Healthcare delivery
DHSC and NHSE justify slippages in issuing guidance and approving budgets with reference to the amounts of funding involved and external factors, such as high inflation. However, PAC is not persuaded these are “sufficient reason for disregarding fundamental principles of meaningful and timely financial planning.” Recommendation: DHSC, NHSE and HMT should publicly commit to issue guidance and meaningful indicative budgets to systems no later than Christmas in future, and NHSE should approve ICB final budgets at least a month before the start of each financial year.
Tackling ‘short-termism’ 2. Despite having last published a plan in January 2019, and the major disruption caused by COVID to the NHS since, DHSC and NHSE are yet to recognise the scale of transformation needed to make the NHS financially sustainable. The Government’s desire to publish a new 10-year plan is a golden opportunity to take significant decisions for the longer-term benefit of the nation’s health and the sustainability of the NHS. Yet there seems a lack of readiness among senior health officials to take the radical steps needed. DHSC’s and NHSE’s approach to NHS finances is typified by short-termism. NHSE needed £4.5 billion in extra funding from the government in 2023–24 to deal with issues such as staff pay and industrial action. DHSC has continued to prop up day-to-day spending by raiding precious capital budgets, reallocating £0.9 billion in 2023–24. PAC says that it welcomes the fact that new HM Treasury rules mean it will no longer be able to do this in future. There is a confidence among the NHS’s senior leadership that in the event of a significant challenge, such as another pandemic, government would provide all the extra funding the NHS needed.
PAC adds that it appears that “no one at the top
of DHSC and NHSE has been preparing the NHS for the future” - for example, by putting together a revised strategy or plans as part of the recovery following the pandemic, when it was clear that the Long Term Plan 2019 was no longer valid. The Government’s aims to shift towards prevention, community and digital are not new, with previous plans and strategies having similar objectives but often failing to deliver as intended. Officials acknowledged that these changes
are difficult and should take place only slowly, over the long term, and not at the expense of patients now. Even as the new 10-year plan is being written, the NHS, DHSC and NHSE have not convinced PAC that they are ready to give the ‘three big shifts’ the priority they need. The DHSC and NHSE have become “addicted to moving money from capital to revenue to cover day-to- day pressures” according to PAC. The Committee
welcomes the fact that this behaviour will no longer be possible in future, thanks to a change in Treasury regulations. Recommendation: As they develop the 10-year plan, DHSC and NHSE must take a more planned and disciplined approach to ensuring that enough funding is allocated to those activities that can make the NHS fit for the future, particularly preventing ill health, community healthcare, and digital technology. They should measure, track and report what they spend in these areas, and what they are achieving, so Parliament and the public can assess progress over time, and should take actions to strengthen longer-term strategic financial planning. The Department and NHS England should
not look for loopholes to get round the new regulations and instead should prepare for how it will manage its finances properly without access to the safety valve of moving money from capital to revenue.
Productivity gains 3. PAC says that NHSE displays a “remarkable complacency” about the realisation of future NHS productivity improvements, which, if achieved, would be unprecedented. According to official ONS measures, long-term productivity gains in the NHS averaged 0.6% a year over the period 1996–97 to 2018–19. But productivity subsequently fell and has yet to recover fully. The NHS has 19% more staff compared to before the pandemic but is only seeing 14% more patients. Workforce issues such as sickness and absence continue to impact productivity. NHSE is confident that the annual productivity gains that it has committed to of 2.0% by 2028– 29 can be achieved because it contends the last two years have been affected by ongoing
20
www.clinicalservicesjournal.com I March 2025
ANDREW NORRIS -
stock.adobe.com
ink drop -
stock.adobe.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
