Announcing major reforms to the NHS, including cuts to ICBs, without delivery plans or funding in place was ‘poor practice’ and not ‘prudent’, MPs have said.
MPs in the House of Commons public accounts committee (PAC) raised concerns that the Government was repeating ‘poor practices’ seen in the New Hospitals Programme and the High Speed 2 programme, and that this will lead to ‘wasted effort’.
In a report on Reducing NHS waiting times for elective care, published today, the committee said: ‘We are concerned that the Department for Health and Social Care (DHSC) and NHS England are still announcing major reforms without either delivery plans or secured funding.
‘We do not accept that it is prudent to make a major change, such as the structural changes that are being made to ICBs and NHS England without ensuring there is funding in place to pay for the changes, and without conducting an impact assessment or taking other steps to safeguard value for money.’
It added that these reforms, ‘especially the planned cuts to ICBs’, could have a ‘significant negative impact on patients’ and the healthcare workforce through the uncertainty they create.
The report recommended that the Department of Health and Social Care (DHSC) should ‘confirm to us that it will not announce unfunded commitments’.
It also said the DHSC should ‘set out the likely costs, with associated funding, together with an impact assessment, for the ICB redundancies and the absorption of NHS England’.
Last week it was confirmed that the funding for ICB redundancies will come from within the existing NHS settlement.
However, the Department of Health and Social Care (DHSC) added they will ‘not be cutting any investment to the NHS, frontline or backroom’ and that ‘further detail will come forward in the coming weeks’.
It’s been reported that redundancies across ICBs are estimated to cost around £1bn in total, after ICBs were told to make 50% cuts to their systems in March.
10 year plan
The committee also stated that it was ‘not confident that the Department is being realistic about the immense effort needed to reduce NHS elective care waiting times’.
It said that too many people were still waiting too long for diagnostic tests and treatment, and that NHS England’s approach to transformational change was ‘deeply flawed’ in both monitoring of progress and the delivery of intended outcomes.
It raised concerns about the 10 year plan and said there was a ‘significant risk’ that digital solutions were being treated as a ‘cure all’ within the plan.
It said: ‘While NHS England and the DHSC have outlined an ambitious programme for future change, the current picture of performance for transformation is poor. The integration and sharing of digital records across the NHS is a key weakness and the NHS lacks some of the basics in IT connectivity, with General Practitioners, hospital trusts and consultants still working on different systems.
‘With technology moving quickly, the timing and funding of digital change remains uncertain. At the same time, we are sceptical that digital change can satisfactorily reach all patients as there is likely to always be a part of the population who find digital technology and tools too difficult to use.’
The report recommended that NHS England and the DHSC should ‘set out whether the 10 Year Plan itself has sufficient funding to deliver the digital transformation required by the plan’.
Dr Hugh Alderwick, director of research and policy at the Health Foundation said: ‘The committee is right to question the government’s approach to major policy change in the NHS. The government has embarked on yet another round of top-down restructuring of the health service, at a time when the NHS is under massive pressure and political ambitions for improvement are sky-high.
‘This is risky, at best, given experience from a long line of previous reorganisations suggests they cause widespread disruption, take years to deliver, and rarely deliver the benefits policymakers expect. The big worry is that NHS leaders are distracted from the task of improving services.’
It added: ‘Rather than reforms to the structure of the health service, like merging or scrapping organisations, greater attention is needed on what happens within it, including by developing the skills and capabilities for the NHS to identify, implement, evaluate and spread improvements to care in different contexts. Cuts to local NHS bodies risk making this harder.’
Rory Deighton, acute and community care director at the NHS Confederation, added: ‘To be in with a fighting chance of meeting these recovery targets for waiting lists and improving patient access, health service leaders are calling for more capital funding to modernise NHS buildings and for digital infrastructure to be upgraded so that they can provide faster, more efficient care.
‘While waiting lists have fallen slightly recently and productivity has increased, there is still a long way to go to restore performance and meet the health service’s constitutional target that 92 per cent of patients should wait no longer than 18 weeks for consultant-led treatment from the point of referral by March 2029.’
Daniel Elkeles, chief executive, NHS Providers, said that NHS-wide transformation requires ‘significant government investment in community services and the primary care ‘gateway’ to keep people well and out of hospital to ease pressure on services’.
He added it is a ‘big task in the face of soaring demand’.
