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NHS finances state still 'perilous' from short-term fixes, MPs warn

GP roles need to expand to drive care away from hospitals

Adrian O'Dowd

Tuesday, 27 March 2018

Finances in the NHS are still in a ‘perilous’ state despite a rescue fund of around £1.8bn being injected in 2016-17, MPs have warned in a report published today.

The report from the parliamentary public accounts committee has also highlighted the lack of progress in recruiting badly needed additional GPs and for a boost to the roles of GPs to allow for more care to be delivered outside of hospitals.

In their Sustainability and transformation in the NHS report, the committee’s MPs said the NHS was stuck in what they called ‘survival mode’ as the government’s focus seemed only to be on short-term fixes.

The Department of Health and Social Care (DHSC) had used the £1.8bn Sustainability and Transformation Fund in 2016-17 to address the financial deficit in the trust sector, rather than improving and developing services for patients.

This cash injection had helped, said MPs, but budgets were still unable to keep pace with demand and it was clear that the DHSC, NHS England and NHS Improvement were too focused on propping up the system and balancing the books in the short-term.

These bodies had, “[…] not paid enough attention on transforming and improving patient services in the long-term,” says the report, which also criticises the DHSC for continuing to transfer money from its capital to its revenue budget without considering the long-term consequences on services and patient care.

This short-term view was apparent over the winter when, despite early warnings of a looming crisis, the chancellor only announced additional funding of £337m in November.

MPs concluded that given trusts were forecasting a deficit of more than £900m in 2017-18, the NHS still had a long way to go before it was financially sustainable.

“These cash injections paper over the cracks in NHS finances rather than achieve lasting improvement,” says the report.

“Even with additional funding, clinical commissioning groups and trusts are increasingly resorting to non-recurrent, one-off savings to balance their books.”

Staff shortages across the NHS were having a serious and negative impact on both the sustainability and transformation of services, said the MPs.

They argued that as well as keeping services afloat, an expansion in the responsibilities of key roles, such as those of GPs, was needed to shift more care out of hospital and into the community.

NHS England had various initiatives in place to boost recruitment and retention of GPs, but despite these, the number of full-time equivalent GPs has fallen in the last year, driven partly by GPs retiring early, they warned, adding that there were also worrying variations in unfilled GP training places across the country.

The report recommends that the DHSC and NHS England should, by May, report back to the committee on what action they are taking to tackle key workforce issues, including high levels of GP retirement and nursing shortages.

Committee chair Meg Hillier said: “The National Health Service continues to scrape by on emergency hand-outs and funds that were intended for essential investment.

“Rescue packages and budget transfers are no substitute for a coherent, properly funded strategy that enables NHS trusts to plan, focus on patient care and lay the groundwork for long-term financial sustainability.

“Government’s last-minute response to what were entirely predictable winter pressures is just the latest vivid demonstration of why fresh thinking is so desperately needed.”

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