The Long-term Sustainability of the NHS and Adult Social Care

On 5th April 2017 the House of Lords Select Committee on the Long-term Sustainability of the NHS published their report titled “The Long-term Sustainability of the NHS and Adult Social Care”. The report provides a series of recommendations for the government in order to improve the outlook for the NHS.

On 5th April 2017, the House of Lords Select Committee on the Long-term Sustainability of the NHS published a report of their inquiry into the sustainability issues facing the NHS: “The Long-term Sustainability of the NHS and Adult Social Care”.

The report is critical of previous efforts to effectively plan for the long-term future of the NHS, and provides a series of challenging recommendations for the government in order to improve the outlook for the NHS.

The recommendations have been welcomed by the likes of the Health Foundation and the Nuffield Trust, as well as many professional organisations. It has previously been suggested that 30-40% of Select Committee recommendations end up as government policy, but will this happen here?

As detailed below, one of the recommendation is ‘realistic and consistent funding’, but adequate funding underpins all of the recommendations. The elephant in the room is where this funding will come from: higher taxation or cutting funding to other public services. If the general public are unwilling to pay more taxes to fund the NHS, is it realistic to expect that these recommendations will be implemented?

Key recommendations from the report include:

1.       The Establishment of an Office for Health and Care Sustainability

The Select Committee state that there is a culture of short-termism in the NHS and adult social care, where the future is left to ‘take care of itself’. They propose that an Office for Health and Care Sustainability is established to look 15-20 years ahead into the future. This office should focus on:

1. the monitoring and publication of authoritative data relating to changing demographic trends, disease profiles and the expected pace of change relating to future service demand;
2. the workforce and skills mix implications of these changes; and
3. the stability of health and adult social care funding allocations relative to that demand, including the alignment between health and adult social care funding.

2.       Transforming Services

A renewed drive to integrate health and social care is badly needed. The Select Committee state that service transformation is key to achieving this goal and that with this focus there is no need for NHS England and NHS Improvement to co-exist. Thus, they conclude that the two should be merged to create a new body with “streamlined and simplified regulatory functions”.

3.       Realistic and Consistent Funding for Health and Adult Social Care

The Select Committee state that either a shift in government priorities or an increase in taxation is needed to sustain the NHS. Specifically:

• Health spending beyond 2020 needs to increase at least in line with GDP.
• The Government needs to provide further funding between now and 2020 for social care (beyond 2020 funding increases should be aligned with NHS funding increases at a minimum).
• Budgetary responsibility for adult social care at a national level should be transferred to the Department of Health.
• There should be a funding system for social care that enables those who can afford it to pay for the care they need but with the costs falling on individuals capped in the manner proposed by the Dilnot Commission .
• The Government should give serious consideration to an insurance-based scheme which would start in middle-age to cover care costs.

4.       The absence of long-term workforce planning

The Select Committee state that the biggest internal threat to the sustainability of the NHS is the inability to secure an appropriately skilled and committed workforce. Specifically they report that Health Education England needs to be substantially strengthened and transformed into an integrated strategic workforce planning body for health and social care with a rolling 10-year outlook.

5.       Innovation, technology and productivity

It should be made clear that the adoption of innovation and technology, after appropriate appraisal, across the NHS is a priority and the Government should decide who is ultimately responsible for this overall agenda.

Additionally, a newly unified NHS England and NHS Improvement should work with commissioners to achieve greater levels of consistency in NHS efficiency and performance at a local level.

6.       Public health, prevention and patient responsibility

The Select Committee state that continued cuts to the public health budget are short-sighted and counter-productive. The burden of disease could increase if these cuts continue, which is bound to result in a greater strain on all services. Therefore they recommend that the Government restores the funds which have been cut in recent years and maintain ring-fenced public health budgets for the next 10 years at a minimum.

Additionally, the Select Committee recommend that the Government is clear with the public that access to the NHS involves patient responsibilities as well as patient rights. They recommend that the NHS Constitution is redrafted and relaunched with a greater emphasis on these individual responsibilities.

Further information:

Watch or read evidence  given to the committee by leading health economists: Professor Alistair McGuire; Professor Andrew Street.

Listen to John Appleby’s (Nuffield Trust) Radio 4 programme entitled: Can the NHS Survive?