Set up independent ‘Office for Health and Care Scrutiny,’ Lords demand

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Set up independent ‘Office for Health and Care Scrutiny,’ Lords demand Peers slam serial failures to ensure sustainability of health and social care

Caroline White

Wednesday, 05 April 2017

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A new, independent Office for Health and Care Sustainability should be set up to look at health and care needs for the next 15-20 years, concludes a highly critical report* published today by the House of Lords Select Committee on the Long Term Sustainability of the NHS.

This body should report to parliament on the impact of changing demographic needs, the workforce and skills mix in the NHS, and the stability of health and social care funding relative to demand, says the report, which lambasts the “short-sightedness” of successive governments for their failure to plan adequately for the long-term future of health and social care provision.

The committee makes it clear that a tax-funded, free-at-the-point-of-use NHS is the most efficient way of delivering health care now and in the future. But for that to continue, many aspects of healthcare delivery will have to change, it says.

The NHS and social care have been dogged by “a culture of short-termism,” with the Department of Health unwilling or unable to look beyond the next few years, it says.

A political consensus on the future of the health and care system is “not only desirable, it is achievable” insists the committee, calling on the government to kick-start cross-party talks and a meaningful "national conversation.”

But the government will have to face up to the need for more money for health and social care, says the report, which argues that national and local public health budgets be ring-fenced for at least the next ten years.

Health funding will need to increase at least in line with growth in GDP, and NHS financial settlements should be agreed for an entire parliament to ensure effective planning, says the report, adding that beyond 2020, the government will have to boost social care, and at the very least align it with the increases in funding for the NHS.

Failure to implement a comprehensive long-term strategy to secure the appropriately skilled, well-trained and committed workforce that the health and care system will need is, the “biggest internal threat to the sustainability of the NHS,” says the report highlighting hindrances such as over-burdensome regulation, unnecessary red tape, a prolonged period of pay restraint, and low morale.

While service transformation is at “the heart of securing the long-term future of the health and care systems,” says the report, the model of primary care will need to change, secondary care will need to be reshaped, and specialised services consolidated further. A renewed drive to integrate health and social care is essential, it says.

Among its 34 recommendations, the report suggests that budgetary responsibility for adult social care at a national level should be transferred to a new Department of Health and Care.

The traditional small business model of GP services is no longer fit for purpose, it insists and recommends that NHS England should look at alternative models including direct employment.

NHS England and NHS improvement should be merged to create a new body with simplified regulatory functions and strong local government representation to reflect the increasing policy focus on integrated, place based care, it says.

And to try and redress recruitment and retention issues, the government should commission an independent review to look at the impact pay restraint has had.

Cross-bench peer and obstetrician, Lord Patel, who chaired the committee, accused the Department of Health of “a shocking lack of long-term strategic planning in the NHS.” 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,” he said.

A trusted independent body would help to redress this, he said, but pointed out: “We also need to recognise the NHS will need more money. NHS spending will need to rise at least as fast as GDP for 10 years after 2020.”

Lower paid staff had to be paid more, he said. “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.”

“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,” commented Dr Mark Porter, BMA Council Chair.

* The long-term sustainability of the NHS and adult social care. Select Committee on the Long-term Sustainability of the NHS. HL Paper 151, Report of Session 2016–17. Published by the authority of the House of Lords, April 2017.

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