Recommendations & Conclusions
20 items
2
Recommendation
Thirty-Fifth Report - Introducing Integ…
Accepted
We remain very concerned about the critical shortages across the NHS workforce and the Department’s repeated delays in publishing a strategy to address them. Workforce shortages are widespread across the NHS, and particularly acute in some specialisms, for example midwifery. This can result in unsafe care for patients. This is …
Government response. The government agrees with the recommendation and will publish a long-term workforce plan for the NHS in 2023.
HM Treasury
3
Recommendation
Thirty-Fifth Report - Introducing Integ…
Rejected
The Department has started taking some action to address workforce challenges in social care, but vacancies have increased by 50% in the last year and the number of people working in social care fell in 2021/22 for the first time in at least 10 years. The NAO report sets out …
Government response. The government disagrees with the committee’s recommendation to provide a breakdown of how it spent and what impact it achieved and to set out the underlying reasons and forecasts for social care vacancies. The department will publish additional information on …
HM Treasury
4
Recommendation
Thirty-Fifth Report - Introducing Integ…
Rejected
These reforms do nothing to address the longstanding tension caused by differences in funding and accountability arrangements between the NHS and social care. The Department, which has policy responsibility for both health and social care, is showing a worrying lack of leadership, and it is not clear who will intervene …
Government response. The government disagrees with the recommendation to publish guidance for ICSs on resolving joint working issues, stating that the existing structures and processes are designed to ensure partners support each other.
HM Treasury
5
Recommendation
Thirty-Fifth Report - Introducing Integ…
Accepted in Part
The NHS estate is in an increasingly decrepit condition, but the Department seems unable to make timely decisions to address these problems. The NAO report found that the cost of tackling outstanding maintenance work on the NHS estate has now reached £9 billion, up from £5 billion seven years ago. …
Government response. The government agrees with the committee’s recommendation for a capital strategy, but suggests that updates are provided to the Committee as necessary rather than annually. Decisions affecting capital projects will be communicated via regular channels.
HM Treasury
6
Recommendation
Thirty-Fifth Report - Introducing Integ…
Accepted
NHS funded dental care is in crisis in some parts of the country, and NHS England’s failure to ensure people can access routine dental care is leading to more acute dental health problems. NHS England, rather than ICSs, remains responsible for most NHS dentistry but in some parts of the …
Government response. The government agrees with the committee’s recommendation and sets out the funding intended for NHS dentistry in 2022/23 and 2023/24. The government outlines several measures taken to secure recovery of dental access, improve accessibility and indicates people can attend any …
HM Treasury
1
Conclusion
Thirty-Fifth Report - Introducing Integ…
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department) and NHS England about the introduction of Integrated Care Systems (ICSs) in England.1
Government response. The government agrees with the Committee’s recommendation and states Integrated Care Systems will provide tangible benefits for local population, including the delivery of commitments that are set out in the government’s mandate to the NHS England and accompanying documents.
HM Treasury
7
Conclusion
Thirty-Fifth Report - Introducing Integ…
We are concerned ICSs may struggle to make progress on their longer-term aims to prevent ill-health, given pressure for progress on immediate national priorities, for example, the need to reduce elective care backlogs and bring down A&E and ambulance waiting times.15 We asked NHS England how ICSs can be expected …
HM Treasury
8
Conclusion
Thirty-Fifth Report - Introducing Integ…
We are also concerned about the lack of progress on preventing ill-health rather than simply treating it.17 There also do not appear to be effective joint working arrangements between different government departments to tackle the causes of ill-health.18 The Department began a consultation in July 2019, Advancing our health: prevention …
HM Treasury
9
Conclusion
Thirty-Fifth Report - Introducing Integ…
Accepted
The threadbare provision of NHS funded dental care is a further example of a failure to provide preventative or protective routine care leading to more acute health problems.24 NHS England, rather than ICSs, remains responsible for most of NHS dentistry provision in England.25 In some parts of the country it …
Government response. The government agrees with the committee's concerns and states that securing recovery of dental access is a key NHS priority, outlining existing measures such as funding allocations and reforms to the national dental contract.
HM Treasury
10
Conclusion
Thirty-Fifth Report - Introducing Integ…
Accepted
However, NHS England was unable to tell us how many more dentists it expected these reforms to produce, or by when they would appear. It told us that a sustainable solution required further engagement with the dental profession on the longer-term elements such as workforce and contract reform.29 NHS England …
Government response. The government agrees with the committee's concerns and states that securing recovery of dental access is a key NHS priority, outlining existing measures such as funding allocations and reforms to the national dental contract.
HM Treasury
11
Conclusion
Thirty-Fifth Report - Introducing Integ…
Rejected
There is a well-established interdependency between health and local government, with local authorities responsible for managing local social care markets. The stability and resilience of social services have a direct impact on the NHS. High-quality social care, if available, can keep people independent, healthy, and out of hospital.31 Despite the …
Government response. The government disagrees with the committee's recommendation, stating that the Health and Social Care Act 2022 is designed to ensure partners support each other and that they will take action if arrangements are not working.
HM Treasury
12
Conclusion
Thirty-Fifth Report - Introducing Integ…
Rejected
The oversight of ICSs largely focuses on the NHS elements, and we are concerned the wider system is being overlooked. NHS England has established a very detailed performance regime to monitor Integrated Care Boards’ contributions to NHS objectives. NHS England confirmed to us that it retains its power of intervention, …
Government response. The government disagrees with the Committee's recommendation, stating that the Health and Social Care Act 2022 is designed to ensure partners support each other and that they will take action if arrangements are not working.
HM Treasury
13
Recommendation
Thirty-Fifth Report - Introducing Integ…
Rejected
NHS England noted the importance of ICSs’ Integrated Care Boards working constructively with the full range of local partners, including local government, elected members, community groups and the voluntary sector.40 We highlighted the necessity of MPs being able to raise issues on behalf of their constituents who encounter problems with …
Government response. The government disagrees with the recommendation, stating that the Health and Social Care Act 2022 is designed to ensure partners support each other and resolve issues together, further reinforced by the NHS Act 2006's duties to co-operate.
HM Treasury
14
Conclusion
Thirty-Fifth Report - Introducing Integ…
Deferred
ICSs must contend with the legacy of an increasingly decrepit NHS estate and infrastructure. The NAO’s report highlights that the cost of the work needed to bring the NHS estate back up to scratch has increased from just under £5 billion in 2015–16 to an eye-watering £9 billion by 2020–21, …
Government response. The government agrees and states that plans for a capital strategy remain under consideration, and the strategy is intended to be published within 2023.
HM Treasury
15
Conclusion
Thirty-Fifth Report - Introducing Integ…
Deferred
We asked the Department about the limited extent of capital investment in the NHS. It told us that it had taken an explicit decision to reduce capital investment prior to the COVID-19 pandemic in the interests of managing budgets but accepted this has now put pressure onto capital programmes.48 The …
Government response. The government agrees and states that plans for a capital strategy remain under consideration, and the strategy is intended to be published within 2023.
HM Treasury
16
Recommendation
Thirty-Fifth Report - Introducing Integ…
Accepted
We have been raising concerns about the lack of long-term planning for the NHS workforce since well before the COVID-19 pandemic52. We have noted that among comparable OECD countries the UK has relatively low numbers of nurses and doctors per 1,000 population.53 The Department has repeatedly failed to make good …
Government response. The government commits to publishing a long-term workforce plan for the NHS in 2023.
HM Treasury
17
Conclusion
Thirty-Fifth Report - Introducing Integ…
Deferred
The January 2019 NHS Long Term Plan originally committed to producing a workforce implementation plan by late 2019. In September 2020, the Department told us that it expected to publish the workforce plan following the December 2020 Spending Review.59 In July 2021, it finally commissioned the work from NHS England …
Government response. The government agrees and committed to publishing a long-term workforce plan for the NHS in 2023.
HM Treasury
18
Recommendation
Thirty-Fifth Report - Introducing Integ…
Deferred
The social care workforce is in a similarly precarious position, against a wider backdrop of declining local authority resources.64 Despite the Department’s assurances that “the numbers are moving in the right direction”, vacancies in social care have been on an upward trend over the last ten years at a national …
Government response. The government agrees with the recommendation but defers implementation until April 2025, when interim findings of its formal evaluation of workforce reform initiatives will be available; an update on the breakdown of spend will be available in April 2024 and …
HM Treasury
19
Recommendation
Thirty-Fifth Report - Introducing Integ…
Rejected
The Department told us numbers in the social care workforce were going in the right direction and that domiciliary care and care home workforces were expanding.70 However, written evidence sent to us by the National Care Forum highlights that, as of October 2022, there were 165,000 vacancies in the sector …
Government response. The government disagrees with the Committee’s recommendation, stating that they don't hold further information to explain the underlying reasons for social care vacancies and don't produce forecasts for vacancies.
HM Treasury
20
Recommendation
Thirty-Fifth Report - Introducing Integ…
Deferred
We asked the Department what the £500 million Adult Social Care Discharge Fund would achieve. It informed us this funding would be used primarily for measures to support discharge from hospitals into social care, with an expectation that much would be focussed on the domiciliary care workforce.73 The Department also …
Government response. The government provided £500 million to support safe discharge from hospital into social care and will publish joint plans from local authorities and NHS integrated care boards shortly; it will provide more detailed analysis and findings of the fund's evaluation …
HM Treasury