A damning report by the Public Accounts Committee warns that the NHS is facing huge challenges and, criticising "public bickering between key players running service", stresses that a "united effort" is needed to resolve these for the long term.

According to the report, the financial performance of NHS bodies has "worsened considerably" and this trend is "not sustainable". It calls on the Department of Health, NHS England and No. 10 to work together "in the best interests of patients", alongside a stream of other recommendations including "a clear and transparent" recovery plan - to be delivered by March 2017 - which targets those in severe financial difficulty.

The Committee has slammed central government for asking local bodies "to solve multiple problems and deliver a range of priorities" without having a proper understanding of what can be achieved, and highlighted concerns that action to restore financial stability is affecting patients' access to services and their experience of care. Performance against access targets continues to deteriorate, it notes, and points out the link between trusts' financial performance and their overall Care Quality Commission rating.

It also stressed that "repeated raids" on investment funds to meet day-to-day spending could have "damaging consequences", resulting in "ill equipped and inefficient hospitals". The PAC said it is "concerning" that the Department moved £950 million out of its separate £4.5 billion capital budget to its revenue budget in 2015/16 in order to fund day-to-day activities, and that it plans similar action to balance the budget in this and future years.

"Reducing investment in this important area risks making the NHS less sustainable in the longer-term and limits funding for investing in new community services," it concludes, and recommends that The Department, NHS England and NHS Improvement "should review and improve national and local planning for capital expenditure in order to call a halt to crisis driven transfers out of capital budgets to meet day to day revenue spending, which is not good value for the taxpayer or the future of the estate".

Highlighting issues with the controversial sustainability and transformation plans (STPs), the PAC concluded that NHS England and NHS improvement "have much more to do before the public can feel confident that they are about delivering transformation and efficiencies and not just a cover for cuts in services". As yet there are no publicly available performance measures for help gauge whether the local organisations that have been grouped together have a track record of success, it noted, and recommended that NHS chiefs "set out how they will support organisations to deliver real transformation in the areas where plans fall short".

Elsewhere, the report underscores that the social care system is grappling with "extreme" pressures on funding and is unable to meet demand, which is "placing enormous extra pressure on NHS services". The Department and NHS England should assess the impact this is having on the NHS, so it can better understand the issues, the PAC said, calling for an analysis outcome by July this year.

The Committee also voiced concern over whether plans to generate efficiency savings of £22 billion are really achievable. Not only has there been "limited testing" by the Department, NHS England and NHS Improvement of their estimates for how much they can generate from their savings programmes, but local bodies are now facing new challenges, such as the repercussions of Brexit and the challenge of implementing seven-day services. As such, NHS leaders should publish by March this year an assessment of "whether there is the capacity in NHS bodies to deliver everything they are expected to within the agreed timeframes".

Insult to taxpayers
"Contradictory statements about funding from the Prime Minister and head of NHS England are an insult to taxpayers who deserve an honest, grown-up conversation about future finance and service provision," said PAC chair Meg Hillier. "It is inconceivable the Government would allow a catastrophic failure in the NHS and we expect it to take targeted action now to support NHS bodies facing severe financial problems.

"But let us be clear: this sticking-plaster approach is not sustainable, will not enable the NHS to get ahead of the problems it faces, and represents neither good value to taxpayers nor the best interests of patients."

Commenting on the report, BMA council chair Mark Porter said: "The simple fact is that the NHS is at breaking point because politicians have chosen to underfund our health and social care system and ignore the warnings of healthcare professionals. Tragically it is our patients who are unfairly suffering the consequences of these bad choices.

"The concern for patients, the public and NHS staff is that the Government doesn't have an answer to the £30bn funding shortfall in the NHS in England.

"Now is the time to put politics to one side and reach a cross-party consensus on how to tackle this crisis in the long term by funding services to meet the needs that we know patients have."