The House of Lords Select Committee on the Long-term Sustainability of the NHS convened in May 2016 has released a report today, the product of a major inquiry including a public consultation and evidence sessions with selected experts (including PHG Foundation Chairman Dr Ron Zimmern). The Long-term Sustainability of the NHS and Adult Social Care sets out their conclusions and recommendations.
The report finds that the existing NHS and adult social care health system is simply not sustainable in its current form, and says transformational change is essential. It says a new political consensus on the future of the health and care system is desperately needed to address long-term issues.
Transforming services to meet future demand
The Committee argues for radical service transformation – ‘tantamount to a fundamental reinvention of the delivery model’. While the NHS Five Year Forward View (FYFV) (2015-2020) is endorsed, ‘a significant lack of long-term thinking’ on how to expand service transformation beyond 2020 is criticised.
Current Sustainability and Transformation Plans (STPs) are said to have promise, but lack the statutory footing, sufficient investment and transparency necessary to achieve their full potential. It calls for a change to the current small business model of general practice, ‘reshaping’ of acute and secondary care with increased moves into primary and community settings, consolidation of specialised services and closer integration of health and social care services. A merger of NHS England and NHS Improvement to create a single new body with streamlined and simplified regulatory functions is recommended.
The Committee also propose that the Department of Health should be renamed the Department of Health and Social Care, and that legislative modifications be made to the Health and Social Care Act 2012 to remove obstacles to new ways of working. These were highlighted by the PHG Foundation consultation response, which is quoted as having noted that by reinforcing the independence of hospital trusts, the Act results in ‘misaligned incentives to compete, not co-operate and to a drive to develop ‘distinctive’ services rather than learn from and adopt best practice developed elsewhere’.
The greatest threat to sustainability: workforce
As the Committee acknowledges, ‘appropriate training and a healthy morale are critical if this workforce of the future is to be delivered’ – but they found ‘no comprehensive national long-term strategy to secure the appropriately skilled, well-trained and committed workforce that the health and care system will need over the next 10-15 years’. This problem could be further exacerbated by the potential loss of staff from the EU due to Brexit.
The report calls for the Government to acknowledge shortcomings in workforce planning and improve education and training, retention of EU staff and increased recruitment of UK staff, as well as addressing the detrimental impact of over-burdensome regulation on workforce morale and retention. In particular, the current performance of Health Education England (HEE) was strongly criticised and an overhaul proposed to create a single independent strategic workforce planning body for health and social care, with a ring-fenced budget and a mandate to deliver a more multi-professional skills mix.
Facing the funding crisis
Given the current period of ’extreme financial challenge’ and resulting system strain, the Committee concluded that the current model of general taxation should continue as the principal method of funding. No alternative funding model was considered viable, and the evidence was found to be overwhelmingly against the introduction of additional charging systems. The report concludes that the only answer for sustainable NHS and social care is ‘increased health funding to match growing and foreseeable financial pressures more realistically’. The recent boost to social care funding was welcomed, but said to be insufficient to address previous underfunding and rising demand.
Innovation, technology and productivity
It was felt by the Committee that the NHS has failed to secure the take-up of innovation and new technology at scale or to make effective use of data – a problem noted by PHG Foundation Chairman Dr Ron Zimmern, who is quoted as saying: “The health service is already awash with ‘big data’, but its inability to standardise it, aggregate it, share it, analyse it and then use it intelligently to drive changes in practice means that its impact on reducing cost and managing demand are limited”.
The report accurately conveys the complexity of pursuing innovation in the NHS, with obstacles including inadequate funding, persistent ‘cultures of complacency’ and the uncertainty of achieving cost savings or improved productivity. Ultimately, the report reflects a consensus amongst witnesses including the PHG Foundation that better incentives are needed for NHS uptake of innovation and technology at scale, as well as ‘strong leadership and a radical culture shift’.
It calls for the Government to acknowledge that the adoption of innovation and technology in the NHS is a priority, to decide who is ultimately responsible for driving this overall agenda, and outline the consequences for Trusts who fail to engage with the innovation agenda. Local public engagement on data sharing is also recommended, along with learning about the testing and adoption of new health technologies in medical and non-medical NHS leadership education.
Public health, prevention and patient responsibility
The vital role of public health and disease prevention is underlined by the report, alongside the contradictory low priority currently assigned to such issues in the UK. It observes that preventable ill health ‘continues to place a significant burden on patients and on the health service’; and that despite the Five Year Forward View’s call for a ‘radical upgrade’ in prevention there have been wide-ranging cuts to national and local public health funding and activity.
The committee say they were ‘totally unconvinced’ by the Secretary of State for Health’s arguments on this issue and call for the restoration and ring-fencing of national and local public health funding and a shift in the NHS from ‘rhetoric to reality’ on preventative care. They also note that ‘promoting personal responsibility for health’ is important and call for clarity from the Government that ‘access to the NHS involves patient responsibilities as well as patient rights’.
Next steps towards sustainability
Whilst acknowledging the current day-to-day struggles faced by NHS and social care staff, the Committee says that a new political consensus on the future of the health and care system, and an end to the current culture of short-termism, are vital for survival. The report therefore concludes that the Government should establish a separate, independent Office for Health and Care Sustainability that will report to Parliament.
A formal response to the report from the Government and debate in parliament should follow in due course – but this may take some time, given the profound implications of some of the major policy recommendations made by the Committee.
Meanwhile, PHG Foundation Director Dr Hilary Burton commented:
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“We strongly welcome this hard-hitting and comprehensive report from the Lords Select Committee, and look forward to a constructive response from the Government”.