Recommendations & Conclusions
5 items
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, …
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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, of which £4.5 billion was assessed as high or significant risk repairs.44 We have previously reported on capital expenditure pressures in the NHS and the Department’s ongoing failure to publish a capital funding strategy, which was originally due in 2019.45 The situation is exacerbated by the limited pots of capital funding in the NHS, and long delays to decision making for existing capital programmes. We highlighted the example of the Queen Elizabeth hospital in King’s Lynn, which currently has 3,000 timber and steel supports holding up a cracked aerated concrete roof.46 Staff and patients at the hospital have been waiting many years for a decision on whether they will be included in the government’s new hospitals programme, and we were told they must now wait until later this year for a decision that was most recently expected in spring.47
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Government response AI summary
The government agrees and states that plans for a capital strategy remain under consideration, and the strategy is intended to be published within 2023.
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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 …
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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 Department highlighted how Integrated Care Boards now have more discretion to target capital resources towards local priorities than under previous arrangements, and will also have greater flexibility to retain and deploy proceeds from asset disposals. However, when we pressed on whether this meant they will be able to keep all proceeds from such disposals, the Department told us that further guidance on how this flexibility will be managed would be provided by government in 39 Q 147 40 Q 42 41 Qq 38–39, 43–47 42 Q 46 43 Letter dated 26 November 2022 from Amanda Pritchard at NHS England to the Committee 44 C&AG’s Report, para 2.29 45 Committee of Public Accounts, NHS capital expenditure and financial management, Eighth report of Session 2019–21, HC 344, 8 July 2020 46 Qq 59–62, 66–67 47 Q 67 48 Q 61–62 14 Introducing Integrated Care Systems due course.49 In September 2020, the Department told us it would publish its long-term strategy for capital in Autumn 2020, and in June 2022 it told us that it would be published in Autumn 2022. The strategy remained unpublished at the time of the evidence session, and the Department has since written to inform us that it currently expects to publish the strategy in early 2023.50 51 NHS workforce
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Government response AI summary
The government agrees and states that plans for a capital strategy remain under consideration, and the strategy is intended to be published within 2023.
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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 …
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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 and Health Education England and expected to publish this in Spring 2022, but this date was again missed and the plan was still unpublished when we took evidence for this report.60 NHS England informed us it hoped to complete and deliver this work to the Department before Christmas 2022, or by the end of the financial year at the very latest.61 We asked the Department to commit to publishing the plan by April 2023, but it declined to do so and informed us key conclusions from the plan would be published by ministers in due 49 Qq 63–65 50 HM Treasury, Treasury Minutes, Government response to the Committee of Public Accounts on the Seventh to the Thirteenth reports from Session 2019–21, CP 291, September 2020 51 Letter dated 15 November 2022 from the Shona Dunn at the Department of Health & Social Care to the Committee 52 Committee of Public Accounts, Sustainability and transformation in the NHS, Twenty-Ninth report of Session 2017–19, HC 793, 27 March 2018 53 Committee of Public Accounts, NHS backlogs and waiting times in England, Forty-Fourth Report of Session 2021–22, HC 747, 16 March 2022 54 Qq 75–76, C&AG’s Report, paras 2.25–2.26, ICS0011, ICS0012, ICS0019, ICS0048 55 C&AG’s Report, paras 2.25, ICS0048 56 Qq 97–98, 100 57 Q 80 58 Q 82, C&AG’s Report, para 2.26, ICS0012 59 Committee of Public Accounts, NHS capital expenditure and financial management, Eighth report of Session 2019–21, HC 344, 8 July 2020 60 C&AG’s Report, para 2.28 61 Qq 85–87 Introducing Integrated Care Systems 15 course.62 Shortly after our evidence session, the Department committed to “publishing a comprehensive NHS workforce plan, including independently verified workforce forecasts
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Government response AI summary
The government agrees and committed to publishing a long-term workforce plan for the NHS in 2023.
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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 …
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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 level, rising from 4.4% in 2012–13 to 9.2% in 2020–21.65 Within ICSs, social care vacancies varied from 5% to 13% and turnover in roles range from 23% to 37% in 2020–21.66 The Department told us it is taking several steps to address this situation.67 These include recently launching a national advertising campaign to encourage people to work in social care; committing £500 million to the sector through its Adult Social Care Discharge Fund as part of the Plan For Patients; adding social care to the shortage occupation list, which it told us had resulted in between 10,000 and 15,000 new recruits from overseas; and working with the Department for Work and Pensions to better match jobseekers to social care roles.68 The Department also committed £500m for investment in the social care workforce in December 2021, as part of its white paper on adult social care reform People at the Heart of Care.69
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Government response AI summary
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 a plan for adult social …
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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 …
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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 noted this funding would be used differently in different places, and that it was for local authority and NHS partners within ICSs to decide, through place-based decision-making, how best to deploy resources for the greatest impact in their areas.74 62 Qq 74, 78, 88–90 63 HM Treasury, Autumn Statement 2022, 17 November 2022 64 Q 104, C&AG’s Report, para 2.35–2.36, ICS0012 65 C&AG’s Report, para 2.37, Q104 66 Q 133, C&AG’s Report, para 2.37 67 Q 104 68 Q 104, C&AG’s Report, para 3.9 69 C&AG’s Report, para 2.38 70 Q 104 71 ICS0013 72 C&AG’s Report, para 2.36, ICS0012 73 Q 134–136 74 Q 137 16 Introducing Integrated Care Systems
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Government response AI summary
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 in summer 2023.
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HM Treasury