Lords highlight lack of long-term planning in NHS
Absence of a comprehensive national long-term workforce strategy is biggest threat to sustainability of NHS
Published on 11th April 2017
There is a shocking lack of long-term strategic planning in the NHS, the Lords Select Committee has warned.
The Select Committee on the Long-term Sustainability of the NHS has raised fears that the Department of Health is failing to think beyond the next few years at both the political and official level.
“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,” said Lord Patel, committee chair and eminent obstetrician.
New political consensus is needed
A report by the Lords Select Committee warns that “a culture of short-termism” seems to prevail in the NHS and adult social care and the short-sightedness of successive governments is reflected in a Department of Health that is unable or unwilling to think beyond the next few years.
It states that the Department of Health “has failed in this regard” over a number of years. “Almost everyone involved in the health service and social care system seems to be absorbed by the day-to-day struggles, leaving the future to ‘take care of itself’. A new political consensus on the future of the health and care system is desperately needed and this should emerge as a result of Government-initiated cross-party talks and a robust national conversation,” says the report.
The committee is proposing the introduction of a new body, The Office for Health and Care Sustainability, which would be independent of government that will clearly identify the healthcare needs of a changing and ageing population and the staffing and funding the NHS will require to meet those needs.
The body would be similar to the Office for Budget Responsibility which has become a trusted, independent voice on economic forecasting and on public finance matters. It will need to look ahead and plan for 15-20 years into the future but should play no part in the operation of the health and care systems, or make decisions, but should be given the independence to speak freely about issues relating to its remit.
The Office for Health and Care Sustainability should report to Parliament, initially focusing on:
1) the monitoring of and publication of authoritative data relating to changing demographic trends, disease profiles and the expected pace of change relating to future service demand;
2) the workforce and skills mix implications of these changes; and
3) the stability of health and adult social care funding allocations relative to that demand, including the alignment between health and adult social care funding. The body should be established in statute before the end of this Parliament.
Social care funding welcome, but insufficient to make up shortfall
The select committee report adds that the model of primary care will need to change, secondary care will need to be reshaped and specialised services consolidated further. A renewed drive is needed to realise integrated health and social care is badly needed, it adds.
“Service transformation will be key to delivering a more integrated health and social care system and although there are some positive examples in some areas, there is more to be done,” said the report.
The committee says it can no longer see a case for the continued existence of two separate national bodies and recommend that NHS England and NHS Improvement are merged to create a new body with streamlined and simplified regulatory functions. This merged body should include strong representation from local government.
The report adds that “a tax-funded, free-at-the-point-of-use NHS” should remain in place as the most appropriate model for the delivery of sustainable health services, but in coming years this will require a shift in government priorities or increases in taxation.
Health spending beyond 2020 needs to increase at least in line with growth in GDP in real-terms. The committee heard that publicly-funded adult social care is in crisis and while the additional funding for social care announced in the 2017 Budget is welcome and means funding for social care will increase by more than 2% a year for the next three years, it is “clearly insufficient” to make up for many years of underfunding and the rapid rise in pressures on the system.
Adoption of innovation and technology is a priority
“The government needs to provide further funding between now and 2020. Beyond 2020 a key principle of the long-term settlement for social care should be that funding increases reflect changing need and are, as a minimum, aligned with the rate of increase for NHS funding,” says the report. “Funding for health and adult social care over the past 25 years has been too volatile and poorly co-ordinated between the two systems, and this should be addressed as a matter of priority.”
“We recommend that the budgetary responsibility for adult social care at a national level should be transferred to the Department of Health which should be renamed the ‘Department of Health and Care’,” it adds.
The select committee further raises concerns by the absence of a comprehensive national long-term strategy to secure the appropriately skilled, well-trained and committed workforce that the health and care system will need over the next 10–15 years. The report highlights that this represents the biggest internal threat to the sustainability of the NHS.
Health Education England needs to be substantially strengthened and transformed into a new single, integrated strategic workforce planning body for health and social care which should always look ten years ahead, on a rolling basis. This will enable it to produce and implement a joined-up place-based national strategy for the health and social care workforce, which utilises a greater proportion of the domestic labour market, says the committee.
The report also points to innovation and technology and says that leaders in the NHS seem to be “incapable of driving the much needed change” in levels of productivity, uptake of innovation, effective use of data and the adoption of new technologies. Government should make it clear that the adoption of innovation and technology, after appropriate appraisal, across the NHS is a priority and it should decide who is ultimately responsible for this overall agenda. It should also identify the bodies and areas within the NHS which are falling behind in the innovation and technology agenda and make it clear that there will be funding and service delivery consequences for those who repeatedly fail to engage.
It concludes that cuts to funding for the public health budget are short-sighted and counter-productive. National and local public health budgets should be ring-fenced for at least the next ten years.
Review of pay and morale
Julia Scott, CEO of the Royal College of Occupational Therapists, said: “This report is an important and timely contribution to the debate about the future of the health and social care system. We wholeheartedly support the select committee's call for politicians of all parties to come together to tackle the monumental challenge of funding a sustainable and high quality health and social care system for the long term.
“Occupational therapists are qualified to work across both NHS and Social Care sectors. They have therefore seen for some time the negative consequences for patients and service users of the fragmented and adversarial nature of the health and social care system.
“The select committee is also correct to point out the link between many years of pay restraint and recruitment problems. We recently highlighted the fact that there are over 250 vacant occupational therapist posts in London alone, with some services carrying a 40% vacancy rate. We therefore support the select committee’s call for an urgent review to examine the impact of pay on morale and retention of health and care staff,” added Ms Scott.
Chief Executive of The King’s Fund, Chris Ham, 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,” he added.
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