the Code, we are required to consider whether the Trust has put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2026.

The Code requires us to report our commentary on the Trust’s arrangements under three specified reporting criteria:

• Financial sustainability – how the Trust plans and manages its resources to ensure it can continue to deliver its services;
• Governance – how the Trust ensures it makes informed decisions and properly manages its risks; and
• Improving economy, efficiency and effectiveness – how the Trust uses information about its costs and performance to improve the way it manages and delivers its services.

The National Audit Office has issued guidance for auditors to report against each of the three specified reporting criteria. The guidance also includes a number of further areas for review within each criterion to assess those arrangements.

Our risk assessment did not identify any potential risks of significant weakness.

We asked management to complete an evidenced self-assessment of the Trust’s arrangements. We then reviewed the evidence provided and carried out follow up work as appropriate to consider whether there are any significant weaknesses in the Trust’s arrangements for securing economy, efficiency and effectiveness in its use of resources.

Our commentary on the Trust’s arrangements in each of these three areas is set out in sections 5, 6 and 7 of the Auditor’s Annual Report.

5. Financial sustainability

We considered how the Trust plans and manages its resources to ensure it can continue to deliver its services, including how the Trust:

• ensures that it identifies all the significant financial pressures that are relevant to its short and medium-term plans and builds these into them;
• plans to bridge its funding gaps and identifies achievable savings;
• plans finances to support the sustainable delivery of services in accordance with strategic and statutory priorities;
• ensures that its financial plan is consistent with other plans such as workforce, capital, investment, and other operational planning which may include working with other local public bodies as part of a wider system; and
• identifies and manages risks to financial resilience, e.g. unplanned changes in demand, including challenge of the assumptions underlying its plans.

Overview and 2025/26 outturn

The Trust’s draft financial statements for 2025/26 reported a surplus of £345k against a planned breakeven position, compared with a surplus of £10k in 2024/25. The marginal year-on-year improvement in financial performance is attributable to a combination of underlying movements across income and expenditure.

As in previous years, the quality of the draft financial statements provided for audit was good. This is evidenced by the fact that there were minimal findings as a result of our audit work other than that, as highlighted in Section 3 of this report, during 2025/26, the Trust released its annual leave accrual brought forward from 2024/25, totalling £3.4m, through the Statement of Comprehensive Income. Based on the accrual made in the last three years, we estimated that, had an annual leave accrual been recognised on 31 March 2026, it would have been approximately £3.794m. This is not material to the financial statements, but its impact would have been to reduce the Trust’s reported surplus of £0.345m to a deficit of £3.449m. The annual leave accrual represents a non-cash accounting adjustment required by IAS 19.

Total income from patient care activities in 2025/26 amounted to £471.3m; of which more than 80% relates to the provision of Emergency and Urgent Care services commissioned by six Integrated Care Systems (ICSs): Birmingham, Black Country, Staffordshire, Coventry and Warwickshire, Shropshire, and Herefordshire and Worcestershire.

Financial planning and monitoring

The Trust has appropriate financial planning and monitoring processes in place. Finance reports are presented to the Trust Board on a regular basis throughout the year, and monthly monitoring returns are submitted to NHS England (NHSE) in line with established requirements. Forecasts are kept under review to reflect any changes in circumstances as they arise.

As last year, at the outset of the 2025/26 financial year, both a budgeting report and workforce planning reports were presented to the Executive Management Board (EMB) as part of the planning and budget-setting cycle. Finance and workforce teams work together on these documents to ensure consistency across the organisation. During 2025/26, monthly informal discussions have taken place to assess the current position on Emergency & Urgent Care workforce and to anticipate future recruitment needs, so that these are accurately reflected in the financial projections. Joint monthly meetings have also been established between finance, workforce, the lead commissioning Integrated Care Board (ICB), and NHSE to monitor the Trust’s overall performance.

The Board Assurance Framework (BAF), discussed in more detail in the Governance section of this report, captures relevant financial risks and associated metrics. Financial planning documents and monthly reports highlight areas of risk, while the Trust’s risk register and BAF provide a structured approach to risk management, covering the identification of key financial risks and the steps in place to mitigate them.

We examined the assumptions behind the 2025/26 financial plan, the reports prepared for the Board, and the minutes of relevant meetings at which the plan was considered. In our view, management’s assumptions were reasonable, the reports were clear and well-structured, and the Board demonstrated appropriate scrutiny. Risks associated with the plan including those linked to the Cost Improvement Programme, the Trust’s savings programme, were clearly communicated.

Achieving efficiency savings

Initially the Trust set a savings target of £19.715m for 2025/26. Despite the challenges the Trust is facing, the Trust delivered total financial efficiencies of £22.3m, exceeding its target by £2.6m. Of this, £16.7m related to recurrent savings and £5.7m to non-recurrent savings. This demonstrates effective in-year financial management, moving from the reliance on non-recurrent savings in the prior year to recognising the importance of embedding longer-term, sustainable efficiency measures i.e. recurrent savings.

During the year Internal Audit carried out a review of the Cost Reduction Programme of the Trust. The work found that the Trust’s approach to reducing costs is working effectively and is well managed. As a result, it received a “Significant assurance with minor improvement opportunities” rating, indicating the Trust’s arrangement in place are appropriate with strong controls in place, savings plans properly approved, and progress regularly reported to senior management.

The audit identified a small number of areas where processes could be improved. These included checking the longer-term impact of removing staff roles, improving the reporting of progress against savings targets, and ensuring that all projects consistently complete the required documentation.

Looking forward – 2026/27 financial planning

The Trust’s initial 2026/27 financial plan was submitted to NHS England in December 2025, with the final version subsequently presented in February 2026, as part of the Medium-Term Planning returns required. The Board formally approved the 2026/27 opening budget on 25 March 2026. Further details of the budget-setting process and associated controls are set out in the “Budget Setting and Budgetary Control” section within the Governance section of this report.

The Trust is operating within a highly challenging financial environment in 2026/27, with NHSE requiring all regional organisations to submit weekly efficiency returns to monitor progress in the development and delivery of Cost Improvement Programmes. The Trust has demonstrated positive momentum in strengthening its scheme pipeline; however, the overall Cost Improvement Programme target for the year remains significant at £20.09m. Weekly return submissions to date indicate that, whilst progress has been encouraging, the rate of development and delivery has not yet reached the level required to fully close the remaining gap. Returns submitted since early April 2026 show a continued reduction in the unidentified element of the pipeline amounting to £1.43m.

The Trust presented the Month 1 year-to-date delivery position to the Board and the Executive Management Board including full-year forecast against the £20.09m Cost Improvement Programme target present a more detailed and pressured financial outlook. Year-to-date delivery of £1.643m is marginally below the Month 1 target of £1.652m, representing a variance of £9k. Although relatively minor, this variance indicates that delivery from implemented schemes is not yet fully aligned with plan. As of April 2026, more materially, the full-year forecast of £18.664m results in a forecast shortfall of £1.426m against the target of £20.09m, indicating that the Trust will be unable to achieve financial breakeven unless additional schemes are identified, approved, and delivered during the year.

Most of the expected savings are coming from schemes that have already been put in place (about 83%), with only a small proportion coming from fully developed or early-stage plans. However, around 7% of the target is still not yet clearly identified, which creates some risk to overall delivery. While the majority of the savings are currently considered low risk, there is still a portion classed as medium and high risk, particularly within schemes that are underway or still being developed, meaning these will need close monitoring to ensure the savings are achieved.

In response to the forecast shortfall, the Efficiency and Transformation Team is working closely with the Finance Team to develop a credible bridging strategy. The Team was formally established in May/June 2025 as a dedicated function created from existing organisational staff to provide greater strategic focus on the Trust’s efficiency programme in response to ongoing financial pressures. While operating as a standalone team, it is noted that the roles also include wider operational and compliance responsibilities. Its core responsibilities include governance and oversight of programme documentation, financial efficiency planning, Cost Improvement Programme, and supporting the identification and delivery of efficiency and transformation initiatives across the organisation.

A structured programme of engagement with Directors commenced during the week beginning 11 May 2026 to identify further mitigating actions and delivery opportunities. Measures currently under consideration include extending recruitment controls to secure additional non-recurrent vacancy savings, strengthening controls over overtime and non-pay expenditure across the Trust, reviewing training and Continuing Professional Development (CPD) expenditure, and assessing opportunities to expand the scope of existing schemes or convert non-recurrent savings into recurrent efficiencies.

The achievement of savings targets and appropriate governance arrangements indicate that the budgeting process is working effectively and delivering planned outcomes.

Based on the work carried out, we were satisfied that there are no significant weaknesses in the Trust’s financial sustainability arrangements.

6. Governance

We considered how the Trust ensures that it makes informed decisions and properly manages its risks, including how the Trust:

• monitors and assesses risk and how the body gains assurance over the effective operation of internal controls, including arrangements to prevent and detect fraud;
• approaches and carries out its annual budget setting process;
• ensures effective processes and systems are in place to ensure budgetary control; to communicate relevant, accurate and timely management information (including non-financial information where appropriate); supports its statutory financial reporting requirements; and ensures corrective action is taken where needed, including in relation to significant partnerships;
• ensures it makes properly informed decisions, supported by appropriate evidence and allowing for challenge and transparency. This includes arrangements for effective challenge from those charged with governance/audit committee; and
• monitors and ensures appropriate standards, such as meeting legislative/regulatory requirements and standards in terms of officer or member behaviour (such as gifts and hospitality or declarations/conflicts of interests), and for example where it procures or commissions services.

Risk management

The Trust has appropriate and effective risk management arrangements in operation. Central to this is the Board Assurance Framework (BAF), which captures the Trust’s principal strategic risks and aligns them directly to its strategic objectives. For each risk, the BAF sets out the controls designed to reduce the likelihood and impact of those risks materialising, together with assurances that those controls are functioning as intended.

Every risk within the BAF is assigned to a named senior officer and connected to a corresponding corporate objective. The framework records each risk’s RAG status and score trajectory, identifies current challenges and gaps in control or assurance, and outlines the steps being taken to address them, including future opportunities for improvement.

The Audit Committee receives an update on the BAF at each of its scheduled meetings. The BAF is also presented to the Trust Board on a bi-monthly basis as part of the Chief Executive’s report. Strategic risks scoring 12 or above are escalated to the relevant Sub-Committees to ensure appropriate visibility and scrutiny.

Risk review is embedded as a standing agenda item across the Trust Board, Finance and Performance Committee, Quality Governance Committee, and Audit Committee. The Trust’s governance structure comprises the Trust Board and six sub-committees, each chaired by a Non-Executive Director (NED), supported by sub-groups chaired by Executive Directors. This arrangement facilitates robust and direct reporting channels between operational sub-committees and the Board.

The Trust operates a NED skills matrix, which is reviewed and refreshed on an annual basis to confirm that Board composition remains appropriate and capable of meeting its stewardship responsibilities.

The detailed risk register, which sits beneath the BAF, establishes clear escalation pathways for risks falling outside the Trust’s risk appetite, enabling the Board to concentrate its attention on the most significant risks facing the organisation. Internal Audit conducted a review of the BAF and risk management processes during the year. The review concluded that controls and processes were operating effectively, with a limited number of exceptions identified. Overall, the framework was rated as providing “Significant assurance with minor improvement opportunities.”

Internal control

The accountable officer of each NHS organisation has the responsibility for maintaining a sound system of internal control and governance that supports the achievement of the organisation’s policies, aims and objectives, while safeguarding quality standards and public funds.

Internal Audit remains central to the Trust’s internal control framework. The internal audit function has remained active throughout the current year, delivering against its Audit Plan. Internal Audit has a representative at each of the Audit Committee meetings to present any findings from their work. The Annual Internal Audit Plan 2026/27 was formally approved by the Audit Committee in March 2026, with the Committee receiving a progress report at each meeting.

The Audit Committee has primary responsibility for overseeing the effectiveness of the Trust’s internal control environment. It discharges this responsibility in accordance with its terms of reference and through active challenge of officers in response to findings raised by both internal and external audit.

The Internal Audit Annual Report explains that from April 2025, new global internal audit standards have been adopted, meaning the audit now gives an overall annual conclusion rather than a single formal opinion. Based on nine reviews completed in 2025/26, the audit found that across governance, risk management, financial reporting, and data handling, the Trust generally has sound controls in place, with some working well, but others needing to be applied more consistently.

Our review of Internal Audit reports, alongside examination of Audit Committee minutes and associated documentation, has not identified any material gaps in the assurance provided to the Trust across the matters covered within the work programme.

Counter fraud services continue to be delivered internally through the Local Counter Fraud Service (LCFS). An annual LCFS plan is produced and submitted to the Audit Committee for approval – the 2026/27 Work Plan was approved at the March 2026 meeting. A designated Counter Fraud lead oversees delivery of the plan, reports progress to the Audit Committee and attends all Committee meetings. Regular LCFS newsletters are circulated across the Trust to promote a culture of counter-fraud awareness throughout the organisation.

Budget setting and budgetary control

The Trust’s financial budgets continue to be constructed at cost centre level and subject to detailed scrutiny by both budget managers and finance teams prior to submission for Board approval. Central NHS planning assumptions, including those relating to staff costs, are incorporated during the budget-setting process. Once finalised, budget holders formally sign off their respective budgets at cost centre level.

Heads of Directorate/Division (HODs) take ownership of their area budgets for the purposes of in-year monitoring and reporting. Budget holders have direct access to online financial reporting tools, enabling ongoing engagement and the ability to interrogate, query, and challenge financial data as required. Draft budgets are presented to the Executive Management Board (EMB) in the first instance, before the finalised budget is submitted to the Trust Board for approval.

A review of committee minutes confirms that budget setting and monitoring activities are reported consistently throughout the year. Our examination of the integrated reporting pack presented to the Trust Board confirms that relevant non-financial information is included, supporting the interpretation of material variances identified during the reporting period.

Decision making

As in previous years, the Trust has appropriate arrangements in place to ensure that decision makers are provided with all relevant information ahead of significant decisions, and that mechanisms exist to facilitate effective challenge before such decisions are concluded. Our attendance at Audit Committee meetings has provided evidence that it holds officers to account and exercises meaningful challenge.

All papers presented to the Board and its Committees are accompanied by a mandatory cover sheet, setting out the purpose of the report, the recommendations being made, and the actions required. Each paper also summarises the key issues and identifies the relevant strategic objectives, which is consistent with good governance practice.

Ensuring appropriate standards

The Trust has a suite of policies and procedures in place to maintain appropriate standards of conduct across the organisation. These include the Counter Fraud, Corruption and Bribery Policy and the Gifts and Hospitality Policy.

We have been advised that there were no instances of non-compliance with the Trust’s standards and policies during the year. Our work has not revealed any information that would call this into question. Compliance matters are monitored by the Quality Governance Committee, which provides oversight of issues with potential implications for non-compliance across the Trust.

The most recent CQC inspection, conducted between August and October 2023 and published in February 2024, resulted in an overall rating of “Good”. All five domains – Safe, Effective, Caring, Responsive, and Well-led – were rated at least Good, with the Caring domain achieving an Outstanding rating.

Declarations of interest are completed annually by Board members, with the Register of Interests maintained on the Trust’s public website. Arrangements are in place to ensure declarations are made at the commencement of all Board and Committee meetings.

Based on the work carried out, we arrangements.

7. Improving economy, efficiency and effectiveness

We considered how the Trust uses information about its costs and performance to improve the way it manages and delivers its services, including:

• how financial and performance information has been used to assess performance to identify areas for improvement;
• how the Trust evaluates the services it provides to assess performance and identify areas for improvement;
• how the Trust ensures it delivers its role within significant partnerships and engages with stakeholders it has identified, in order to assess whether it is meeting its objectives; and
• where the Trust commissions or procures services, how it assesses whether it is realising the expected benefits.

Assessing performance and evaluating service delivery

The Trust continues to provide regular performance reporting to both the EMB and the Trust Board through a monthly integrated report. This report delivers a comprehensive assessment of performance against key indicators aligned to the Trust’s strategic objectives and encompasses both financial and operational data. Movements in performance are analysed to identify areas requiring improvement, with reporting covering all Integrated Care System (ICS) areas within the Trust’s operating footprint.

The Trust’s clinical performance reporting includes benchmarking against national standards, enabling identification of areas where improvement is needed or where strong performance can be maintained. The Trust uses this analysis to define priority areas within each of its local health and care systems and to determine how improvements can be effectively implemented. The System Operations and Resource Data schedule provides further details to the Board on how the Trust intends to deliver against these priorities. It helps ensure alignment between strategic objectives and day-to-day delivery, enabling progress to be tracked and managed effectively. For Board members, it provides clear visibility of planned activity, accountability, and performance to support informed oversight and decision-making. There is demonstrable collaboration across all six health economies in which the Trust operates, with a focus on how these systems support one another to drive overall performance improvement.

As stated earlier in the report, the Trust’s Cost Improvement Programme policy provides a structured approach to identifying and delivering efficiencies, setting out how reviews are undertaken and the processes that follow once a decision to proceed has been taken. Transformational savings proposals are supported by Quality Impact Assessments to ensure any wider operational and service impacts are fully evaluated.

Throughout 2025/26, West Midlands Ambulance Service faced continued operational pressures due to persistent hospital handover delays, resulting in around 384,000 lost hours waiting at hospitals to hand over patients instead of helping others. Despite this, the Trust delivered strong performance, achieving the second-best national Category 2 response times and sector-leading ambulance call handling results. In the Annual Report the Trust highlighted that it has also strengthened frontline staffing, maintained a paramedic on every vehicle, and recorded the lowest staff turnover rate among ambulance trusts, demonstrating its ongoing focus on workforce wellbeing and retention.

NHS England Segmentation Score (NHS Oversight Framework)

During 2025/26, NHS England implemented a revised Oversight Framework and Provider Capability Assessment, designed to enhance monitoring of performance, financial sustainability, and leadership capability across NHS organisations. West Midlands Ambulance Service University NHS FT was initially placed in Segment 3 as a result of the unresolved funding matter relating to hospital handover delays, before subsequently improving to Segment 1 following resolution of this issue. A Quarter 3 assessment returned the Trust to Segment 3 following a minor financial variance; however, the Trust was assessed as Segment 2 in Quarter 4, reflecting the achievement of a non-deficit financial position. This classification has been verified against the NHS England Oversight Framework dashboard.

Under the recently introduced Provider Capability Assessment framework, NHS bodies’ leadership capability is evaluated across six defined domains. The scoring matrix is green, green-amber, amber-red and red. The Trust has an initial green-amber rating, which considered favourable.

We are satisfied that the Trust has robust arrangements in place to monitor compliance with applicable legislation and regulatory obligations.

Partnership working

The Trust’s partnership working arrangements are considered appropriate given the breadth and nature of its operational responsibilities.

As stated previously, the Trust operates across six Integrated Care Systems (ICSs), with a lead commissioner coordinating service commissioning arrangements across these areas. As referenced elsewhere in this report, Black Country ICB serves as the Trust’s lead commissioner.

Collaborative arrangements are monitored through the Board, and formal governance structures are in place with key partners, including the Trust’s lead commissioner. There is clear evidence of effective communication between the Board and its key partners, with Trust Board representation maintained on Black Country ICB.

Activities across the local ICS areas are reported to and monitored by the Board through the Integrated Governance Report. Evidence reviewed demonstrates that the Trust engages constructively and collaboratively with its key stakeholders across all ICS areas in which it operates.

NHS England has confirmed a number of Integrated Care Board (ICB) clustering arrangements effective from April 2026 as part of wider system efficiency and strategic commissioning reforms. Following discussions with management, the Trust’s view is that the current clustering arrangements are not expected to have a direct impact on the operations, governance, or financial arrangements of the Trust.

Management has therefore concluded that no specific monitoring arrangements are currently required in relation to these changes. Accordingly, no significant risk of weakness consideration has been identified for 2025/26 in respect of the proposed ICB clustering arrangements.

Commissioning and procuring services

The Trust has an established procurement strategy. This strategy has been integrated since 2024 with the Trust’s finance strategy to ensure strategic alignment.

The Trust’s Standing Financial Instructions set out the operational framework for procurement activity, including requirements relating to quotations, tendering, and requisitions. They specify the financial thresholds at which tenders or quotes are required, define delegated authorisation levels, and establish the criteria for the selection of suppliers and approved contractors. There is no evidence to indicate that the Trust is failing to conduct fair and transparent procurement exercises for significant contracts.

Service provider performance is subject to ongoing monitoring, with action taken to address issues as they are identified. Financial performance, service quality, and emerging issues are reported through the Director of Finance’s financial dashboards to each Clinical Operational Board. The Trust Board also receives regular updates on these matters, ensuring that the financial effectiveness of ongoing service delivery is subject to regular and consistent review.

Based on the work carried out, we were satisfied that there are no significant weaknesses in the Trust’s arrangements for improving economy, efficiency and effectiveness.

8. Recommendations

Current Year Issues

No recommendations have been made as a result of our value for money work in 2025/26.