Can the NHS reform itself? MPs on the powerful Public Accounts Committee (PAC) say it doesn’t know how to. It has published a stinging report this morning, accusing both NHS England (NHSE) and the department of Health and Social Care (DHSC) of ‘complacency’ and blaming external factors for the poor financial position of the health service. In return, the NHS has lashed out at what it calls a ‘flawed’ report which contains ‘basic factual inaccuracies’.
The select committee report complains that the health service is relying on overly optimistic projections of the improvements to productivity that it can achieve, and that it ‘was unable to convince us that it has a detailed plan to achieve the promised productivity gains’. The NHS claims in response that ‘we regularly discuss the challenges with productivity at our board meetings’, and is open about the challenges of meeting the ambitious targets.
It is unfair to blame just the NHS for a pretty uninspiring effort at reforming
This is not the most reassuring counterpoint with which to start debunking the report. Instead, it serves to underline how anxious those at the top of the health service are about political confidence in their work. This anxiety pre-dates the current Labour government, with a long period of paranoia among senior management when Rishi Sunak was prime minister that he might include the NHS in his list of institutions that weren’t delivering in the 21st century – though they were reassured when it transpired that Sunak was just searching for something to talk about, rather than any meaningful upending of British politics. Ever since Wes Streeting has been Health Secretary, there has been an open question about how long Amanda Pritchard might remain chief executive of NHS England, with many around Streeting believing that the NHS leadership needs to change before the health service can properly reform. The PAC report will be grist to that mill, hence the furious NHS response.
The report also argues that ‘NHS, DHSC, NHSE have not convinced us that they are ready to give the three big shifts desired by government the priority they need’, adding:
This led the impression that there was no real urgent motivation and readiness to drive the change in the NHS that is needed. The DHSC and NHSE have become addicted to moving money from capital to revenue to cover day-to-day pressures. It is welcome that this behaviour will no longer be possible in future, thanks to a change in Treasury regulations.
All the analysis suggests that resources continue to flow towards acute care, rather than in the direction of community and preventive services, despite ministers’ ambition to move to the latter – and the NHS’s insistence that it is committed to that too.
It is unfair to blame just the NHS for a pretty uninspiring effort at reforming. Ministers might have stated their ambition to move from an acute-led service to one that aims to prevent ill-health and treat it earlier and closer to home. But they have not given much detail on how they plan to turn the oil tanker around beyond saying where they want it to go. They repeatedly said ‘no more money without reform’, and then contradicted that by announcing more money in the autumn Budget, still without any wider reform beyond those productivity targets.
Streeting talked a good game on reform when in opposition, but is now largely producing a tribute act to the New Labour reforms of the 2000s, some of which had very clear unintended consequences that ministers shouldn’t want to repeat. The health service is having to wait for the conclusion of the ‘national conversation’ before the ten-year plan is published, but it already knows that its ability to become more efficient will always be limited if there is to be no meaningful reform of adult social care until the next parliament. It’s not an inspiring picture, and while the NHS itself has much to learn from the PAC report, ministers must take their share of the blame.
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