Healthcare delivery
PAC report criticises ‘lack of fresh thinking’ on NHS
The Public Accounts Committee (PAC) has published a report on NHS financial sustainability which claims that there is a ‘lack of fresh thinking and decisive action’ within NHS England and DHSC, combined with ‘overly optimistic planning assumptions’, as the UK’s financial position continues to worsen.
A new report published by the Public Accounts Committee (PAC) warns that, while Government’s forthcoming 10-year plan will be essential to the health service’s recovery, senior health officials seem to be unambitious when it comes to taking the radical steps to begin to implement it. The Government has laid out its planned
‘three big shifts’: from hospital-based to community care; from analogue to digital; and from treating ill health to prevention. However, in questioning both the Department for Health and Social Care (DHSC) and NHS England (NHSE), the PAC found that officials do not seem ready to prioritise these shifts – agreeing with the Government’s aims, but arguing they are difficult and should take place only slowly, over the long- term, and not at the expense of patients now. PAC claims that this risks “letting slip a golden opportunity to take significant decisions for the longer-term benefit of the nation’s health, at precisely the moment where ideas to meet the level of change required would be highly desirable.” The PAC’s report calls for the development
of the 10-year plan to ensure enough funding is allocated to future-proofing the NHS, particularly on prevention, community healthcare, and digital technology. The report makes specific recommendations
in each of these three areas: l On community healthcare, the report finds that the long-held ambition to move more care from hospitals has stalled. It recommends that NHSE ensure that more funding, year on year, is spent in the community, in line with its own ambitions.
l On prevention, it is likely that refocusing from treating sickness to prevention will require a similar shift of funds in the same direction. The PAC recommends that a definition be reached for what counts as prevention spending; that officials set out the funding increases required to achieve it; and for local systems to be given the required flexibility and autonomy to direct funds to the right areas.
l On the switch to digital, the PAC’s report warns 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 calls for plans to reduce this reliance on paper within 18 months, and a specific deadline to end the use of fax.
The report further notes “unconvincingly optimistic assumptions underpinning current plans of annual productivity gains of 2%” by 2028-29. The committee calls on Government to give local health bodies earlier certainty about how much money they will have, and highlights perverse incentives around vaccination funding for GP surgeries which could be seeing more deprived areas losing out. The PAC’s full conclusions and
recommendations are shown below:
Budgets and financial planning 1. Integrated Care Boards’ capacity to carry out thorough and timely financial planning is severely hampered by delays in NHSE issuing planning instructions and approving final budgets. To budget effectively, ICBs need early sight of guidance and certainty about how much money they will have. In 2022–23 and 2023–24, NHSE did not approve ICBs’ financial plans until June and May respectively, months after the financial year had begun. For 2024–25, planning guidance about how much funding would be available to ICBs was not released by NHSE until a week before the start of the financial year, due to delays in agreeing priorities and a final budget with DHSC and wider government. NHS bodies and local authorities must work
together to deliver a joint strategy, but it is difficult to see how this can be done effectively when local authorities receive their finance settlements by February and their local NHS colleagues’ budgets are approved so much later. The PAC Committee has previously expressed concern about late local authority settlements limiting time to plan, but the timetable for their NHS colleagues is even worse.
March 2025 I
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