Senior health officials lack the ideas or drive to deliver the government’s mission to build an NHS fit for the future, MPs have claimed in a new report.
The Public Accounts Committee describes officials in the Department of Health and Social Care and NHS England as being “out of ideas and remarkably complacent” in a report on the NHS's financial sustainability.
The report also warns that "it appears that no one at the top of DHSC and NHSE has been preparing the NHS for the future, for example by putting together a revised strategy or plans as part of the recovery following the pandemic when it was clear that the Long Term Plan 2019 was no longer valid."
Building an NHS that is fit for the future is one of Labour’s five missions for this parliament, and the government is currently running a consultation on its 10 Year Health Plan for England, which is due to be published this spring.
The report argues that the government’s desire to publish a new 10-year plan is a “golden opportunity to take significant decisions for the longer-term benefit of the nation’s health and the sustainability of the NHS”. But it says there “seems a lack of readiness amongst senior health officials to take the radical steps needed”.
“Despite having last published a plan in January 2019, and the major disruption caused by Covid to the NHS since, DHSC and NHSE are yet to recognise the scale of transformation needed to make the NHS financially sustainable,” the report says.
The government has laid out “three big shifts” it wants to deliver in this parliament as part of the NHS mission: from hospital-based to community care; from analogue to digital; and from treating ill health to prevention.
But the PAC report warns that DHSC and NHSE "have not convinced us that they are ready to give the three big shifts desired by government the priority they need."
It said this "left the impression that there was no real urgent motivation and readiness to drive the change in the NHS that is needed".
"We are concerned about the lack of fresh thinking and decisive action we heard from DHSC and NHSE," the report says. "The scale of government’s ambitions is great, but senior officials do not seem to have ideas, or the drive, to match the level of change required, despite this being precisely the moment where such thinking is vital.”
DHSC and NHSE's approach to NHS finances is "typified by short-termism", according to the report, which points to the NHSE needing £4.5bn in extra funding from the government in 2023–24 to deal with issues such as staff pay and industrial action, and DHSC "continuing to prop up day-to-day spending by raiding precious capital budgets". It describes DHSC and NHSE as being "addicted to moving money from capital to revenue to cover day-to-day pressures" and welcomes the new HM Treasury rules which will prevent this happening in the future.
A rapid review of the NHS by Ara Darzi, commissioned by Labour following July's election and published in September, found that a funding shortfall, “dysfunctional” capital funding scheme, and raids on capital budgets have left the NHS in “critical condition”.
The PAC report urges DHSC and NHSE to take a "more planned and disciplined approach" to ensuring that the 10-year plan allocates enough funding to future-proofing the NHS, particularly on the “three big shifts”.
It says they should "measure, track and report what they spend in these areas, and what they are achieving, so Parliament and the public can assess progress over time, and should take actions to strengthen longer-term strategic financial planning".
It also asks the department and NHSE not to "look for loopholes to get round the new regulations and instead...prepare for how it will manage its finances properly without access to the safety valve of moving money from capital to revenue".
Sir Geoffrey Clifton-Brown, 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 amongst senior officials in charge of delivering these ambitions some of the worst complacency displayed to the PAC in my time serving on it."
Clifton-Brown said the committee has a "simple message" for 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.”
A DHSC spokesperson said: “We have been consistently clear that fixing the broken NHS and ensuring it is fit for the future requires urgent and radical reform.
“This will be a challenge, but health leaders in the NHS have said they will meet this task, and we will work with them to deliver it as part of our Plan for Change – as we shift healthcare from hospital into the community, from sickness to prevention and from analogue to digital.”