But NHS England hits back blaming ‘starvation’ of funds for capital investment under the Tories as well as ‘unprecedented strikes and a fragile social care sector’
Hospitals are being overwhelmed because the NHS is failing in its mission to treat people closer to their homes.
The damning verdict in a parliamentary report comes after England’s top doctor warned half the population will end up in A&E every year if more care is not delivered by GPs, community clinics and social care. A cross-party commission of MPs concluded the “long-held ambition to move more care from hospitals to community” to keep people out of A&Es concluded it has “stalled”.
Emergency departments around the country have reported extreme pressure in recent weeks, unprecedented outside of the Covid-19 pandemic, with many declaring critical incidents. NHS England hit back, pointing to “starvation” of funds for capital investment under the Tories as well as “unprecedented strikes and a fragile social care sector”.
It comes a week after the Mirror reported from the frontline of the NHS “corridor care” crisis which the Royal College of Nursing says is the worst it has ever been.
Now the Public Accounts Committee has found “the Government’s NHS ambitions run counter to officials’ lack of ideas or drive to change”. Sir Geoffrey Clifton-Brown, PAC chair, 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.”
It comes after Sir Stephen Powis, NHS England’s medical director, said if more care is not shifted to community settings to keep people out of hospitals then on current trends the equivalent of around half the population will be visiting A&E every year by 2034.
The ambition to move care from hospitals to the community existed under the previous Tory government and has become a central “shift” being championed by Labour now they are in power. However the report shows this ambition has not previously been matched by effective incentives throughout the complex NHS ecosystem.
The report found that redirecting funds to areas of the NHS which will enable this shift in the long term – such as GP, dental and mental health services – is not happening because of pressures on health leaders to use scarce funds for current priorities.
It states: “There would have been more investment and progress in mental health and community services, particularly GP surgeries and dental services, in 2023/24 had NHSE not redirected funding to prop up the day-to-day spending of local NHS systems.”
A source close to Health Secretary Wes Streeting said: “Pointless paperwork, stodgy process and a severe lack of urgency – this is exactly what Wes has been fighting against and he is determined to win. The whole system needs a proper shake-up and he’s the only person with the guts to do it.”
Hugh Alderwick, director at the Health Foundation, said: “The short-termism and dysfunction in financial planning for the NHS identified by the committee will come as no surprise to those working in the health system. Ambitions to develop new ways of delivering care, improve the NHS’s ailing infrastructure, and boost spending on preventive services repeatedly get crowded out by day-to-day pressures.
“While it might be tempting to blame officials and accounting rules, the root causes of these problems are political. Pressures on the NHS increase each year – for instance, as the population ages and wages and other costs grow – meaning government investment needs to increase just to stand still. Short-term political decisions, including cuts to capital budgets, reductions in the public health grant, and the failure to reform social care, have taken a severe toll.”
Shawn Charlwood, chair of the British Dental Association’s General Dental Practice Committee said: “Ministers say they want to shift the focus from hospital to community, but their spending plans tell a very different story. Primary care is the front door of the NHS and it’s clearly broken. Government needs to put its money where its mouth is and start fixing it.”
The report highlighted how local NHS payment mechanisms do not incentivise prioritising the more at risk but “hard to reach” patients – who are then more likely to fall seriously unwell and turn up in A&E. An example of this was how GP surgeries receive a payment for every child vaccination. The report said: “This vaccination funding mechanism favours areas where parents are more willing to inoculate their children, while areas with higher levels of vaccine hesitancy, which may be more deprived areas, receive less funding and therefore have fewer resources to carry out much-needed activities such as outreach and education”
The committee accused NHS England of being “overly optimistic” regarding improving productivity in the NHS, adding that the financial position of the health service overall continues to worsen.
An NHS England spokesman said: “The report from the PAC contains basic factual inaccuracies and a flawed understanding of how the NHS and the Government’s financial processes work. While NHS productivity is now improving at double pre-pandemic levels, far from being complacent, NHS England has repeatedly been open about the problem and the actions being taken to address it, including in the December public board meeting, and we will be publishing further improvement measures later this week in planning guidance.
“Reform is part of the NHS’s DNA and has ensured performance improvements for patients in the past year, including innovations such as virtual wards – despite the huge challenges the NHS has faced, including capital starvation, unprecedented strikes and a fragile social care sector.”
A spokesman for the Department of Health and Social Care 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.”
