Recommendation 24

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