Source · Select Committees · Public Accounts Committee
Recommendation 23
23
Accepted
NHSE's top-down guidance significantly hinders local health systems' intended resource allocation autonomy.
Conclusion
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. ICBs were supposed to have greater autonomy in determining how to allocate resources locally compared to their predecessor bodies, including freedom to shape future local health services. However, there is widespread agreement that NHSE’s approach to planning and governance, in particular the all-encompassing nature of its top-down guidance, has meant negligible autonomy in the real world for local health systems.40 NHSE told us there are certain prevention programmes, such as for diabetes prevention or targeted lung health checks, where it made sense to fund activities nationally rather than giving local areas discretion over whether to deliver those services.41 Moving care from hospital to community
Government Response Summary
The department and NHSE recently announced changes to the NHS operating model to move power from the health centre to local leaders. 2025-26 Operational Planning Guidance removed many ringfences, giving local systems greater control and flexibility over how funding is deployed to best meet the needs of their population. NHSE will soon publish a revised NHS oversight framework that will reward those ICBs and providers that are doing well with greater financial freedoms and flexibilities. ICSs already have a duty to base their integrated care strategies upon local joint strategic needs assessments.
Government Response
Accepted
HM Government
Accepted
5.11 The department and NHSE recently announced changes to the NHS operating model to move power from the health centre to local leaders. In keeping with this change, 2025-26 Operational Planning Guidance removed many ringfences, giving local systems greater control and flexibility over how funding is deployed to best meet the needs of their population. 5.12 Additionally, NHSE will soon publish a revised NHS oversight framework that will reward those ICBs and providers that are doing well with greater financial freedoms and flexibilities. 5.13 To maximize the impact of investment, Integrated Care Systems (ICSs) already have a duty to base their integrated care strategies upon local joint strategic needs assessments (JSNAs). These JSNAs identify the areas and cohorts of greatest need in a system that providers and the ICB within the ICS are required to address.