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• Read the full report: Financial sustainability of the NHS

Public bickering between key players running service does not inspire confidence

Its report, the latest in a series from the cross-party Committee examining the growing pressure on health finances, sets out new and urgent recommendations to government.

The Committee criticises "bickering in public" between key figures responsible for the health service at a time when the financial performance of NHS bodies has worsened considerably—a trend which is not sustainable.

It calls on the Department of Health, NHS England and No. 10 to work together "in the best interests of patients".

Transformation under such pressure is hard to achieve

The Committee warns that central government is asking local bodies "to solve multiple problems and deliver a range of priorities" without a proper understanding of what can be achieved, concluding:

"Transformation under such pressure is hard to achieve."

It highlights concerns that action to restore financial stability is affecting patients’ access to services and their experience of care, and warns of the potentially damaging consequences of "repeated raids" on investment funds to meet day-to-day spending.

Government has much more to do before the public can feel confident that local sustainability and transformation plans (STPs) are about delivering transformation and efficiencies "and not just a cover for cuts in services", the Committee concludes.

A "clear and transparent recovery plan" needs to be set out

Among its recommendations, the Committee says the Government should set out urgently a "clear and transparent recovery plan" targeting NHS bodies and health economies in severe financial difficulty.

NHS England and NHS Improvement must explain how they will support transformation in areas where STPs fall short and take action to "convince the public of the benefits of the plans to them".

Government should also publish its assessment of whether there is the capacity in NHS bodies "to deliver everything they are expected to within the agreed timeframes".

Further information needed on link between financial performance and patient care

By July the Government should report back to the Committee on what it has done to understand the link between financial performance and the impact on patient care.

It should also analyse the impact financial pressure in social care is having on the NHS and publish its findings.

Chair's comments

Meg Hillier MP, Chair of the PAC, said:

"The NHS as we know it is under threat from growing and unsustainable financial pressures.

Few trusts feel they have a credible plan for meeting the financial targets they have been set by Government.

At the same time, the Government seems unable to get its own house in order—plundering NHS investment funds to plug holes elsewhere, and falling out in public over its longer-term strategy.

Contradictory statements about funding from the Prime Minister and head of NHS England are an insult to taxpayers who deserve an honest, grown-up conversation about future finance and service provision.

Government's rigid adherence to a set of stock lines about funding, in the face of mounting evidence its plan isn't up to the job, is not it.

It is inconceivable the Government would allow a catastrophic failure in the NHS and we expect it to take targeted action now to support NHS bodies facing severe financial problems.

But let us be clear: this sticking-plaster approach is not sustainable, will not enable the NHS to get ahead of the problems it faces, and represents neither good value to taxpayers nor the best interests of patients.

We urge the Government to respond positively to the recommendations in this Report and make rapid progress in understanding and addressing these very real challenges."

Report summary

The Committee's evidence session began with the Head of NHS England speaking out against comments made in that day’s press by sources at No. 10.

We believe that the Department of Health, NHS England and No. 10 must work together in the best interests of patients.

The fact that key players running our NHS are bickering in public does little to inspire confidence that patients are at the heart of everyone's priorities.

United effort needed to resolve challenges

As this report underlines, the NHS is facing huge challenges. This requires a united effort to resolve these for the long term.

Faced with these pressures, the Department of Health has resorted to raiding the separate capital budget earmarked for long-term investment and is using this to fund day-to-day spending. 

Reducing investment in the hospital estate and medical equipment risks making the NHS less sustainable in the longer-term and limits the funding for investing in new services in the community. 

Pressures makes transformation hard

Local sustainability and transformation plans are supposed to be a vehicle for creating a modern day NHS, but NHS England and NHS Improvement have much more to do before the public can feel confident that plans are achievable, especially when the Head of NHS Improvement acknowledges that the 4% efficiency savings required are so challenging. 

We recognise the unprecedented challenge of achieving financial sustainability when patient demand is rising, budgets are tight and pressures in social care are impacting on the NHS.

But the Department, NHS England and NHS Improvement are asking local bodies to solve multiple problems and deliver a range of priorities, without a proper understanding of what they can realistically achieve.

Transformation under such pressure is hard to achieve.