NHS reforms will not work until chronic problems solved, MPs warn

The latest NHS reforms will not work until the Government fixes systemic issues including record backlogs, staff shortages and “decrepit” buildings, MPs have warned.

The Commons Public Accounts Committee (PAC) criticised a trend towards “paralysis by analysis” by the Government, which it accused of repeatedly reconsidering and delaying key interventions such as the NHS workforce plan and capital funding strategy.

The PAC said new regional authorities in England called integrated care systems (ICSs), the latest attempt to bring NHS and local government services together, have the potential to better prevent ill health.

But ICSs “will not succeed” unless the Department of Health and Social Care (DHSC) tackles the NHS’s multiple long-standing problems, according to the PAC’s report.

These include an elective care backlog which has topped seven million for the first time, severe workforce shortages in the NHS and social care, demand outweighing capacity, a crumbling NHS estate, and limits on funding.

National leadership is required to address these issues, the PAC said, while noting there is “a worrying lack of oversight in the new system”.

Dame Meg Hillier, chairwoman of the committee, said: “Staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety.

“But Government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability.

“The ICS reforms have potential but there is no clear responsibility for ensuring that social care is properly integrated with health care or that patients will see the difference on the ground.

“Changes will not succeed if they are imposed on the NHS in its current state. Government needs to get a grip on the wider, full-blown health and social care crisis it allowed to develop from long before the pandemic.”

Tory PAC member Anne Marie Morris added: “While the ambition is right, the tool kit simply isn’t there to deliver on it.”

The committee urged the DHSC to set out the tangible benefits ICSs will bring to patients, and by when.

The department should also make good on its commitment to publish this year a much-delayed comprehensive NHS workforce plan and the forecasts underpinning it, it said.

With the cost of overdue maintenance work on the NHS estate rising by £4 billion over the last seven years to reach £9 billion, the PAC also called for a long-term strategy for capital to be published in early 2023.

Miriam Deakin, NHS Providers director of policy and strategy, said the PAC was “right to highlight that creating ICSs alone cannot address all of the major underlying problems across the national health and care system”.

She added: “To fulfil their potential ICSs must be true partnerships with the NHS, local government, social care services and voluntary and community sector organisations.

“The Government can back this joined-up working by helping to boost staff recruitment and retention with a long-term, fully funded national workforce plan, ensuring that the whole health and care system, including community services and social care, has the capacity and funding to deliver first-class care.”

A Government spokesman said: “Integrated Care Systems are a crucial part of the Government’s vision to bring together the NHS and local government to work jointly on improving health outcomes for people in their communities and tackle inequalities in access to care.

“It is right that there is transparency regarding spending across all parts of the health and care system.

“In November 2022, we announced an independent review into Integrated Care Systems to look at their autonomy and accountability in the way they work.

“We are taking immediate action to reduce long waits for urgent and emergency care through our new recovery plan published last week, and we will publish a workforce plan this year focused on recruiting and retaining more staff.”