Healthcare delivery
whether best use is currently being made of funding for Continuing Healthcare assessments and the Better Care Fund, intended to support joint working between the NHS and social care. Recommendation: NHSE should ensure that, year on year, a greater proportion of its funding is spent in the community, in line with its own policy ambition. Any review of Continuing Healthcare funding and the Better Care Fund, DHSC and NHSE should not make changes that will see these community-based funds redirected to hospitals.
The switch to digital 7. Despite ambitions to improve productivity through the introduction of new technologies, the switch to digital in parts of the NHS has been glacially slow. Digital and technological improvements could have a transformative effect on the NHS. However, NHSE’s investment in technology
over the period 2022–23 to 2024–25 stalled because funding was redirected to mitigate ICBs’ spending deficits. For example, a number of NHS Trusts continue to rely on outdated IT equipment such as fax machines. PAC says that the NHS currently lacks a
consistent data infrastructure across its entirety and NHS providers vary in terms of technological maturity. NHS providers are often still too reliant on paper records but NHSE says it has a programme to address this over the next 18 months. NHS providers that have implemented electronic patient records have productivity levels that are 13% higher than those without them. Recommendation: Alongside its Treasury
Minute response, NHSE should write back to the Committee setting out its plans to reduce the reliance of NHS providers on paper within 18 months, including key milestones, and the proportion of NHS institutions it expects to be paperless at each milestone. A specific deadline should be set to end the use of fax machines within the NHS.
Response to the report Sir Geoffrey Clifton-Brown MP, Chair of the Committee, said: “The current Government has told the public that the NHS is broken. This will not come as news to NHS patients, nor to its hard-working staff across the country. Nor indeed does it to this Committee, which has long warned of the systemic issues plaguing the NHS, issues which the Government has transformative ambitions to address. We were aghast, then, to find among senior officials in charge of delivering these ambitions some of the worst complacency displayed to the PAC in my time serving on it. “The evidence given to our inquiry exposes
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the perennial weaknesses with which those scrutinising this country’s health systems are now very familiar. We therefore have a simple message for those senior officials responsible for delivery. Truly fresh ideas and radical energy must be generated to meet the scale of what is required - on community healthcare, on prevention, on digital transformation. Given the position of the NHS, forcing this Committee to wade through treacle by mouthing the same stale platitudes of incremental change is simply not going to cut it.” Responding to the report, Director of Policy at the Health Foundation, Hugh Alderwick, also said: “The short-termism and dysfunction in
financial planning for the NHS identified by the committee will come as no surprise to those working in the health system. Ambitions to develop new ways of delivering care, improve the NHS’s ailing infrastructure, and boost spending on preventive services repeatedly get crowded out by day-to-day pressures. “While it might be tempting to blame
officials and accounting rules, the root causes of these problems are political. Pressures on the NHS increase each year – for instance, as the population ages and wages and other costs grow – meaning government investment needs to increase just to stand still. Short-term political decisions, including cuts to capital budgets, reductions in the public health grant, and the failure to reform social care, have taken a severe toll. “How much funding the NHS needs over the coming years will depend on the extent to which the health system can boost its productivity. A mix of policy changes could help, including investment in buildings, equipment, and technology. Understanding how much the NHS spends on
preventive services would help improve planning and accountability. But the Committee is right that current assumptions on NHS productivity are overly optimistic. The question for the new government is what package of investment and policy change they will offer the NHS to help achieve these ambitious productivity targets – or even get close to them.” NHS England described the Public Accounts Committee report as ‘flawed’. In a position statement posted online, a spokesperson stated: “The report from the Public Accounts Committee contains basic factual inaccuracies and a flawed understanding of how the NHS and the government’s financial processes work. “While NHS productivity is now improving at double pre-pandemic levels – far from being complacent, NHS England has repeatedly been open about the problem and the actions being taken to address it, including in the December public board meeting, and we will be publishing further improvement measures later this week in planning guidance. “Reform is part of the NHS’ DNA and has
ensured performance improvements for patients in the past year, including innovations such as virtual wards – despite the huge challenges the NHS has faced, including capital starvation, unprecedented strikes and a fragile social care sector. Lord Darzi’s report was clear many of the solutions can be found in parts of the NHS today, and we are working closely with the government to drive this innovation forward as we develop the ambitious 10-Year Health Plan to build an NHS which is fit for the future.” To view the PAC report in full, visit:
https://committees.parliament.uk/ publications/46303/documents/233234/ default/
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