Latest NHS reforms will not succeed until Government fixes longstanding problems
8 February 2023
- Benefits for patients of new Integrated Care Systems have not been made clear
- Decrepit NHS estate, record treatment backlogs, workforce and financial issues risk national health, patient safety and success of reforms
- “Paralysis by analysis” as crucial projects are repeatedly delayed
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Major new reform of the NHS will not work until Government addresses multiple chronic issues in the service, says PAC in a report released today. The case has not been made for what improvements Integrated Care Systems (ICSs) will bring to patients, and by when.
ICSs are the latest attempt to bring NHS and local government services together to join up services and focus on prevention. But the Committee says the reforms will founder if the major systemic problems in the NHS are not addressed by Government at a national level:
the elective care backlog has breached seven million cases for the first time; major workforce issues have hamstrung both the NHS and social care; constantly increasing demand; a crumbling NHS estate; and limits on funding.
These challenges require national leadership but there is a worrying lack of oversight in the new system, and crucial national projects like the NHS Workforce Plan and capital funding strategy are repeatedly delayed – what the Committee calls 'paralysis by analysis'. The cost of overdue maintenance has reached £9 billion - £4.5 billion classed as high or significant risk - and there are questions about who gets to keep proceeds of any assets sold under ICSs.
Not enough is being done to focus on preventing ill-health, and not enough joint working between government departments to tackle the causes of ill-health. The failure to ensure adequate NHS funded dental care risks creating more acute dental health problems.
Public Accounts Committee chair, Dame Meg Hillier MP, said: “Far from improving the health of the nation, staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety. But Government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability.
“The ICS reforms have potential but there is no clear responsibility for ensuring that social care is properly integrated with health care or that patients will see the difference on the ground. Changes will not succeed if they are imposed on the NHS in its current state. Government needs to get a grip on the wider, full-blown health and social care crisis it allowed to develop from long before the pandemic.”
Lead PAC Member
Anne Marie Morris MP said: “Everything changes yet nothing changes. ICSs are the latest iteration of a plan to organise the NHS and integrate health and social care. While the ambition is right, the tool kit simply isn’t there to deliver on it. As one of the biggest spending departments funded by taxpayers, more transparency is needed to show what, how and by when the taxpayer will see not just an improvement but a health and care system that works and is truly there when it’s needed.”
- Inquiry: Introducing Integrated Care Systems
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