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ICSs won’t work unless longstanding problems are fixed, warns PAC report
Major new reforms of the NHS will not work until the Government addresses multiple chronic issues in the service, the Public Accounts Committee (PAC) has warned in a new report. The Committee states that the case has not been made for what improvements Integrated Care Systems (ICSs) will bring to patients, and by when. ICSs aim to bring NHS and local government services together to join up services and focus on prevention. However, the Committee believes that the reforms will founder if major systemic problems in the NHS are not addressed by the Government at a national level. The report on ‘Introducing Integrated Care
Systems’ warns that there is a risk that ICSs will struggle to make progress on local or longer- term priorities, such as increasing healthy life expectancy and reducing avoidable ill-health, given the national focus on shorter-term challenges, such as the elective care backlogs and A&E waiting times. At a national level, not enough is being done
to focus on preventing ill-health. There does not appear to be effective arrangements for joint working between Government departments to tackle the causes of ill-health, while NHS England’s failure to ensure adequate NHS funded dental care risks creating more acute dental health problems. The report goes on to point out that it is not clear what tangible benefits for patients will arise from the move to ICSs, nor is it clear by how much or by when things will improve. The Committee added that it is concerned about the critical shortages across the NHS workforce and the Department’s repeated delays in publishing a strategy to address them. The Department has started taking some action to address workforce challenges in social care, but vacancies have increased by 50% in the
l 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.
l Not enough is being done to focus on preventing ill-health, and there is 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.
last year, and the number of people working in social care fell in 2021/22 for the first time in at least 10 years. The Committee adds that the reforms do
nothing to address the longstanding tension caused by differences in funding and accountability arrangements between the NHS and social care. It claims that the Department, which has policy responsibility for both health and social care, is showing “a worrying lack of leadership”, and it is not clear who will intervene if relationships between local partners break down. Furthermore, the NHS estate is in an increasingly decrepit condition, but the Department seems “unable to make timely decisions to address these problems”. In summary the report states that:
l The elective care backlog has breached seven million cases for the first time; there are major workforce issues in the NHS and social care; there is increasing demand; a crumbling NHS estate, and limits on funding.
l 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. The Committee refers to this as ‘paralysis by analysis’.
Increased efforts in search for MND cure
People with motor neurone disease (MND) are set to benefit from improved collaboration between the Government, researchers and charities, on top of accelerated access to funding, to speed up progress into developing treatments and finding a cure. The Health and Social Care Secretary, Steve
Barclay, met with leading representatives from across the MND research community to discuss ways to fast-track research into the disease and look at how the Government and sector can work better together to benefit patients. The roundtable
set out how the Government will cut red tape to make accessing funding easier and boost research into new treatments. The NHS App has also been updated to make it easier for people to take part in MND and wider health research. Steve Barclay commented: “We have made strong progress since we pledged £50m for MND research, with new treatments being developed, and promising results from clinical trials reported, but I know there is still more to
do...By cutting red tape and building on existing investments, we are making sure funding gets to researchers as quickly as possible.”
March 2023 I
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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 healthcare 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. The 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.”
Anne Marie Morris MP said: “Everything changes
yet nothing changes....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.”
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