Publication Health and Care 21 March, 2018

Reform submission: Public Accounts Committee’s inquiry on “Sustainability and Transformation in the NHS”

Read the full report  

NHS England is right to have ambitious plans for reform. The nature of patient care is changing because of new challenges, such as an ageing population and the rise of long-term health conditions. Care is also changing because of new opportunities for the NHS, such as innovative technologies. However, to deliver a true transformation of services, the NHS should ensure that funding incentives are to be delivered in the most efficient ways.

Unfortunately NHS England has directed extra spending toward meeting short-term demand rather than enabling transformational reform. Cash bailouts from the Treasury risk becoming routine, serving only to diminish incentives across the NHS to deliver the new models of care essential for longer-term improvements and efficiencies.

The NHS has not been strategic in delivering recurrent savings. Short-term financial targets, set by NHS England, distort priorities away from medium and long-term care delivery. Substantive reforms to the NHS workforce, estates and procurement practices are needed to ensure the long-term sustainability of the NHS.

The vehicles set up to deliver these changes through region-wide planning, STPs, are yet to provide strategic leadership in this regard. Care continues to be funded in silos and STP budgets are mainly devoted to trust deficits, rather than integrating services with different providers for communities. STPs need control of healthcare commissioning and stronger executive authority to deliver results.