MPs have warned that government reforms to move to a system where services are commissioned by GP-led clinical commissioning groups are distracting NHS organisations and undermining efforts to cut NHS spending by £20 billion by 2014/15.
The report by the House of Commons Health Select Committee on Public Expenditure, published today, criticises NHS organisations for taking a short-termism approach to making savings and cutting services by “salami-slicing” rather than using innovation to rethink and redesign the way services are delivered to find savings.
Although the Committee agreed that it was too early to fully assess the implications of the types of saving being made in 2011–12, the first year of the QIPP programme, it said it was alarmed by evidence that NHS organisations were giving the highest priority to achieving short-term savings which allow them to meet their financial objectives in the current year, rather than planning service changes which would allow them to meet their financial and quality objectives in later years.
Reconfiguration taking place under the government’s NHS reforms was complicating the push for efficiency gains, the committee added. “Although it may have facilitated savings in some cases, we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings,” the report says.
The Committee pointed out that the long-term efficiency savings required of the NHS could only be made through such redesign and closer integration of health and social care. It said that the Nicholson Challenge can only be achieved by making fundamental changes to the way care is delivered.
“While the separate governance and funding systems make full-scale integration a challenging prospect, health and social care must be seen as two aspects of the same service and planned together in every area for there to be any chance of a high quality and efficient service being provided which meets the needs of the local population within the funding available,” it says.
“We would like to see best practice in this rolled out across the health service and underperforming commissioners held to account for failure to engage in this necessary process of change.”
Where some NHS funding has been transferred to social care (around 1% of the budget) and spent by agreement, the Committee found that overall it had been an effective use of funds. “The Committee believes that, as a matter of urgency, the Department of Health should investigate the practicalities of greater passporting of NHS funding to social care,” the report says.
However, MPs pointed out that £116m of the £648m intended to be spent through the NHS on improving the interface between health and social care had been spent on sustaining existing eligibility criteria to social care which was “deeply concerning” and “a lost opportunity to promote the necessary process of service integration”.
Launching the report, Stephen Dorrell, Chair of the Health Select Committee, said: “The NHS funding challenge can only be met by rethinking and redesigning the way health services are delivered now, in order to deliver lasting long term benefits.
As the health service and local authorities were struggling to make the demanding efficiency gains required of them by the 2010 Spending Review, while maintaining quality of care, he said: “The need to provide high-quality and efficient services that meet local needs within the funding available must be addressed as a matter of urgency. This requirement underlies the importance of developing new structures which deliver genuinely integrated services.”
Mike Farrar, chief executive of the NHS Confederation’s chief executive, said the report showed “how dangerous it could be for short-termism to dominate the response”.
"Anybody who thought the NHS was simply ‘protected’ is sleep walking into some serious difficulties,” he said
“We don’t want to see local NHS leaders making unplanned cuts in response to crises caused by problems that have festered. We need politicians to face the issues and to take the decisions that will allow people to plan properly.”
"More care can be provided in the community while some hospital services will need to close and be provided in larger specialist centres. This can be better for patients, particularly those who make up the vast majority of NHS patients: older people with various long term conditions.”
Professor Norman Williams, president of the Royal College of Surgeons, said that in too many parts of the country patients were being denied access to elective operations they needed on the basis of short-term and short-sighted cost cutting. “We have seen lists of forbidden procedures, pressure applied to GPs not to refer, blocks in referrals by third-parties and higher thresholds set before treatment is offered all of which have had a negative effect on patients. Cutting activity to balance the finances for the current year is a strategy that guarantees failure as those patients conditions worsen and the NHS eventually picks up the higher costs of emergency admissions or more complicated co-morbidity.”
Dr Jennifer Dixon, director of the Nuffield Trust, said the Committee's report was spot on and that the Health and Social Care Bill had been a distraction.
“There is a gap between the national rhetoric and the work being done on the ground in NHS Trusts to increase front line productivity. Recent data showing that the NHS is on track to deliver this year’s savings target obscures the worsening financial position of many NHS Trusts,” she said.
“To improve quality and lower costs, much more creative and radical thinking needs to take place. As the Committee suggests, the NHS and social care boundary is one place to start, another is to tackle long-ducked decisions around the reconfiguration of hospitals.”