The House of Lords Select Committee has questioned the long-term sustainability of the NHS and slammed the ‘short-sightedness’ of successive governments for failing to plan effectively for the long-term future of the health service and adult social care.
The long-term future of the NHS is an increasing public concern, with a record 55% of people saying they expect the NHS to deteriorate over the longer term.
The Committee makes it clear that a tax-funded, free-at-the-point-of-use NHS is the most efficient way of delivering healthcare and should remain in place now and in the future. For that principle to remain, however, many aspects of the way the NHS delivers healthcare will have to change.
The Committee concludes that “a culture of short-termism” seems to prevail in the NHS and adult social care and that the Department of Health has been unwilling or unable to look beyond the next few years. It recommends that a new, independent Office for Health and Care Sustainability should be established to look at health and care needs for the next 15-20 years and report to Parliament on the impact of changing demographic needs, the workforce and skills mix in the NHS and the stability of health and social care funding relative to demand. A political consensus on the future of the health and care system is “not only desirable, it is achievable” according to the Committee and they call on the Government to initiate cross-party talks and a meaningful "national conversation.”
The Committee says that in the past funding has been “too volatile and poorly coordinated between health and social care.” This has resulted in poor value for money and resources being allocated in ways which don’t meet patient needs. In the future health funding will need to increase at least in line with growth in GDP, and NHS financial settlements should be agreed for an entire Parliament to enable effective planning.
Commenting, Lord Patel (pictured), chairman of the Committee, cross bench peer and eminent obstetrician, said: “The Department of Health at both the political and official level is failing to think beyond the next few years. There is a shocking lack of long-term strategic planning in the NHS. This short sightedness stems from the political importance of the NHS and the temptation for politicians to reach for short-term fixes not long-term solutions.
“To solve this we need a new body that is independent of government and is able to identify clearly the healthcare needs of a changing and ageing population and the staffing and funding the NHS will require to meet those needs. This new Office for Health and Care Sustainability should be a trusted, independent voice as the Office for Budget Responsibility has become on economic forecasting and on public finance matters. It will need to look ahead and plan for 15-20 years into the future.
“We also need to recognise the NHS will need more money. NHS spending will need to rise at least as fast as GDP for 10 years after 2020. One area where more spending will be required is on pay for lower paid staff. We are in an increasingly competitive international market for health professionals and a decade of pay constraint in the NHS has damaged morale and made it difficult to train and recruit the staff we need.
“We have heard much about the need to integrate health and social care and we think the best way to do that is make the Department of Health responsible for both health and adult social care budgets. We also think it is time to look at the way care is delivered. This may well involve changing the model where GPs are self-employed small businesses. Delivering healthcare fit for the 21st century requires improvement in primary care to relieve pressure on hospitals. That change should be delivered by GPs.”
Industry reaction:
Dr Liam Brennan, president of the Royal College of Anaesthetists, said: “Finally, we see an acknowledgement that we can’t keep doing the same thing over and over, with fewer resources, and expect better results.
“This report shows the glaring gap between what we need to provide quality patient care and what has been provided by successive governments. It’s time the government acknowledged the overwhelming evidence that NHS funding simply isn’t enough to make ends meet.
“If we are going to keep our commitment to providing quality patient care, now is the time to take action. This report starkly highlights the significant workforce issues facing the NHS. We know without proper long-term planning, we won’t have enough doctors, including anaesthetists, to treat the ever-increasing number of patients in the NHS.
“We need the government to take responsibility not just for the short-term but for the long-term future of the NHS. We look forward to working with the government to help shape what the future of the NHS should look like for our patients, members and for the health service overall.”
Nuffield Trust chief economist Professor John Appleby said: “I am pleased that the Committee has backed my proposal for an independent organisation to make recommendations to Parliament on future funding and demand for healthcare, as the Office for Budget Responsibility currently does for the Treasury on public spending. It is crucial, as the Committee recognises, that the health service can plan for steady funding increases that are in line with what experts recommend, rather than the current regime of feast and famine. I hope that the Committee’s conclusion that the current system of funding from general taxation is by far the most fair and efficient one will lay this question to rest once and for all.”
Royal College of Physicians president Jane Dacre said: “We are very pleased to welcome today’s findings by the Lords Select Committee and agree with the view that for too long successive governments have failed to plan for the long-term future of the NHS.
“The report’s focus on transformation and call for a long term strategy on how we care for a changing population are essential and agrees with much of our own ‘Future Hospital’ work. If we are to improve the care for patients we treat, as clinicians, in collaboration with patients, we need to reshape the secondary and specialist care we provide.
“However, as we highlighted in our recent report Underfunded, Underdoctored and Overstretched, our hospitals and NHS staff are only just coping and we cannot underestimate either the time or effort needed to make these fundamental changes. Therefore, the recommendation to increase funding for the NHS before 2020 is welcome.
“We would also agree with the long term ambition to move the NHS from an ‘illness’ service to a ‘wellness’ service, but as we outlined in our own evidence the current failure to protect and enhance the public health budget is at best short-sighted and at worst counterproductive.”
Chris Ham, chief executive of The King’s Fund, said: “This bold and thoughtful report should serve as a wake-up call to politicians from all parties to initiate a long overdue debate about how to pay for health and social care in the future. We are pleased to see the report echoes the work of the Barker Commission, which recommended a new settlement for health and social care and a single budget to put them both on a sustainable footing.
“In particular, we welcome the committee’s clear recommendation that we should stick with a tax-funded, free-at-the-point-of-use NHS. There is no evidence to suggest that a different way of funding our health service would be any better, and changing the system would be a significant distraction.
“As the report makes clear, spending on health and social care will need to increase in the future. Investment in services has failed to keep pace with increasing levels of demand, making it impossible to maintain standards of care for an ageing population.
“The NHS has been hampered by cycles of boom and bust while social care has been systematically under-funded for many years.
“We agree with the recommendation to move the social care budget to the Department of Health – bringing together spending on the NHS, social care and public health into a single spending review settlement would simplify departmental responsibilities and act as a further catalyst to integrate care. We also welcome the committee’s call for a public consultation on how to remove the barriers to integrating care created by the Health and Social Care Act, although it is important to emphasise that there is no appetite for a major reorganisation of the NHS.”
