Sustainability and transformation in the NHS - PAC committee report and Liaison Committee

Sustainability and transformation in the NHS
House of Commons Public Accounts Committee 27 March 2018

• The latest report from the HC PAC describes an NHS "still in survival mode", using capital budget to fund short term needs rather than long term transformation. 
• The Department have been asked to report back to the Committee on a number of issues: 
• progress towards more stable long-term funding arrangements, 
• action to tackle workforce issues, a strategy for addressing long-term structural problems in trusts, 
• a review of how capital budgets are spent, outlining model guidance articulating how accountability will work under the new integrated care systems
• guidance and evidence of how the NHS, local government and the voluntary sector can work more cohesively as a whole system, including communication and engagement with patients and 
• work to promote new ways of working and examples of good practice by vanguards to all areas of the country.
• Speaking at the Liaison committee on Tuesday (listen from 17.51) the Prime Minister's comments very much reflects findings with the announcement of a new “sustainable long term plan” for the NHS based on “genuine cross party engagement” (but not a public commission).

PAC report Summary

Access to General Practice - progress report from PAC

Access to General Practice: progress review
Public Accounts Committee 27 April 2017

• The committee has revisited their work on variation in access to general practice and conclude that, despite efforts to recruit GPs, make better use of other staff groups and improve retention the Department of Health and Health Education England are “are pursuing these discrete initiatives without a credible plan for how to develop a cost-effective, sustainable workforce.”
• Recommendations include 
• NHS England must set out how it will collect data on the availability of, and waiting times for, appointments during core hours at each practice, and when it plans to publish these data.
• NHS England must report on how it is ensuring that CCGs are delivering the wider benefits intended from extended hours funding and minimising any duplication of funding.
• NHS England, working with Health Education England, should explore how it can encourage GP practices to employ a wider mix of staff to improve access and capacity in an effective and efficient manner.

Financial sustainability of the NHS

Financial sustainability of the NHS
Public Accounts Committee 21 February 2017

• Summary
• The Committee’s evidence session began with the Head of NHS England speaking out against comments made in that day’s press by sources at No. 10. We believe that the Department of Health, NHS England and No. 10 must work together in the best interests of patients. The fact that key players running our NHS are bickering in public does little to inspire confidence that patients are at the heart of everyone’s priorities. As this report underlines, the NHS is facing huge challenges. This requires a united effort to resolve these for the long term. 
• Faced with these pressures, the Department of Health has resorted to raiding the separate capital budget earmarked for long-term investment and is using this to fund day-to-day spending. Reducing investment in the hospital estate and medical equipment risks making the NHS less sustainable in the longer-term and limits the funding for investing in new services in the community. Local sustainability and transformation plans are supposed to be a vehicle for creating a modern day NHS, but NHS England and NHS Improvement have much more to do before the public can feel confident that plans are achievable, especially when the Head of NHS Improvement acknowledges that the 4% efficiency savings required are so challenging. We recognise the unprecedented challenge of achieving financial sustainability when patient demand is rising, budgets are tight and pressures in social care are impacting on the NHS. But the Department, NHS England and NHS Improvement are asking local bodies to solve multiple problems and deliver a range of priorities, without a proper understanding of what they can realistically achieve. Transformation under such pressure is hard to achieve.
• Recommendations
• The Department, NHS England and NHS Improvement should set out a clear and transparent recovery plan by March 2017 which targets those NHS bodies and health economies in severe financial difficult
• The Department and NHS England should report back to us by July 2017 on what they have done to understand the association between financial performance and the impact on patient care.
• 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.
• In its analysis of the 44 sustainability and transformation footprints, due by the end of March 2017, NHS England and NHS Improvement should set out how they will support organisations to deliver real transformation in the areas where plans fall short. They also need to convince the public of the benefits of the plans to them.
• The Department and NHS England should assess the impact that financial pressure in social care is having on the NHS, so that it can better understand the nature of the problem and how it can be managed. It should publish the findings of its analysis by July 2017
• The Department, NHS England and NHS Improvement should publish by March 2017 its assessment of whether there is the capacity in NHS bodies to deliver everything they are expected to within the agreed timeframes.
• See also verbal evidence to the PAC by Simon Stevens on 27 February 2017 here.

PAC inquiry into Better Care Fund

Inquiry into Planning for the Better Care Fund
Public Accounts Committee, started 1 December 2014

• This ongoing inquiry will allow the Committee to assess and comment at the planning stage of the BCF on the risks to successful integration of services, value for money and the impact on patients. It will also explore how accountability for the local use of the Fund will operate.
• Includes oral evidence and related evidence. 

PAC investigates waiting times

NHS waiting times for elective care in England
Pubic Account Committee, 7 April 2014

• The Commons’ public accounts committee is “sceptical” about NHS England’s ability to fully utilise the e-referrals service.
• Recommendation include
• Whether or not CCGs apply fines [for for not meeting waiting time standards] they should agree clear performance improvement plans with those trusts which fail to meet waiting time standards
• NHS England must work with CCGs and trusts to make sure that patients are clear about their rights and responsibilities under the NHS Constitution.
• To realise the full benefits of e-Referrals, NHS England must develop clear plans for how it intends to build up confidence in and utilisation of the new system.
• See commentary E Health Insider 7 May