Lords report is ‘wake-up call’ the NHS desperately needs, health leaders say

Health organisations have today welcomed the publication of the House of Lords Select Committee report into the long-term sustainability of the NHS in England, and urged the government to wake up to the severity of the problems the sector is currently facing.

The report slammed the failure of successive governments to look more than a few years into the future in creating policies for the NHS, and recommended the establishment of an independent Office for Health and Care Sustainability to scrutinise the government and ensure policies take into consideration the next 15 to 20 years of the NHS, rather than just the next five years.

Chairman of the committee, Lord Patel, argued that there was a “shocking lack of long-term strategic planning in the NHS,” adding: “This short-sightedness stems from the political importance of the NHS and the temptation for politicians to reach for short-term fixes, not long-term solutions.”

Lord Patel also recognised the importance of providing new money to health care as well as social care, commenting that “one area where more spending will be required is on pay for lower paid staff”.

“We are in an increasingly competitive international market for health professionals and a decade of pay constraint in the NHS has damaged morale and made it difficult to train and recruit the staff we need,” he added.

He also suggested that the Department of Health (DH) should be made responsible for health and adult social care budgets in order to integrate health and social care more easily.

NHS organisations as well as unions and doctors’ groups have today said that the Lords’ report comes as one of the first practical and sensible recommendations to attempt to improve conditions in both health and social care, which are struggling with growing demand and a lack of staff and resources.

Providers: ‘We must act now to protect future generations’

NHS Providers director of policy and strategy, Saffron Cordery, who is part of the NHE Editorial Board, said the report made “important and timely” recommendations which are appropriate for the severity of the challenges facing health and social care.

“The pressures are growing year on year and we must act now to help these services adapt to serve future generations,” she said. “The uncertainties surrounding Brexit have raised further questions about the ability of the system to cope with these pressures.

“We particularly welcome the call for an Office for Health and Care Sustainability with the independence and authority to say what needs to be said in order to help the government plan objectively for future needs.”

Cordery emphasised that it was right for politicians to decide on priorities – but argued that they should only do so on the basis of the best evidence and advice available.

The NHS Providers director also endorsed concerns about staff shortages over the next 10-15 years and the need to strengthen planning, supported by a protected budget – something that Cordery described as “fast becoming the number one concern for NHS trusts”.

“The report is also right to emphasise the importance of a long-term commitment to increase health funding, at least in line with growth in GDP,” she added. “We still lag behind countries such as France, Germany and the Netherlands, and NHS real terms spending per person (adjusting for age) will actually decrease in 2018-19 – a very rare occurrence.”

But a DH spokesperson said: “We are totally committed to an NHS, free at the point of use, providing world-class care – and we agree that means taking decisions to ensure the sustainability of the service in future.

“That's why we are already expanding the number of medical training places by 25% to ensure we have all the doctors we need, investing in social care and working on a long-term funding solution in a Green Paper, and putting £325 million into local transformation plans to improve services, with more to follow in the autumn.”

Doctors: Politicians must not play games with NHS

BMA council chair Dr Mark Porter agreed emphatically with the report, arguing that it reiterates a point his own union has made a number of times before.

“For too long successive governments have based health policy on short-term measures that do not benefit patients or staff in the long term,” he said. “This is especially evident in cuts to funding for public health which this report identifies as short-sighted and counter-productive.”

The NHS can only be hauled from “breaking point” through increased, realistic investment based on an assessment of what is needed to meet the needs of current and future generations, Dr Porter stated, adding: “We need politicians of all parties to come together to agree a long-term approach and put an end to political game-playing with the NHS.

“The committee is right to identify the serious and ongoing problems in recruiting and retaining NHS staff, and the morale damage of years of ongoing pay restraint. Only last week, doctors got yet another real-terms cut in pay despite working harder than ever before.

“At a time when GPs are unable to keep up with the number of patients coming through the surgery door and hospital doctors are working under impossible conditions, our government should heed the committee’s recommendation and allocate the investment needed to match the promises made.”

And Helen Stokes-Lampard, chair of the Royal College of GPs (RCGP), also said that the government needed to do more to ensure the long-term future of the health service in the UK.

“The NHS is precious and it is important that we take whatever steps necessary to ensure it is sustainable, so that patients can benefit from it for years to come – we are pleased that the House of Lords agrees, and that it recommends spending on the health service must increase, at least in line with any growth in GDP,” she said.

“We welcome the report’s acknowledgment that healthcare professionals across the NHS are facing ‘over-burdensome regulation’ and ‘unnecessary bureaucracy’. This is affecting staff morale, and contributes to workforce pressures, and it must be addressed.”

Stokes-Lampard agreed with the Lords’ recommendation that the whole of health and social care needed to work together better, with more effective communication between general practice, hospitals and social care services – and that all must be properly funded to safely deliver the care patients need.

Think tanks: Planning needed to break ‘boom or bust cycle’

Chris Ham, chief executive of The King’s Fund, claimed the report was “bold and thoughtful” and should serve as a wake-up call to politicians from all parties to start a long-overdue conversation about how to pay for health and social care in the future.

“As the report makes clear, spending on health and social care will need to increase in the future,” Ham said. “Investment in services has failed to keep pace with increasing levels of demand, making it impossible to maintain standards of care for an ageing population.

“The NHS has been hampered by cycles of boom and bust while social care has been systematically underfunded for many years. We need to start planning for the long-term, and regular independent assessments of funding needs.”

Ham added that his think tank agrees social care budgets should be moved to DH to allow for more seamless integration and act as a catalyst to integrate care.

Similarly, the Nuffield Trust’s chief economist, Professor John Appleby, said: “I am pleased that the committee has backed my proposal for an independent organisation to make recommendations to Parliament on future funding and demand for healthcare, as the Office for Budget Responsibility currently does for the Treasury on public spending.

“It is crucial, as the committee recognises, that the health service can plan for steady funding increases that are in line with what experts recommend, rather than the current regime of feast and famine.”

His colleague at the Fund, Candace Imison, director of policy and workforce expert, also added: “Shortages of staff have been exacerbated by years of bad planning, and are set to be worsened by the UK’s imminent departure from the European Union. 

“The committee is right to recognise that the long-term pay restraint imposed on the NHS workforce is having a serious impact on the health service’s ability to retain staff – we need to bear in mind that a large part of the efficiency savings so far produced by the NHS have come from this continued pay freeze for staff.”

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