Recommendations & Conclusions
8 items
5
Recommendation
5th Report - NHS financial sustainabili…
Deferred
Given the constraints on public spending, it is highly likely that re- focusing attention from sickness to prevention cannot be achieved without re-allocating existing NHS funds in the same direction. Senior ICB leaders report a continued lack of progress with the government’s long-standing aim to move towards preventing ill health …
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Given the constraints on public spending, it is highly likely that re- focusing attention from sickness to prevention cannot be achieved without re-allocating existing NHS funds in the same direction. Senior ICB leaders report a continued lack of progress with the government’s long-standing aim to move towards preventing ill health rather than 5 treating it. Furthermore, the public health grant used by local authorities to commission preventative measures such as health-visiting and drug and alcohol services is expected to fall in value by £193 million (5%) over the period 2022–23 to 2024–25 (at 2022–23 prices), despite government’s commitment in 2021 to maintain it in real terms. However, DHSC does not view providing more resources for prevention as a substantive part of the solution. Instead, it considers that a shift towards prevention might be achieved through longer-term legislative and culture change to tackle issues such as obesity, physical activity and poor air quality alongside a shift in the way GPs advise patients. Both DHSC and NHSE see the 10-year health plan as an opportunity to crystallise their prevention ambitions, but the lack of a precise definition of what even counts as prevention spending will make assessing progress against this vital policy aim impossible. Local areas would value more flexibility about where they can direct their resources to achieve greatest impact, including how they fund measures to prevent ill health. recommendation a. DHSC, NHSE and HMT should define what counts as health prevention spending for the whole of government within the next six months, and track that spending annually, using 2024–25 as a baseline year. b. DHSC and NHSE should set out the funding increases required for prevention and give local systems the flexibility and autonomy they need to direct this funding where it can have the greatest impact.
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Government response AI summary
The government is considering defining health prevention spending, deferring to the upcoming 10 Year Health Plan and Spending Review Phase 2. It notes that 2025-26 planning guidance has removed many ringfences for local flexibility and NHS England will soon publish a revised oversight framework.
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HM Treasury
6
Conclusion
5th Report - NHS financial sustainabili…
Deferred
NHSE’s long-held ambition to move more care from hospitals to the community has stalled. There would have been more investment and progress in mental health and community services, particularly GP surgeries and dental services, in 2023–24 had NHSE not redirected funding to prop up the day-to-day spending of local NHS …
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NHSE’s long-held ambition to move more care from hospitals to the community has stalled. There would have been more investment and progress in mental health and community services, particularly GP surgeries and dental services, in 2023–24 had NHSE not redirected funding to prop up the day-to-day spending of local NHS systems. Despite carrying out 15% more elective activity compared to before the pandemic, the NHS is less productive overall once the activities of mental health trusts, community trusts and GPs are considered. NHSE makes trade-offs between spending that will yield benefits in the longer term and spending to meet current priorities, and it acknowledges funding increases for mental health and community services are slow. NHSE recognises there is value in considering whether best use is currently being made of funding for Continuing Healthcare assessments and the Better Care Fund, intended to support joint working between the NHS and social care. 6 recommendation NHSE should ensure that, year on year, a greater proportion of its funding is spent in the community, in line with its own policy ambition. Any review of Continuing Healthcare funding and the Better Care Fund, DHSC and NHSE should not make changes that will see these community-based funds redirected to hospitals.
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Government response AI summary
The government is considering the recommendation, stating it will be addressed within the 10 Year Health Plan and multi-year Spending Review for decisions on shifting funding to community care. It highlights increased mental health spending in 2023-24 and the maintenance of Better Care Fund funding …
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HM Treasury
1
Conclusion
5th Report - NHS financial sustainabili…
Deferred
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (DHSC), NHS England (NHSE), and HM Treasury (HMT) on the financial management and financial sustainability of the NHS in England.1
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On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (DHSC), NHS England (NHSE), and HM Treasury (HMT) on the financial management and financial sustainability of the NHS in England.1
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Government response AI summary
The government states it is working with NHS England to publish planning guidance earlier and aims to improve the planning process for future years. It defers further consideration of this recommendation to the upcoming 10 Year Health Plan.
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HM Treasury
19
Conclusion
5th Report - NHS financial sustainabili…
Deferred
DHSC described how the new government had set out three shifts that they want to see in the NHS: from analogue to digital; from treatment to prevention; and from acute to community. DHSC said that it wanted “to see those shifts over time, but not at the expense of patients …
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DHSC described how the new government had set out three shifts that they want to see in the NHS: from analogue to digital; from treatment to prevention; and from acute to community. DHSC said that it wanted “to see those shifts over time, but not at the expense of patients now.33 Focusing on preventing ill health
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Government response AI summary
The government is considering measures for supporting the prevention shift in the context of the work of the 10 Year Health Plan and does not wish to pre-empt the content, but will consider defining health prevention spend as an enabler and will notify the Committee …
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HM Treasury
20
Conclusion
5th Report - NHS financial sustainabili…
Deferred
Senior ICB leaders reported to the National Audit Office a continued lack of progress with the government’s long-standing aim to move towards preventing ill health rather than treating it. One of the most important reasons cited by ICBs has been the focus on other pressing national priorities, particularly elective care …
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Senior ICB leaders reported to the National Audit Office a continued lack of progress with the government’s long-standing aim to move towards preventing ill health rather than treating it. One of the most important reasons cited by ICBs has been the focus on other pressing national priorities, particularly elective care backlogs and acute services, which has meant they have had little additional headroom to grow preventative services as they would have wanted to.34 The public health grant used by local authorities to commission preventative measures such as health visiting and drug and alcohol services is expected to fall by £193 million (5%) between 2022–23 and 2024–25 (at 2022–23 prices), despite government’s commitment in the 2021 spending review to maintain it in real terms.35
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Government response AI summary
The government states that measures for supporting the prevention shift are being considered in context of the work of the 10 Year Health Plan.
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HM Treasury
21
Conclusion
5th Report - NHS financial sustainabili…
Deferred
DHSC told us it did not view providing more resources, or redirecting them from elsewhere, as a substantive part of the solution to the lack of progress with prevention. Instead, it considers that a shift towards prevention might be achieved through longer-term changes in culture, public attitudes and the legislative …
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DHSC told us it did not view providing more resources, or redirecting them from elsewhere, as a substantive part of the solution to the lack of progress with prevention. Instead, it considers that a shift towards prevention might be achieved through longer-term changes in culture, public attitudes and the legislative environment.36 There is a role for GPs to advise patients, and hospitals might choose to reach out into communities to carry out preventative measures.37 NHSE told us it viewed the 10-year health plan as 33 Q 29 34 C&AG’s Report, para 4.14 35 C&AG’s Report, para 4.20 36 Q32 37 Q 32 14 an opportunity to crystallise ambitions around prevention, but warned there would be difficult trade-offs to consider between actions which may only deliver a longer-term benefit and actions that meet a priority today.38
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Government response AI summary
The government is considering measures for supporting the prevention shift in the context of the work of the 10 Year Health Plan and does not wish to pre-empt the content, but will consider defining health prevention spend as an enabler and will notify the Committee …
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HM Treasury
22
Conclusion
5th Report - NHS financial sustainabili…
Deferred
Currently, NHSE does not even track spend and activity on prevention by ICBs at local levels, due to unavailability of data and the lack of consistency about what counts as prevention spending. While DHSC funds some prevention activities that sit outside the NHS, primarily through its Office for Health Improvement …
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Currently, NHSE does not even track spend and activity on prevention by ICBs at local levels, due to unavailability of data and the lack of consistency about what counts as prevention spending. While DHSC funds some prevention activities that sit outside the NHS, primarily through its Office for Health Improvement and Disparities (OHID), it similarly lacks a precise definition of what counts as prevention spending. This makes assessing the extent of spending and progress against this important policy aim impossible.39
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Government response AI summary
The government states that defining health prevention spend could enable a shift from sickness to prevention, and that this recommendation will be considered in the context of developing the 10 Year Health Plan.
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HM Treasury
24
Conclusion
5th Report - NHS financial sustainabili…
Deferred
Despite carrying out 15% more elective activity than before the pandemic, the NHS is less productive overall once the activities of mental health trusts, community trusts and GPs are considered.42 NHSE told us that, while government has had a long-term aim to shift more care and services into local communities, …
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Despite carrying out 15% more elective activity than before the pandemic, the NHS is less productive overall once the activities of mental health trusts, community trusts and GPs are considered.42 NHSE told us that, while government has had a long-term aim to shift more care and services into local communities, funding increases for these services had often been slow.43 However, it highlighted how recent capacity investments had been in community services rather than hospitals, for example in 12,500 virtual ward beds in people’s homes, and had focussed on the data and technology needed to support moving more care into the home.44 NHSE acknowledged 38 Q 37 39 C&AG’s Report, paras 4.15 to 4.16 40 C&AG’s Report, para 2.12 41 Q 48 42 Q 12 43 Q 37 44 Q 29 15 that there would have been more investment and progress in enhancing community services in 2023–24 had it not been obliged to redirect funding to prop up the day-to-day spending of local NHS systems.45 NHSE recognised there may be value in considering whether best use is currently being made of the Better Care Fund, intended to support joint working between the NHS and social care, and assessments of continuing healthcare needs outside of hospitals. NHSE said a review of the Better Care Fund might sensibly re-evaluate the structures that currently surround the fund and the content of what its money is being spent on. NHSE reported that it was increasingly seeing improved system working at local level, particularly regarding annual planning processes.46 However, DHSC acknowledged that there were still many problems underlying joint working between health and local authorities, primarily due to having to integrate a service that answers nationally to ministers and a service that answers locally to councillors, with significant variation evident across the country.47 Switching to digital
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Government response AI summary
NHSE, with DHSC, is focusing on enabling a greater shift from hospital to community – including considering how funding decisions over coming years can support this through the 10 Year Health Plan and the multi-year Spending Review. This recommendation is therefore under consideration and The …
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HM Treasury