The government has published its response to the Long-term Sustainability of the NHS Select Committee report of April 2017, which focused on issues relating to the sustainability of the NHS and adult social care.
Commenting in the introduction to the response, Lord O’Shaughnessy, Parliamentary Under Secretary of State for Health, admits: “As the Committee’s report makes clear, significant efficiencies will need to be delivered and I do not underestimate the scale of this challenge, even with achievements made by the NHS to date.”
The Committee made 34 recommendations covering issues including service transformation, funding, innovation, technology and productivity, public health, prevention and patient responsibility.
It repeatedly made the point that the government should be looking at long-term sustainability (15-20 years ahead), saying it is: “extremely concerned that the Department of Health is failing to plan for the long-term.” In response, the government says it believes it is right to focus on the immediate future, with the delivery of the Five Year Forward View but that the long-term sustainability of the NHS is a “key priority.”
Since the Select Committee report was published steps have been taken towards greater integration between health and social care. Following the Cabinet re-shuffle in January the Department was re-named the Department of Health and Social Care and it has responsibility for the forthcoming social care Green Paper that will set out the government’s proposals to improve care and support for older people and tackle the challenges of an ageing population.
Further integration was strongly recommended via the merging of the two separate national bodies of NHS England and NHS Improvement into one single body. The government’s response does not endorse this recommendation but does support a policy of working more closely together and confirms they “will continue to look for opportunities to go further here, to ensure that their regulatory functions are as streamlined and aligned as possible.”
A number of joint appointments have also been made to provide strategic leadership across the NHS including the Chief Information Officer for health and care a joint national lead to support Trusts and CCGs to make improvements in urgent and emergency care.
Other key responses:
Recruitment strategies: Although EU and overseas-trained staff are valued, the government agrees that the NHS should seek to become more self-sufficient by maximising the supply of domestically-trained staff in the UK. The Department of Health and Social Care will implement some practical steps to increase the supply of domestically-trained staff.
Integrating budgets at a local level: The Select Committee recommended a review to accelerate changes that would enable difficulties with integrating budgets at a local level to be achieved. The government’s response confirms that in addition to the review of 12 of the most challenged systems that the Secretary of State for Health asked the Care Quality Commission to undertake in July 2017, a further eight areas for review have now been identified. These are Cumbria, Hampshire, Liverpool, Northamptonshire, Sheffield, Stockport and Wiltshire. Bradford will also be reviewed as a high-performing area to support learning from good practice. All reviews will take place by the end of March 2018.
Means testing and paying for social care: The government has confirmed that it has started a process of engagement, with a Green Paper committed for Summer 2019, which will examine the broader networks of support and services that help older people to live independently. This will include housing and interaction with other public services.
Innovation & technology: The Select Committee raised concerns that there is no credible strategy to encourage the uptake of innovation and technology with no clear leadership or responsibility for driving this agenda. It recommended introducing funding and service delivery consequences for those who repeatedly fail to engage.
Several initiatives have been announced recently, including the launch of the Global Digital Exemplar (GDE) programme last year, which will see 16 acute Trusts and seven mental health Trusts receive up to £10m and £5m respectively, to be matched by investment from the Trust. GDEs are partnered with ‘Fast Follower’ Trusts, the idea being that the GDE can share experience of implementation, enabling the Fast Follower to support the spread of best practice and innovation. Acute Fast Followers can access up to £5m and mental health Fast Followers up to £3m on a matched basis.
An NHS Digital Academy will train aspirant digital leaders of the future and the first cohort is expected to start early-mid 2018.
Support also continues for Academic Health Science Networks and Test Bed programmes.
Greater consistency in efficiency & performance: NHS England and NHS Improvement will continue to work actively to monitor and support Trusts and CCGs to achieve greater efficiency performance.
“It is right that questions about the long-term sustainability of health funding are openly discussed, and my Department welcomes the opportunity to debate these crucial issues about the long term sustainability of our health and care services in England further. We have already acted to address some of the recommendations made in the report, and we intend to consider the others in the longer-term,” says Lord O’Shaughnessy.
“The Committee’s report has identified many of the key issues which need to be addressed in order to make the NHS and social care system sustainable for the long term.”
Download the full report here.
