The Public Accounts Committee (PAC) has published a new report that underlines that there is a lack of fresh thinking and decisive action within NHS England (NHSE) and the Department of Health and Social Care paired with overly optimistic planning assumptions as financial position continues to worsen. However, NHS England has described the report as “flawed”.

Entitled ‘NHS financial sustainability’, the PAC’s latest report delves into the NHS’ current financial position and makes a series of recommendations to the government.

The PAC warns that while the UK Government’s forthcoming 10-year plan will be essential to the health service’s recovery, senior health officials seem to be unambitious when it comes to taking the radical steps to begin to implement it.

The government has laid out its planned three big shifts: from hospital-based to community care; from analogue to digital; and from treating ill health to prevention.

However, in questioning both the Department for Health and Social Care (DHSC) and NHSE, the PAC found that officials do not seem ready to prioritise these shifts, agreeing with the government’s aims but arguing they are difficult and should take place only slowly, over the long-term, and not at the expense of patients now.

This risks letting slip a “golden opportunity” to take significant decisions for the longer-term benefit of the nation’s health, at precisely the moment where ideas to meet the level of change required would be highly desirable, according to the PAC. The report calls for the development of the 10-year plan to ensure enough funding is allocated to future-proofing the NHS, particularly on prevention, community healthcare, and digital technology.

The report makes specific recommendations in each of these three areas.

On community healthcare, the report finds that the long-held ambition to move more care from hospitals has stalled. It recommends that NHSE ensures that more funding, year on year, is spent in the community, in line with its own ambitions.

On prevention, it is likely that refocusing from treating sickness to prevention will require a similar shift of funds in the same direction. The PAC recommends that a definition be reached for what counts as prevention spending; that officials set out the funding increases required to achieve it; and for local systems to be given the required flexibility and autonomy to direct funds to the right areas.

On the switch to digital, the report argues that there is glacially slow progress in parts of the NHS. A number of trusts still work with fax machines, and NHS providers are often still too reliant on paper records, PAC states. The report calls for plans to reduce this reliance on paper within 18 months and a specific deadline to end the use of fax.

The report further notes unconvincingly optimistic assumptions underpinning current plans of annual productivity gains of two percent by 2028-29, calls on the government to give local health bodies earlier certainty about how much money they will have, and highlights perverse incentives around vaccination funding for GP surgeries which could be seeing more deprived areas losing out.

Sir Geoffrey Clifton-Brown MP, Chair of the Public Accounts Committee, said: “The current Government has told the public that the NHS is broken. This will not come as news to NHS patients, nor to its hard-working staff across the country. Nor indeed does it to this Committee, which has long warned of the systemic issues plaguing the NHS, issues which the Government has transformative ambitions to address.

“We were aghast, then, to find amongst senior officials in charge of delivering these ambitions some of the worst complacency displayed to the PAC in my time serving on it.

“The evidence given to our inquiry exposes the perennial weaknesses with which those scrutinising this country’s health systems are now very familiar. We therefore have a simple message for those senior officials responsible for delivery.

“Truly fresh ideas and radical energy must be generated to meet the scale of what is required – on community healthcare, on prevention, on digital transformation. Given the position of the NHS, forcing this Committee to wade through treacle by mouthing the same stale platitudes of incremental change is simply not going to cut it.”

However, NHSE has responded, underlining that the report features a “flawed” understanding of how the NHS and the government’s financial processes work.

An NHS spokesperson commented: “The report from the PAC contains basic factual inaccuracies and a flawed understanding of how the NHS and the government’s financial processes work.

“While NHS productivity is now improving at double pre-pandemic levels – far from being complacent, NHS England has repeatedly been open about the problem and the actions being taken to address it, including in the December public board meeting, and we will be publishing further improvement measures later this week in planning guidance.

“Reform is part of the NHS’ DNA and has ensured performance improvements for patients in the past year, including innovations such as virtual wards – despite the huge challenges the NHS has faced, including capital starvation, unprecedented strikes and a fragile social care sector.

“Lord Darzi’s report was clear many of the solutions can be found in parts of the NHS today, and we are working closely with the government to drive this innovation forward as we develop the ambitious 10 Year Health Plan to build an NHS which is fit for the future.”

In its response, NHSE specifically addresses some of the PAC’s key findings. For example, NHSE states that the NHS is not complacent when it comes to productivity and regularly discusses the challenges with productivity at its board meetings. NHSE also provides some specific examples where it has been open about productivity here and here.

Addressing the PAC’s concerns around community shift stalling, NHSE underlines that NHS investment in primary medical care and community services increased faster than overall integrated care board (ICB) spend in 2023/24.

NHSE also states that the report is incorrect to suggest it is within NHS’ power to avoid delays to budgets. NHSE’s publication of annual priorities and planning guidance for the NHS, alongside ICB financial allocations, is subject to cross-government clearance. It adds that NHSE publishes the guidance as soon as clearance is granted.

Responding specifically to technology spend falling, NHSE says that it and the DHSC consistently prioritise resources to support patients and frontline services. However, it is not accurate to say spending adjustments were made specifically to mitigate ICB’s spending deficits; decisions were made on a range of factors and to support various priorities, including staff pay deals.

In addition, NHSE emphasises that while it accepts there is “much further to go” on technology, it has made progress in improving its digital offering to patients and digitising the NHS itself. For example, patients at 95 percent of GP surgeries in England can use all the features of the NHS App, and over 92 percent of practices allow patients to use the app to register.