A new report by the Commons Public Accounts Committee raises serious questions over the reorganisation of England’s NHS into 42 new “Integrated Care Boards” (ICBs) last July.
Campaigners argued that the reorganisation, embodied in the controversial Health and Care Act 2022, would lead to a loss of local accountability, and that the new bodies would be mired in deficits and the quest for massive “efficiency savings” from the outset: and early surveys of the financial plight of ICBs tends to confirm that.
It now appears from the PAC’s analysis that there are few if any compensating benefits claimed by those
The first of the report’s conclusions begins: “It is not clear what tangible benefits for patients will arise from the move to ICSs, nor is it clear by how much or by when things will improve.”
It goes on to raised concerns over the lack of any workforce plan:
“We remain very concerned about the critical shortages across the NHS workforce and the Department’s repeated delays in publishing a strategy to address them. …The NHS Long Term Plan committed to producing a Workforce Implementation plan by late 2019, and in September 2020 the Department told us that it expected to publish it following the 2020 Spending Review. It still has not done so. … It is unclear how ICSs are supposed to plan for workforce shortages when the Department has not published a national plan, or the analysis underpinning it.”
It also notes the striking lack of any actual integration of NHS and social care, which are run and financed separately: “These reforms do nothing to address the longstanding tension caused by differences in funding and accountability arrangements between the NHS and social care. The Department, which has policy responsibility for both health and social care, is showing a worrying lack of leadership, and it is not clear who will intervene if relationships between local partners break down.”
And it points to the increasing problems of the growing backlog of maintenance (now £10.2bn) has left the NHS estate “in an increasingly decrepit condition”. The PAC calls on the Department and NHS England to “ensure the capital strategy is published in early 2023” along with “an annual progress update,” which “should also include details of when the Department and NHS England expect to make decisions that affect current and potential capital projects, to enable ICSs to plan with more certainty.”
It also concludes by demanding government action to address the crisis in NHS funded dental care in some parts of the country, “and NHS England’s failure to ensure people can access routine dental care.”
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