This report examines in detail the 2004-05 revenue situation of NHS organisations and considers key financial management and reporting issues facing the NHS both currently and in the future. Jointly prepared by the National Audit Office and the Audit Commission, the report incorporates the findings of their audit work on the NHS summarised accounts, the consolidated account of NHS foundation trusts, the Department of Health's resource account and the accounts of individual NHS organisations, as well as the unaudited NHS revenue out-turn for 2005-06 as reported by the Department of Health and Monitor. Findings include that in 2004-05, the Department reported a deficit across the NHS as a whole for the first time since 1999-2000, with an aggregate overspend for all NHS bodies of £251.2 million, with 171 out of 615 bodies recording a deficit or overspend, with 68 out of 259 NHS trusts failing to break even, and with 90 out of 303 primary care trusts exceeding their revenue resource limits.

This report is the first in an annual series and covers the first full year of the new complaint handling system for the NHS. The Ombudsman warns that the NHS is missing a rich source of free and readily available information about patients by failing to listen and learn from complaints. The report's scope includes previously unpublished data about the number and type of complaints received by the Ombudsman in 2009-10 for every trust and strategic health authority region in England. It shows how many complaints were received and the outcomes of the complaints investigated. It reveals that 15,579 health complaints were closed by the Ombudsman in 2009-10 and that the two most common reasons for complainants to be dissatisfied with the NHS were failings in clinical care and treatment and the attitude of staff - a poor explanation or an incomplete response were the most common reasons given for dissatisfaction with NHS complaint handling. It presents a perspective not seen before: a national picture of what happens when mistakes occur and the NHS fails to put things right and highlights how often the Ombudsman needs to get involved just to ensure the NHS apologises when a mistake has been made. As the report shows, poor complaint handling can make a difficult situation worse for patients and their families. Poorly handled complaints can also escalate, creating unnecessary demands on NHS resources whilst resolving complaints effectively need not be costly. The report also features patients' stories taken from the Ombudsman's case files