In a recent publication the National Audit Office (NAO) gave its commentary on the NHS Long-Term Plan (LTP). The NAO response came soon after their own report into the current state of the NHS, in which they found that “of 442 local NHS organisations, with a combined spend of £100bn, 38% received ‘qualified opinions’, indicating that the bodies had not met savings targets and were struggling to balance their budgets”. This was an increase from the 29% of qualified opinions in 2015/16.
Major issues with the LTP highlighted by the NAO are current low staffing levels across the Service, and a tendency to short-term thinking. They say the plan:
“does not cover some key areas of health spending such as education, public health and capital investment that could affect the NHS’s ability to deliver the priorities of the long-term plan. In addition, without a long-term funding settlement for social care, local NHS bodies are concerned that it will be very difficult to make the NHS sustainable.
Previous NAO work also highlights that in the past funding boosts have been spent on dealing with immediate, short-term pressures with less devoted to the changes required for long term sustainability. There is also a risk that the extra funding will not be used effectively due to staff shortages as more money may be used to pay expensive agency staff or will go unspent as individual healthcare providers may not be able to recruit the staff to deliver additional activity.”
The Kings Fund echoed the points of the NAO analysis, discussing how complex finances in the NHS are. The Fund point out that many difficult decisions lie ahead to make the most of the money allocated to the NHS:
“Complex NHS finances are bedevilled by short-term fixes, fragile workarounds, and unrealistic expectations. It is striking that the NAO is unable to fully assess the financial health of the NHS because of these complexities.”
This week, a further response was published from NHS Clinical Commissioners (NHSCC). NHSCC are broadly positive about the LTP, as it should enable organisations to work together in its implementation. However, they acknowledge the limitations of the plan and its associated funding levels. Julie Wood, chief executive of NHS Clinical Commissioners, said:
“We recognise the overall findings from the NAO that the NHS’s current financial situation is unsustainable. Even though clinical commissioning groups (CCGs) delivered an unprecedented level of efficiency savings in 2017/18 – 3.1% of their allocations, equating to over £2bn – due to systemic pressures they are increasingly financially challenged.
“As we move towards more collaboration and system working, it is vital that financial and payment structures support this and resolve perverse incentives that encourage a focus on individual organisations as opposed to system working. This is something we have been calling for on behalf of our members for some time and were pleased to see the first steps towards payment reform included in the Long Term Plan.”