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Political culture of short-termism is questioning the sustainability of the NHS

The sustainability of the NHS is at risk with the government pursuing a “a culture of short-termism”.

That’s the conclusion of the House of Lords Select Committee, which has slammed the short-sightedness of successive governments for failing to plan effectively for the long-term future of the health service and adult social care.

The Committee makes it clear that a tax-funded, free-at-the-point-of-use NHS is the most efficient way of delivering health care and should remain in place now and in the future.

But, for that principle to remain, however, many aspects of the way the NHS delivers healthcare will have to change.

It recommends that a new, independent Office for Health and Care Sustainability should be established to look at health and care needs for the next 15-20 years and report to Parliament on the impact of changing demographic needs, the workforce and skills mix in the NHS and the stability of health and social care funding relative to demand.

A political consensus on the future of the health and care system is “not only desirable, it is achievable”, according to the Committee, and they call on the Government to initiate cross-party talks and a meaningful “national conversation”.

The Committee says that in the past funding has been “too volatile and poorly co-ordinated between health and social care”.

This has resulted in poor value for money and resources being allocated in ways which don’t meet patient needs.

In the future health funding will need to increase at least in line with growth in GDP, and NHS financial settlements should be agreed for an entire Parliament to enable effective planning.

Pressures in social care now pose a significant threat to the stability of the NHS so the Government needs to embark on a far more ambitious three-year programme to stabilise publicly-funded social care.

The Committee asserts that, beyond 2020, a key principle of the long-term settlement for social care should be that funding increases reflect changing need and are, “as a minimum, aligned with the rate of increase for NHS funding.”

The report says that the failure to implement a comprehensive long-term strategy to secure the appropriately skilled, well-trained and committed workforce that the health and care system will need is, the “biggest internal threat to the sustainability of the NHS.”

The report highlights the problems of over-burdensome regulation, unnecessary bureaucracy, a prolonged period of pay restraint, low levels of morale and retention problems.

The Committee points out that service transformation is at “the heart of securing the long-term future of the health and care systems.”

They argue that the model of primary care will need to change, secondary care will need to be reshaped and specialised services consolidated further. A renewed drive to realise integrated health and social care is badly needed.

Commenting, Lord Patel, Chairman of the Committee, cross bench peer and eminent obstetrician said: “The Department of Health at both the political and official level is failing to think beyond the next few years. There is a shocking lack of long-term strategic planning in the NHS. This short sightedness stems from the political importance of the NHS and the temptation for politicians to reach for short-term fixes not long-term solutions.

“To solve this we need a new body that is independent of government and is able to identify clearly the healthcare needs of a changing and ageing population and the staffing and funding the NHS will require to meet those needs.”

RCP President Jane Dacre added: “We agree with the long term ambition to move the NHS from an ‘illness’ service to a ‘wellness’ service, but as we outlined in our own evidence the current failure to protect and enhance the public health budget is at best short-sighted and at worst counter-productive.”


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