NHS and Department of Health officials are complacent and “out of ideas” when it comes to transforming the health service for patients, MPs have said.
The Public Accounts Committee (PAC) found that while the Government’s ambition for the NHS represents a “golden opportunity”, leaders at the Department of Health and NHS England (NHSE) are not ready to prioritise the shifts needed, instead arguing they are difficult and should take place slowly.
The cross-party committee accused NHS England of being “overly optimistic” regarding improving productivity in the NHS, adding that the financial position of the health service overall continues to worsen.
MPs said the Government’s NHS ambitions seem to “run counter to officials’ lack of ideas or drive to change”.
An NHS England spokesman said the report contained “factual inaccuracies” and productivity in the NHS had doubled compared with before the pandemic.
In September, Prime Minister Sir Keir Starmer laid out plans for “three big shifts” in the NHS: moving from hospital-based to community care; from analogue to digital; and from treating ill health to preventing people getting sick in the first place.
However, the PAC said that, under questioning, officials from both the Department for Health and Social Care (DHSC) and NHS England do not seem ready to take that on.
Sir Geoffrey Clifton-Brown, Conservative MP and chairman of the committee, said: “The current Government has told the public that the NHS is broken.
“This will not come as news to NHS patients, nor to its hard-working staff across the country.
“Nor indeed does it to this committee, which has long warned of the systemic issues plaguing the NHS, issues which the Government has transformative ambitions to address.
“We were aghast then, to find amongst senior officials in charge of delivering these ambitions some of the worst complacency displayed to the PAC in my time serving on it.
“The evidence given to our inquiry exposes the perennial weaknesses with which those scrutinising this country’s health systems are now very familiar.
“We therefore have a simple message for those senior officials responsible for delivery.
“Truly fresh ideas and radical energy must be generated to meet the scale of what is required – on community healthcare, on prevention, on digital transformation.
“Given the position of the NHS, forcing this committee to wade through treacle by mouthing the same stale platitudes of incremental change is simply not going to cut it.”
The report found that NHS England’s “long-held” ambition to move more care from hospitals to the community “has stalled”.
Furthermore, despite carrying out 15% more planned activity compared with before the pandemic, the NHS is less productive overall once the activities of mental health trusts, community trusts and GPs are considered.
The report said: “NHS England displays a remarkable complacency about the realisation of future NHS productivity improvements, which, if achieved, would be unprecedented.
“According to official ONS (Office for National Statistics) measures, long-term productivity gains in the NHS averaged 0.6% a year over the period 1996–97 to 2018–19. But productivity subsequently fell and has yet to recover fully.
“The NHS has 19% more staff compared to before the pandemic but is only seeing 14% more patients. Workforce issues such as sickness and absence continue to impact productivity.
“NHS England is confident that the annual productivity gains that it has committed to of 2% by 2028–29 can be achieved because it contends the last two years have been affected by ongoing disruptions such as industrial action, and that further recovery is still possible, particularly through technology-enabled change.
“However, NHSE was unable to convince us that it has a detailed plan to achieve the promised productivity gains, and it does not yet fully measure and capture productivity in important areas, such as mental health and community services.”
The report also said that “the switch to digital in parts of the NHS has been glacially slow”.
Money intended for technology has had to be redirected to plug spending deficits elsewhere.
The report noted that some NHS trusts still rely on fax machines, while others “are often still too reliant on paper records”.
This is despite the fact that hospitals with electronic patient records have productivity levels that are 13% higher than those without.
In the study, the MPs argued the Department of Health’s and NHS England’s approach to NHS finances “is typified by short-termism”.
The report also condemned officials for repeatedly failing to provide information about budgets in good time to local NHS systems, saying there was “disregard for basic principles of sound financial planning”.
It added: “Even as they write the new 10-year plan for the NHS, DHSC and NHSE have not convinced us that they are ready to give the three big shifts desired by government the priority they need.
“This left the impression that there was no real urgent motivation and readiness to drive the change in the NHS that is needed.”
An NHS England spokesman said: “The report from the PAC contains basic factual inaccuracies and a flawed understanding of how the NHS and the Government’s financial processes work.
“While NHS productivity is now improving at double pre-pandemic levels, far from being complacent, NHS England has repeatedly been open about the problem and the actions being taken to address it, including in the December public board meeting, and we will be publishing further improvement measures later this week in planning guidance.
“Reform is part of the NHS’s DNA and has ensured performance improvements for patients in the past year, including innovations such as virtual wards, despite the huge challenges the NHS has faced, including capital starvation, unprecedented strikes and a fragile social care sector.”
A Department of Health spokesman said: “We have been consistently clear that fixing the broken NHS and ensuring it is fit for the future requires urgent and radical reform.
“This will be a challenge, but health leaders in the NHS have said they will meet this task, and we will work with them to deliver it as part of our Plan for Change, as we shift healthcare from hospital into the community, from sickness to prevention and from analogue to digital.”