COVID-19 should not be used as an excuse not to address the underlying problems and long-standing issues facing the NHS, according to the latest report from the Public Accounts Committee (PAC).
“Writing off the loans owed by struggling Trusts does not solve the underlying problems facing these NHS bodies,” it says, adding that this approach is not a “substitute for a sustainable system of proper funding.” Trusts that are struggling most financially need support to become sustainable.
The report reflects on the failings and challenges of the health service prior to the pandemic, many of which it has highlighted in previous reports. These challenges include: rising patient demand which has contributed to growing waiting lists for treatment and waiting times in A&E; lack of capital investment which has resulted in record backlog maintenance; staff shortages and other issues including lack of training and investment in people, as the long-awaited People Plan has still not been published; and growing Trust deficits, the drivers of which, the report states, are not fully understood by national bodies.
The ambitions of the Five Year Forward View had not been met when it was superseded by the Long-Term Plan, which has in itself been put on hold throughout the pandemic.
These are all issues that still need to be resolved and indeed some will have compounded over the last few months, such as waiting lists for routine treatments as all such activity was suspended whilst the NHS focused on COVID-19.
In addition, a capital strategy expected as part of the Spending Review in autumn 2019 to support delivery of the Long Term Plan is still awaited.
The PAC report stresses the need for action now on capital funding, the workforce, capacity and access to patient services, provider deficits and PPE shortages, issuing a number of recommendations on which government and national bodies are required to report by the end of this year. On the whole, NHS Providers agrees with and supports the PAC’s comments.
Recommendation: “The Department and NHSE&I should identify a capital strategy and provide clear guidance to local partnerships, that supports the NHS Long Term Plan, including expectations on how backlog maintenance costs will be addressed alongside competing priorities for digital investment and the Health Infrastructure Programme.”
Recommendation: “The Department should review the effectiveness of having a separate body overseeing the planning and supply of the NHS’s future workforce. NHSE&I should work with Health Education England to evaluate how workforce planning can be improved including the integration of training and education funding models with service planning and delivery in order to overcome persistent challenges.”
Recommendation: “NHSE&I should clearly set out and communicate to the public the range and extent of health services that will be available, what patients can expect in terms of access and waiting times, and what it is doing to encourage patients to access services when they need to.”
Recommendation: “NHSE&I should set out a plan with a timetable of steps aimed at getting the 10 most financially distressed trusts back to financial balance.”
Recommendation: “The Department should write to the Committee within two months to clarify its governance arrangements and outline at what point in the future it expects to have a predictable supply of stock and ready access to PPE supply within the NHS and care sectors. This should include detail on the roles and responsibilities for the procurement and distribution of personal protective equipment across NHS and social care settings.”
Saffron Cordery, Deputy Chief Executive of NHS Providers, has commented on the findings, agreeing with the recommendations of this report, saying: “There must be enough money available to the provider sector and it must be accompanied with a framework that supports appropriate prioritisation, good local decision making and value for money.”
On the workforce she adds: "The NHS went into the pandemic with 100,000 vacancies alongside growing demand for healthcare.
"Staff responded magnificently to the unprecedented challenges posed by COVID-19, coming off the back of a tough and relentless winter. Many are exhausted. Some are traumatised. The impact of the pandemic has fallen disproportionately on colleagues from Black, Asian and Minority Ethnic backgrounds.
"We need to protect and support all our staff. We now face the even greater challenge of restoring services while retaining capacity to respond to a second surge in COVID-19 cases as demand for care picks up pace heading into winter."