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Aneurin Bevan University Health Board, which covers the NHS in Caerphilly County Borough, overspent by £86.3 million over the past three financial years, according to Audit Wales.

The cumulative deficit, spanning 2021/22 to 2023/24, is the second highest of Wales’ health bodies, which includes seven health boards, the Welsh Ambulance Trust, Velindre Trust, and Public Health Wales.

Each health board has a legal obligation to ‘break-even’ over a three-year period.

Aneurin Bevan University Health Board has already forecast an overspend of £60m for the current financial year.

According to Audit Wales, which has issued a report on the state of health finances, the NHS in Wales received £10.638 billion of revenue funding in 2023/24, a cash uplift of £744m on the previous year.

This was an increase on the uplift of £131m received in 2022/23. After inflation, the 2023/24 increase amounted to a 1.2% real terms increase in funding, compared with a 4.9% real terms decrease in 2022/23).

The total in-year deficit for 2023/24 has increased to £183 million and the three-year cumulative overspend across the NHS increased from £248 million in 2022/23 to £385 million in 2023/24.

Agency staff spending has grown from 2018/19 to 2022/23 but reduced by 19% in 2023/24 with annual overall agency spend being £262 million across NHS Wales. Whilst the majority of this spend covers workforce vacancies, some also supports additional activity to help meet demand.

The Wales Audit Office said “sound strategic planning is key if the NHS is to deliver services which are clinically and financially sustainable”.

However, none of the health boards were able to secure approval for a three-year integrated medium-term plan for 2023 to 2026 from the Welsh Government’s health secretay.

Auditor General Adrian Crompton said: “Whilst I recognise the scale of the financial and operational challenges faced by the NHS, I am concerned at once again having to qualify my audit opinion on the accounts of all seven health boards because they have failed to meet the statutory duty to break-even over three years.

“The growing cumulative deficit for the NHS in Wales demonstrates that despite record levels of investment and higher than ever levels of savings, the statutory framework put in place by the Welsh Government to drive financial sustainability in the NHS is not working.”

The Welsh NHS Confederation, which represents NHS bodies, said it was “unsurprising” health boards had been unable to break-even, despite extra money being made available, because of demand pressures.

Its director Darren Hughes said: “This should act as a wakeup call to UK and Welsh governments to be honest with the public about the need for long-term service change and what this might look like.

“We need commitments from governments to longer-term thinking, including focusing on prevention to reduce demand, shifting more care into the community, sufficiently investing in NHS estates and infrastructure to improve efficiency and ringfenced investment so social care staff can have parity of pay. 

“We call for long-term financial clarity from the UK Government to enable the Welsh Government to plan effectively for the future. Without this, there’s only so far the monumental efforts already made can go in achieving sustainability for a service we all rely on.”