MPs recently asked the senior leadership of NHS England whether the NHS is well placed to implement the Government’s 'three healthcare shifts', in an evidence session to the Health and Social Care Committee. But high on the agenda were the damning findings of the Public Accounts Committee.
The panel were quizzed on NHS plans to: move care from hospitals to the community, embrace digital transformation, and shift from treatment to prevention.
However, the evidence session to MPs, featuring top NHS England leadership, coincided with the publication of a report by the Public Accounts Committee (PAC) accusing NHS senior leadership of ‘complacency’. The panel were grilled on the findings of PAC, which suggested that there is a “lack of fresh thinking and decisive action” within NHS England and DHSC.
The PAC report made specific recommendations, including the following:
- On community healthcare, the report found that the long-held ambition to move more care from hospitals had stalled. It recommended that NHSE ensure that more funding, year on year, is spent in the community, in line with its own ambitions.
- On prevention, PAC said it is likely that refocusing from treating sickness to prevention will require a similar shift of funds in the same direction. The PAC recommended that a definition be reached for what counts as prevention spending; that officials set out the funding increases required to achieve it; and local systems should be given the required flexibility and autonomy to direct funds to the right areas.
- On the switch to digital, the PAC’s report warned of 'glacially slow progress in parts of the NHS'. A number of Trusts still work with fax machines, and NHS providers are often still too reliant on paper records. The report called for plans to reduce this reliance on paper within 18 months, and a specific deadline to end the use of fax.
Amanda Pritchard, Chief Executive Officer, NHS England, opened the evidence session by stating that “NHS England is not complacent about productivity, and it is completely wrong to suggest otherwise.” She criticised the PAC report for its ‘factual inaccuracies’, to which the Chair of Health and Social Care Committee, Layla Moran MP, sharply responded that this was a “bold claim”.
Addressing some of the points raised in the PAC report, which she felt were contentious, Amanda Pritchard stated that NHS productivity is improving, but added that NHS England has been open and transparent about the challenges and its plans to address it. She announced planning guidance was being published imminently (which can now be accessed here.)
On the need for earlier budget allocations, she agreed that “everyone in the NHS would like to see budgets earlier”. However, she quoted Julian Kelly, Deputy Chief Executive Officer & Chief Financial Officer, NHS England, who had previously made a statement to the Public Accounts Committee. He stated: “We try to give early informal indications of what people can be expecting, but we actually need to know what our budget is in order to be able to give a budget.”
She pointed out that budgets are subject to cross government clearance, adding that there must be proper engagement with ministers given the billions of pounds involved. “These are really difficult decisions for government,” she continued. “As soon as we have had cross government clearance, we have released planning guidance on the same day.”
She also tackled the accusation by PAC that the shift to community has ‘stalled’. Although the shift to community was impacted by the pandemic, she argued that far from stalling, in 2023/24, investment in primary care and community services increased much faster than overall ICB spend. In addition, this year, there has been extra funding for an additional 1,000 GPs.
“There is no shortage of fresh thinking in the NHS. We are working closely with government to drive innovation forward, as part of the development of the 10-year plan. It is going to be a really ambitious plan to build an NHS fit for the future,” Amanda Pritchard exclaimed. “Importantly, no one is waiting for the 10-year plan to get on with the job of delivering reform. As the Secretary of State has said, these shifts are not radical or new – but actually delivering them would be.”
The session saw MPs question the senior leadership of NHS England on a range of topics including productivity, digital transformation, capital spending, workforce, and winter pressures. To view the full recording of the session, visit: https://parliamentlive.tv/event/index/3a2dc85a-9e8e-4b8a-a954-cee999cb11a6
To view the PAC report on NHS financial sustainability, visit: https://committees.parliament.uk/publications/46303/documents/233234/default/
To view NHS England's full response to the PAC report, visit: NHS England » NHS England response to ‘flawed’ Public Accounts Committee report
An in-depth report on the session will feature in the March edition of CSJ.
