Government 'needs to think more long-term' to save NHS 'from collapse', report warns

The House of Lords’ Select Committee Report on the Long-Term Sustainability of the NHS warns culture of short-termism is threatening services

The NHS is ‘near collapse’ and the Government needs to think more long-term if it is to maintain standards and stay within budget, a new report warns.

The House of Lords’ Select Committee Report on the Long-Term Sustainability of the NHS, which was published last week, reveals that the ‘culture of short-termism’ which ‘seems to prevail in the NHS and adult social care’ sectors is threatening services.

We need politicians of all parties to come together to agree a long-term approach and put an end to political game-playing with the NHS

It states that ‘the short-sightedness of successive governments is reflected in a Department of Health that is unable or unwilling to think beyond the next few years’.

It adds: “Almost everyone involved in the health service and social care system seems to be absorbed by the day-to-day struggles, leaving the future to ‘take care of itself’.

“A new political consensus on the future of the health and care system is desperately needed and this should emerge as a result of Government-initiated cross-party talks and a robust national conversation.”

The report recommends the establishment of an Office for Health and Care Sustainability. This would play no part in the operation of health and care systems, or make decisions, but should be given the independence to speak freely about issues relating to its remit.

It would look 15-20 years ahead and report to Parliament, initially focusing on several key areas:

  • The monitoring of, and publication of, authoritative data relating to changing demographic trends, disease profiles, and the expected pace of change relating to future service
  • The workforce and skills mix implications of these changes
  • The stability of health and adult social care funding allocations relative to that demand, including the alignment between health and adult social care funding

The body should be established in statute before the end of this Parliament, the report adds.

It also calls for improvements in the statutory framework and a drive to better align health and social care services in an effort to overcome problems such as bedblocking in hospitals. And it wants to see NHS England and NHS Improvement merged.

It says: “Service transformation is at the heart of securing the long-term future of the health and care systems. It is dependent on long-term planning, broad consultation, appropriate systems of governance, and local accountability.

We need to end the chronic underfunding of our health service and address inadequate staffing and funding for the health and social care system as a whole

“The model of primary care will need to change, secondary care will need to be reshaped and specialised services consolidated further.

“Importantly, a renewed drive to realise integrated health and social care is badly needed. However, the statutory framework is frustrating this agenda and in order for real progress to be made reform is needed to reduce fragmentation and the regulatory burden.

“Service transformation will be key to delivering a more-integrated health and social care system and, although there are some positive examples in some areas, there is more to be done.

“With policy now increasingly focused on integrated, place-based care we see no case for the continued existence of two separate national bodies and recommend that NHS England and NHS Improvement are merged to create a new body with streamlined and simplified regulatory functions. This merged body should include strong representation from local government.”

And, central to the ongoing success of the NHS, will be a proper funding package.

On this issue, the 134-page report states that the 2%% increase in social care funding over the next three years is welcomed, but ‘clearly insufficient’ to make up ‘for many years of underfunding and the rapid rise in pressures on the system’.

“The Government needs to provide further funding between now and 2020,” the report states. “Beyond 2020 a key principle of the long-term settlement for social care should be that funding increases reflect changing need and are, as a minimum, aligned with the rate of increase for NHS funding.”

Responding to the report, Paul Briddock, director of policy at the Healthcare Financial Management Association (HFMA), told BBH the findings echoes its own views on the crisis: “The report highlights some of the same challenges we’ve seen for a while, with long-term funding a key concern and the recent public poll revealing 55% of people expect the NHS to deteriorate is confirmation of this.

Service transformation is at the heart of securing the long-term future of the health and care systems. It is dependent on long-term planning, broad consultation, appropriate systems of governance, and local accountability

“The Committee’s findings echo HFMA’s NHS Financial Temperature Check from 2016, which showed that nearly half of provider finance directors believed the quality of patient services would deteriorate.

“We, therefore, support the committee’s recognition that an honest debate is needed about future NHS funding and we back calls for longer-term NHS and social care planning.

“The cuts to public health budgets are short-sighted and counterproductive and we agree further integration of health and social care needs to be a priority.”

The NHS is at breaking point and this can only be relieved through increasing investment based on a realistic assessment of what is needed to meet the health and social care needs of current and future generations

Ruth Thorlby, assistant director of policy at the Health Foundation, added: “The Committee has rightly identified the phenomenon of short-term and uncoordinated planning that has been seen in health and social care, and public health, as well as the importance of restoring adequate funding as a first step to a sustainable future.

“The Committee’s recommendation to increase health spending in line with GDP is correct, and should be viewed as the absolute minimum needed for the next decade.

“This will be far from easy. In 2020, the Government will still be running a deficit, and providing this extra funding without tax increases would mean eye-watering cuts to other public services, which may themselves be damaging for public health.

“This report is a welcome call for more co-ordination in a system which can appear dauntingly fragmented even to those working in it.

“Many of its findings are consistent with work underway in the

NHS Five Year Forward View, and these principles of long-term, system-wide planning should underpin the decisions made throughout the health service and wider government.”

And British Medical Association council chairman, Dr Mark Porter, said: “This report highlights what we have been saying – that the NHS desperately needs a long-term strategy to deal with the funding and staffing problems threatening the delivery of high-quality care.

The cuts to public health budgets are short-sighted and counterproductive and we agree further integration of health and social care needs to be a priority

“For too long successive governments have based health policy on short-term measures that do not benefit patients or staff in the long term. This is especially evident in cuts to funding for public health, which this report identifies as short-sighted and counter-productive.

“The NHS is at breaking point and this can only be relieved through increasing investment based on a realistic assessment of what is needed to meet the health and social care needs of current and future generations.

“We need politicians of all parties to come together to agree a long-term approach and put an end to political game-playing with the NHS.

Service transformation will be key to delivering a more-integrated health and social care system and, although there are some positive examples in some areas, there is more to be done

He particularly welcomed the focus on improving working conditions for staff, adding: “The committee is right to identify the serious and ongoing problems in recruiting and retaining NHS staff, and the morale damage of years of ongoing pay restraint.

“At a time when GPs are unable to keep up with the number of patients coming through the surgery door, and hospital doctors are working under impossible conditions, our government should heed the committee’s recommendation and allocate the investment needed to match the promises made.

“We spend less on healthcare than other leading European economies and the NHS cannot continue to do more, with less. We need to end the chronic underfunding of our health service and address inadequate staffing and funding for the health and social care system as a whole.”

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