Institute comments on slamming Select Committee’s report on NHS long-term sustainability
“Our NHS, our ‘national religion’, is in crisis and the adult social care system is on the brink of collapse.” The first line in the House of Lords’ report on the NHS long-term sustainability immediately sets a gloomy tone. The 134-page report was published yesterday after a 10-month inquiry into the future of the NHS. The Committee is pushing hard for a complete overhaul of the NHS in the hopes of making it more efficient, transparent, and successful. To achieve this, the Committee is advocating the creation of a completely independent body (Office for Health and Care Sustainability), a merged NHS England and NHS Improvement and other more radical suggestions.
The Report expresses concerns about current levels of funding for adult social care, the absence of long-term workforce planning, and the seemingly incapability of driving much needed change in levels of productivity, uptake of innovation, effective use of data, and the adoption of new technologies. The Committee believes, that in order to achieve long-term sustainability of the NHS, we need 1) radical service transformation, 2) long-term funding solutions for the NHS and adult social care, and 3) immediate and sustained action on adult social care. To achieve these changes, full public consultation is needed according to the Committee Members.
From a consultation and engagement point of view, it is important to note that the Report highlights the immediate opportunity to create a more sustainable NHS by implementing the Sustainability and Transformation Plans (at the moment, the word ‘Plan’ has been replaced with ‘Partnership). Some of the witnesses that appeared in front of the Commission expressed several concerns about the STP process, most notably its lack of governance, insufficient investment, and lack of engagement. Regarding the latter, the Committee notes that there have been widespread reports that in some STP areas there has been a lack of engagement with councillors and communities in the planning process, which, in turn, “deters buy-in at a local level and jeopardises ongoing political support.”
The Institute wholeheartedly agrees. Building political consensus and engaging the public is hampered by politicians who are in a position of responsibility to plan for the long-term future but are cautious to do so. Dr Philippa Whitford MP (SNP), who appeared in front of the Commission as a witness, said: “When we move towards an election time, people are doing soundbites around the NHS because it is so important to the public and we are not moving forward…”. In an earlier piece, Institute Associate Paul Parsons talked specifically about the role of politics in health service transformation. His conclusion was that even where politicians can’t support the proposals, they can certainly support quality public consultations and defend the integrity of the decision-making process.
If the NHS wants to survive, it needs to work closely with local authorities and the public to minimise the likelihood of challenges or delays to its transformation plans. The Report is sceptical about the ability of a non-statutory governance structure to secure medium and long-term survival, and is calling for more meaningful consultations.