In a report published this week, the Public Accounts Committee (PAC) has warned that the NHS reforms embodied in the move to Integrated Care Systems (ICSs) will fail unless longstanding problems facing the health service are resolved.
The report states: “ICSs have the potential to improve the health of the populations they serve by better joining up services and focusing more on longer-term actions and preventative measures to address the causes of ill-health. However, they will not succeed unless the Department addresses the multiple longstanding challenges facing the NHS and social care, which this Committee has repeatedly highlighted, and which remain unresolved. These include an elective care backlog which recently breached seven million cases for the first time, high workforce vacancy rates in both the NHS and social care, increasing demand, a crumbling NHS estate, and a very difficult financial outlook. These challenges require national leadership, and it is the Department and NHS England that are accountable to Parliament for addressing them, but plans to do so (such as the crucial NHS Workforce Plan) are repeatedly delayed. Until the Department has properly addressed these issues, including a trend towards ‘paralysis by analysis’ in formulating plans, it is difficult to see how ICSs can fulfil their potential.”
In addition, the report says not enough is being done to focus on preventing ill-health and there is insufficient joint working between government departments to tackle the causes of ill-health. Nor are problems in social care being addressed, with vacancies rising by 50% in the last year and the number of people working in social care falling in 2021/22 for the first time in at least 10 years. PAC describes what it terms: “a concerning lack of oversight for ICSs,” with the core responsibility for overseeing the delivery of healthcare absorbing most of the focus from NHS England.
Recommendations
The PAC has issued a series of recommendations to Government:
• The Department of Health and Social Care should make good on its commitment to publish a comprehensive NHS workforce plan, and the forecasts underpinning it, in 2023. This should include the assumptions it’s based on, what the NHS is expected to achieve if staffed to the target level, and if the Department intends staffing levels to fall significantly below OECD comparator countries, it should explain why. One year after the plan is published, the PAC wants the Department to update it on progress.
• The Department and NHS England should ensure the capital strategy - originally due in 2019 and repeatedly postponed - is published in early 2023. The strategy should set out an analysis of need and plans to address this, with an annual progress update provided against the strategy. The progress update should include details of when decisions are expected that affect current and potential capital projects, to enable ICSs to plan with more certainty.
• Within six months the Department should publish guidance for ICSs, setting out how it will support systems to resolve joint working issues when these are identified by the Care Quality Commission.
• Within six months the Department should write to the PAC to set out the measurable and specific benefits it expects from the move to ICSs, the barriers that have been overcome between the NHS and social care, and what action it has taken as a result of its 2019 consultation on prevention together with whether and when it expects to publish a response.
PAC Chair, Dame Meg Hillier MP says: “Far from improving the health of the nation, staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety. But Government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability.”
Lead PAC member, Anne Marie Morris MP adds: “While the ambition is right, the tool kit simply isn’t there to deliver on it. As one of the biggest departments funded by taxpayers, more transparency is needed to show what, how and by when the taxpayer will see not just an improvement but a health and care system that works and is truly there when it’s needed.”
