What NHS care costs
England's average cost of common hospital activity, compared with Guy's and St Thomas'.
These are average costs per unit of hospital activity in 2025/26, from NHS England's National Cost Collection (published 9 October 2026). The figures are rounded to two significant figures, which is enough to remember them by. The England average covers all 205 NHS providers in the collection, Guy's and St Thomas' included.
To look up the cost of other activity, NHS England publishes an interactive national schedule of NHS costs in Power BI (2025/26 data).
| Cost of one… | England average | Guy's and St Thomas' | Difference |
|---|---|---|---|
| A&E attendance at a major (type 1) emergency department Pricing avoided A&E attendances. 17.2 million a year in England; 124,000 at GSTT. | £350 | £480 | 37% higher |
| Any emergency care attendance (incl. urgent treatment centres) Same-day and urgent care pathways. 24.7 million a year in England; 184,000 at GSTT. | £290 | £450 | 55% higher |
| Outpatient appointment, consultant-led Pricing avoided or virtual follow-ups. 55.0 million a year in England; 1.4 million at GSTT. | £210 | £200 | About the same |
| Outpatient appointment, nurse or therapist-led Shifting follow-ups to other professions. 25.4 million a year in England; 564,000 at GSTT. | £140 | £210 | 51% higher |
| Outpatient procedure Moving procedures out of theatres. 19.8 million a year in England; 426,000 at GSTT. | £240 | £320 | 35% higher |
| Day case Converting inpatient stays to day cases. 7.6 million a year in England; 109,000 at GSTT. | £1,100 | £1,700 | 50% higher |
| Planned (elective) inpatient stay Elective recovery and cancelled operations. 1.3 million a year in England; 43,400 at GSTT. | £6,800 | £9,800 | 44% higher |
| Emergency (non-elective) inpatient stay Pricing avoided emergency admissions. 11.1 million a year in England; 58,100 at GSTT. | £2,800 | £7,100 | 152% higher |
| Emergency stay of 0 or 1 nights Same-day emergency care (SDEC) cases. 6.6 million a year in England; 25,900 at GSTT. | £840 | £2,600 | 216% higher |
| Adult critical care bed day Avoided or shortened ICU stays. 1.3 million a year in England; 59,600 at GSTT. | £2,600 | £2,800 | 12% higher |
For scale: in 2025/26 the collection covered £112.5 billion of NHS provider costs (not counting high-cost drugs). £2.23 billion of that was at Guy's and St Thomas'.
Allowing for case mix and London costs
A specialist teaching hospital in central London would cost more than average even if it were perfectly efficient. Its patients are more complex, and London pay and buildings cost more. NHS England's National Cost Collection Index allows for both of these. It compares each trust's actual costs with what the national average would predict for the same mix of patients, and adjusts for local costs using the market forces factor. A score of 100 means the trust's costs are exactly as expected. A score of 120 means they are 20% higher. NHS England's cost index dashboard in Power BI compares every trust.
Guy's and St Thomas' overall: 118
| Area of care | Index (100 = as expected) |
|---|---|
| Elective Inpatient and Day Case | 121 |
| Non-Elective Inpatient | 140 |
| Critical Care | 113 |
| Outpatient Services | 101 |
| Other Acute Services | 138 |
| Community Services | 149 |
| Emergency Care | 127 |
| Unbundled | 96 |
Reading these numbers
- These are average costs, not savings. Each figure includes a share of buildings, equipment and overheads. Avoiding one A&E attendance does not free up the full £350. The short-term saving is usually smaller, unless the work removed is enough to close a bed, a clinic or a shift.
- Guy's and St Thomas' is not an average hospital. It runs specialist services, such as heart and lung care at the Royal Brompton and Harefield and children's care at the Evelina, that most trusts do not. That is why the cost index above is the fairer comparison.
- Trusts count some things differently. This is especially true of short emergency stays and same-day emergency care, which helps explain the biggest differences in the table.
- Some small numbers are hidden. NHS England suppresses very small counts to protect confidentiality. Those cells are left out of both cost and activity, so they make little difference to the averages.
How these figures are calculated
Each unit cost is the total actual cost divided by the total activity. Both come from the NCCI by Department and Service (unadjusted) file in the 2025/26 National Cost Collection data publication, which gives every trust's activity and costs by department and service. "A&E attendance at a major emergency department" uses type 1 emergency departments only. "Emergency inpatient stay" combines long and short stays. The cost index uses the market-forces-adjusted file. These are national figures, published by a trust-by-trust collection that is built on patient-level costing (PLICS) for acute trusts.
A script checks NHS England for a new edition every quarter and updates this page when the figures change. This is my personal site, so these are my reading of public data, not an official view of Guy's and St Thomas' NHS Foundation Trust.