The Select Committee on the Long-term Sustainability of the NHS has slammed successive governments’ ongoing attitude of “short-termism” and the failure to plan effectively for the long-term future of both the health service and adult social care.
A new political consensus on the future of the health and care system is “desperately needed”, which should be born from government-initiated cross-party talks and a national conversation, it said.
As such, the Committee is recommending the establishment of an independent Office for Health and Care Sustainability, which should stay out of day-to-day operation of health and care systems but keep a close eye on their future direction, particularly with regard to changing demographics, disease profiles and workforce skill and mix, to ensure that services can meet demand long-term.
"The Department of Health at both the political and official level is failing to think beyond the next few years. There is a shocking lack of long-term strategic planning in the NHS,” said Lord Patel, Crossbench Peer and obstetrician. “This short sightedness stems from the political importance of the NHS and the temptation for politicians to reach for short-term fixes not long-term solutions.”
In its report, the Committee concludes that a tax-funded, free-at-the-point-of-use NHS is still the most efficient way of delivering health care and should remain in place now and in the future, but it also stresses that many aspects of the way the NHS delivers healthcare will have to change to sustain the current model, as well as a shift in government priorities or increases in taxation.
The government must provide further funding between now and 2020, and after this point health spending must increase at least in line with growth in GDP in real-terms, the report stresses. “Funding for health and adult social care over the past 25 years has been too volatile and poorly co-ordinated between the two systems, and this should be addressed as a matter of priority”, it warned.
Paul Briddock, director of Policy, Healthcare Financial Management Association (HFMA), welcomed the Committee’s recognition that an honest debate is needed about future NHS funding, and backed 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 biggest internal threat to NHS sustainability is the failure to implement a comprehensive long-term strategy to secure appropriately skilled, well-trained and committed workforce, according to the Committee. To that end, one of its recommendations is that the government commissions an independent review to assess the impact of pay on morale and retention of staff.
“One area where more spending will be required is on pay for lower paid staff. We are in an increasingly competitive international market for health professionals and a decade of pay constraint in the NHS has damaged morale and made it difficult to train and recruit the staff we need,” said Lord Patel.
“It is imperative the health and social care sector is able to attract and recruit the right staff in order to protect its future, whether that be from the UK or abroad,” agreed Danny Mortimer, chief executive of NHS Employers.
“We also agree that there is a need to give assurances to EU nationals, who make up 6 percent of the health and care workforce, that they will be able to remain, as well as encouraging them to do so. Management of migration policy must take proper account of the needs of the health and social care sector, and must be flexible enough to respond to skills shortages.”
DH to take on social care?
The Committee report also points out that the health and social care systems are currently “interdependent but poorly-coordinated”, and recommends that the budgetary responsibility for adult social care at a national level should be transferred to a new Department of Health and Care to allow money and resources to be used more effectively.
“We also think it is time to look at the way care is delivered. This may well involve changing the model where GPs are self-employed small businesses. Delivering health care fit for the 21st century requires improvement in primary care to relieve pressure on hospitals. That change should be delivered by GPs,” said Lord Patel.
In response, Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “GPs and our teams are open to new ways of working to cope with the changing needs of our patients and the growing demand this brings. But there is no one-size-fits-all approach and GP practices must be able to choose the best ways of working to offer services that local populations want and need.
“The independent contractor model of general practice service delivery brings important benefits and must be nurtured and maintained as an option going forward. It has been a trail blazer for innovation in general practice and created the excellent service that patients rely on and value, as well as providing great value for money to the NHS. This continues today with many GP partnerships taking the lead in developing new models of care.
“The College recognises that the partnership model in some areas is struggling - principally as a result of years of underfunding, and recruitment difficulties - but this is not a reason to give up on it.”
Elsewhere, the report also recommends that NHS England and NHS Improvement should be merged to create a new body with simplified regulatory functions and strong local government representation, to better fit with the increasing focus on providing integrated, placed-based care.