Comment

A starting point to long-term sustainability

Lord Patel, chairman of the House of Lords Select Committee on the Long-Term Sustainability of the NHS (until the dissolution of Parliament), discusses the action that must be taken to develop an NHS fit for the future.

Barely a day goes by without a news story emerging about one crisis or another in the NHS and adult social care. With the system focused on firefighting a series of immediate crises, it is harder to focus attention on the longer-term needs of the health and care systems.  

Over the past year, I have had the honour of chairing a Select Committee in the House of Lords which was established with the explicit aim of examining the long-term sustainability of the NHS. The committee comprised a wide range of experts, including surgeons, doctors, former health ministers and others who still play an active role in the NHS and in local government. We heard from over 100 oral witnesses and received 180 written submissions, which amounted to half a million words of written evidence. 

Our conclusion could not be clearer. Is the NHS and adult social care system sustainable as it is today? No, it is not. 

We concluded that a tax-funded, free-at-the-point-of-use NHS should remain in place as the most appropriate funding model both now and in the future. However, if this is to be maintained, some things need to change. 

We found that a culture of short-termism prevails in the NHS and care system, with the Department of Health (DH) either unwilling or unable to look beyond the most pressing issues. To tackle this, we need political consensus on the way forward, which the government should seek to initiate. 

Building on this consensus, we believe an independent body, charged with making evidence-based projections on the health and care needs for the next 15-20 years, should be established. The Office of Health and Care Sustainability would monitor the impact of changing demographic needs, the workforce and skills mix needs in the NHS and the stability of health and social care funding, providing much-needed forward thinking to help protect both services for the future.  

Getting the funding right is essential, but simply asking for more money is not the solution. Funding for health will need to increase; the reduction in health spending as a share of GDP over the last decade cannot continue. But we believe this should be in an affordable way. We ask that future health funding increases at least in line with growth in GDP. 

We also found that in the past, funding has been too volatile and poorly co-ordinated between health and social care. This has resulted in poor value for money and resources being allocated in ways which don’t meet patient needs. So beyond 2020, social care funding increases should be, as a minimum, aligned with the rate of increase for NHS funding. 

The extra money for social care in the budget was welcome but it will need more before 2020 to firmly close the funding gap, and make up for many years of underfunding and the rapid rise in pressures on the system. 

To allow better co-ordination between funding for health and social care, we think that the budgetary responsibility for adult social care at a national level should be transferred to the DH, which should be renamed the ‘Department of Health and Care’.

As many of the committee members who have worked in the NHS will understand, the workforce is the lifeblood of the NHS. But it is being undermined by a lack of a comprehensive long-term strategy to secure the future workforce that we need. Only a substantially strengthened and transformed Health Education England can do this. Furthermore, to understand the low levels of morale and retention within the workforce, we need a comprehensive assessment of the impact of over burdensome regulation, unnecessary bureaucracy and a prolonged period of pay restraint. 

Finally, we found widespread agreement on the vision for the future – integrated health and care services delivering more care in primary and community settings – but the system is not there yet. We know service transformation is happening, but we urge further action to reconsider the model of primary care, reshape secondary care and to realise integrated health and social care. 

The NHS has been serving the nation well for almost 70 years and we know it can continue to do so well into the future. We hope our report will provide a starting point for others who continue to work to secure the long-term sustainability of both the NHS and adult social care.

FOR MORE INFORMATION

The Select Committee’s ‘Long-term Sustainability of the NHS and Adult Social Care’ report can be accessed at:

W: www.tinyurl.com/NHS-Sustainability

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