12.02.14
‘The future NHS cannot be built on an open-ended pay freeze’– MPs
The NHS needs fundamental change to meet the needs of patients, the health select committee has found. MPs warned that the pace of transformation was not sufficient to meet the challenge ahead and that the health service was not meeting the Nicholson Challenge on efficiency.
The committee’s new report includes concerns about the intervention of the Competition Commission and recommends that government should identify and remove obstacles to the proposed merger of Royal Bournemouth and Christchurch Hospitals and Poole FT merger.
It also points out that the future of the NHS cannot be built on an open-ended pay freeze, and notes that 48% of trusts are forecasting a deficit in the current financial year. Funding for health and social care should be ring-fenced, the committee stated.
Committee chair Stephen Dorrell MP said: “The Nicholson Challenge requires the health and care system to deliver fundamental change so that services are joined up and focused on the needs of patients. What we have heard during our inquiry indicates that while many of the straightforward savings have been made, we have not seen the transformation of care on the scale which is needed to meet demand and improve care quality.
“The NHS budget is static, and the social care budget is falling. In these circumstances, the successful integration of high-quality health and care services represents a substantial and growing challenge.
“The situation is not helped by the current fragmented commissioning structures. The committee’s view is that, as Health and Wellbeing Boards have been established to allow commissioners to look across a whole local health and care economy, their role should be developed to allow them to become effective commissioners of joined-up health and care services.
“We also recommend, as we did a year ago, that the current level of real terms funding for social care should be ring-fenced. Alongside the government’s commitment to maintain health spending at current levels in real terms, this would give certainty about budgets for a whole health and care economy and provide a firm financial basis for Health and Wellbeing Boards to plan and implement transformative service change.
“Without stronger commissioners and ring-fenced health and care funding, we believe there is a serious risk to both the quality and availability of care services to vulnerable people in the years ahead.”
John Appleby, chief economist at The King’s Fund said: “In the short term, finances are tightening significantly, with a growing number of hospitals now in deficit. This raises real questions about whether the NHS will be able to maintain its recent record of balancing its books at the end of the financial year. Beyond 2015, the prospects look even more challenging, with further cuts in public spending likely whoever wins the general election. It is now almost inevitable that the next government will have to find more resources for health and social care if services are to be maintained.
“In the meantime, a combination of unremitting financial and demographic pressures is having a significant impact on social care services – although welcome, implementing the Dilnot reforms is only part of the solution. And while the establishment of the Better Care Fund provides an important opportunity to promote integrated care, it will not offset inadequate funding for social care and will increase financial pressures on hospitals.”
He agreed that a more ambitious approach is needed on integration.
“This raises fundamental questions about whether to maintain the current separation between the NHS as a universal service, free at the point of use, and social care as a separately funded, means-tested service.”
Dr Peter Carter, chief executive & general secretary of the RCN added: “We need more attention and a lot more investment to transform care and meet the challenge of a rapidly changing health system.
“We know the pressures and financial constraints that trusts are facing, and with growing demands for services we need to ensure that the NHS budget, as well as social care budget, is ring-fenced in order to create a sustainable NHS for the future.
“Safe staffing levels and the use of better paid higher skilled staff are complementary initiatives to raise the quality of patient care – better trained and motivated staff deliver better care.”
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Image c. Dominic Lipinski/PA Wire