The government should clearly define what counts as prevention spending within the next six months, the Public Accounts Committee (PAC) chair has urged.
In a debate on the spending of the Department of Health and Social Care (DHSC) in the House of Commons yesterday (5 March), chair of the PAC, Sir Geoffrey Clifton-Brown, added that ICBs should be given flexibility on how they spend their money.
He said: ‘As a committee, we have recommended that the government clearly define what counts as health prevention spending within the next six months and track that spending annually.
‘ICBs should be given more flexibility in how they spend their money, which might include redirecting services to more community settings that are closer to patients. It might also include redirecting funds to help manage discharges from hospital.’
The debate, which featured MPs from the Health and Social Care Committee (HSCC) as well as PAC, looked at the recent PAC report into health and how the money might be spent differently.
MPs heard from the Labour MP from Thurrock, Jen Craft, who welcomed NHS England’s recent move to take away ‘most’ ringfences in the latest planning guidance. But said she had been told by ICBs including hers, Mid and South Essex ICB, that there was a ‘risk that a focus on the elective care target may draw attention away from prevention’.
Labour MP Clive Betts, added that the current system allows for NHS bodies to ‘run up deficits and seemingly there is no consequence’.
‘Unlike local government, which has to balance the books or go to the government for approval to capitalise losses, that does not happen in the NHS,’ he said.
‘We have the problem in South Yorkshire that Doncaster hospital runs at a loss every year—I am not blaming the hospital, because it has an old building that needs massive refurbishment, or probably complete rebuilding, and it has not had the resources—and those losses go into the wider ICB system and put pressure on other hospitals and trusts not to distribute any surplus they might make to community services in Sheffield but to fund others’ losses. That is no way to incentivise a proper financial arrangement.’
Conservative MP John Glen said there were also ‘complicated dynamics’ around ensuring the right allocations for GP practices which need to be addressed.
‘It is mindboggling how difficult that process of securing the right allocations is and the lack of ability to plan effective systems over one, two or three years and beyond because the budget cycle is so overwhelmed with managing the health system,’ he said.
‘If we are to tackle the productivity challenge, we have to come to terms with those connection points between ICBs, GPs and local authorities and with how we can embed behavioural shifts that lift productivity.’
Pharmacy was discussed, with Liberal Democrat Helen Morgan saying there must be clarity on the future of Pharmacy First, as the funding is not confirmed for beyond the first week of April.
In response to this, health minister Ashley Dalton said: ‘We have committed to look at how we can further expand the role of pharmacies and better utilise the clinical skills of pharmacists, and we have now resumed our consultation with Community Pharmacy England regarding the funding arrangements for 2024-25 and 2025-26. I am unable to say any more on that until the consultation has finished.’
It comes as the BMA clarified that GP collective action would now be aimed at ICBs rather than the government.
Think tank the Health Foundation warned in analysis this week that the NHS will face a ‘significant’ funding shortfall if the government’s productivity targets are not met.
