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It ‘beggars belief’ that seven-day NHS plans are uncosted, say MPs

DH and its arm’s-length bodies have provided ineffective leadership and support to trusts

Louise Prime

Wednesday, 11 May 2016

It “beggars belief” that such a major policy as the seven-day NHS is being promoted to taxpayers with no coherent attempt to address its headcount implications and with such a flimsy notion of how it will be funded, the Public Accounts Committee (PAC) reported this morning – and it said the Government’s uncosted plans present a serious risk to public money. MPs criticised the Department of Health for providing ineffective leadership and support to trusts, and demanded that national bodies “need to get a better grip on the supply of clinical staff in order to address current and future workforce pressures”. Doctors’ leaders responded that the PAC’s conclusion “underlines the government’s failure to consider how it will staff and fund additional services when the NHS is struggling to provide existing services”.

In its report, the PAC called for an urgent review of NHS clinical staffing in England and raised serious concerns about supply, budgeting, agency costs and leadership. The cross-party committee warned that the Government has made “no coherent attempt” to assess the headcount implications of major policy initiatives such as the seven-day NHS. It found that the funding promise of an extra £10bn for the NHS by 2020 is a pot that the Department of Health  “seems to expect will cover everything – despite not having separately costed seven-day services and other initiatives”, and concluded: “We are therefore far from convinced that the Department has any assurance that the increase in funding will be sufficient to meet all of its policy objectives.”

In 2014, there was an overall shortfall of about 5.9% between the number of clinical staff that healthcare providers said they needed, and the number of staff in post – a gap of about 50,000 staff. The PAC found that the Government set unrealistic efficiency targets for NHS trusts and foundation trusts, encouraging them to adopt “overly optimistic and aggressive staffing profiles” that led to staffing shortfalls and the “significant increase” in agency costs to cover vacancies – it said the rise in agency costs was not, as NHS England had claimed, largely down to agencies ‘ripping off’ trusts. It added that clinical staff retention was poorly managed, creating further shortfalls, and that the current nursing shortage is expected to continue for the next three years. This undersupply of staff, it warned, inhibits trusts’ ability to provide services efficiently and effectively, and could lead to longer waiting times for treatment and poorer care.

PAC chair Meg Hillier MP commented: “Frontline staff such as doctors and nurses are the lifeblood of the service, yet the supply of these staff in England is not keeping pace with demand. This poor workforce planning means patients face the possibility of longer waiting times and a greater cost to the public purse.”

She went on: “Taxpayers are being asked to accept uncosted plans for a seven-day NHS – plans which therefore present a further serious risk to public money. It beggars belief that such a major policy should be advanced with so flimsy a notion of how it will be funded – namely from money earmarked to cover all additional spending in the NHS to the end of the decade.”

BMA Council chair Dr Mark Porter said: “At a time when there is growing evidence casting doubt on a ‘weekend effect’ – the basis for the government’s plans for expanding seven-day services – this report further underlines the government’s failure to consider how it will staff and fund additional services when the NHS is struggling to provide existing services.

“Despite what ministers claim, NHS funding has not kept up with rising patient demand and the increased cost of delivering care. Staff shortages are seen across the NHS, patients are waiting longer for appointments, and there is no real solution to the £22bn funding gap facing our health service.

“This situation is only set to get worse, not least because the government’s handling of the junior doctor contract which has alienated a generation of doctors. This is disastrous for the delivery of patient care in the long-term.”

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