Britians first medical schoolA new report from the Public Accounts Committee says that the NHS is facing huge challenges and a united effort is required to resolve these for the long term. The report is the latest in a series from the cross-party Committee examining the growing pressure on health finances. It also sets out new and urgent recommendations to government.

The Committee criticises "bickering in public" between key figures responsible for the health service at a time when the financial performance of NHS bodies has worsened considerably—a trend which is not sustainable. It calls on the Department of Health, NHS England and No. 10 to work together "in the best interests of patients".

The Committee warns that central government is asking local bodies "to solve multiple problems and deliver a range of priorities" without a proper understanding of what can be achieved, concluding: "Transformation under such pressure is hard to achieve."

It highlights concerns that action to restore financial stability is affecting patients’ access to services and their experience of care, and warns of the potentially damaging consequences of "repeated raids" on investment funds to meet day-to-day spending.

It also says that Government has much more to do before the public can feel confident that local sustainability and transformation plans (STPs) are about delivering transformation and efficiencies "and not just a cover for cuts in services".

Among its recommendations, the Committee says the Government should set out urgently a "clear and transparent recovery plan" targeting NHS bodies and health economies in severe financial difficulty. NHS England and NHS Improvement must explain how they will support transformation in areas where STPs fall short and take action to "convince the public of the benefits of the plans to them". Government should also publish its assessment of whether there is the capacity in NHS bodies "to deliver everything they are expected to within the agreed timeframes".

By July the Government should report back to the Committee on what it has done to understand the link between financial performance and the impact on patient care. It should also analyse the impact financial pressure in social care is having on the NHS and publish its findings.

Meg Hillier MP, Chair of the PAC, said: "The NHS as we know it is under threat from growing and unsustainable financial pressures. Few trusts feel they have a credible plan for meeting the financial targets they have been set by Government. At the same time, the Government seems unable to get its own house in order—plundering NHS investment funds to plug holes elsewhere, and falling out in public over its longer-term strategy. Contradictory statements about funding from the Prime Minister and head of NHS England are an insult to taxpayers who deserve an honest, grown-up conversation about future finance and service provision.

"Government's rigid adherence to a set of stock lines about funding, in the face of mounting evidence its plan isn't up to the job, is not it. It is inconceivable the Government would allow a catastrophic failure in the NHS and we expect it to take targeted action now to support NHS bodies facing severe financial problems. But let us be clear: this sticking-plaster approach is not sustainable, will not enable the NHS to get ahead of the problems it faces, and represents neither good value to taxpayers nor the best interests of patients. We urge the Government to respond positively to the recommendations in this Report and make rapid progress in understanding and addressing these very real challenges."

Responding to the report, Chris Ham, Chief Executive of The King’s Fund, said: "The committee is right to call on the government and NHS bodies to work more closely together in the interests of patients. Sustainability and transformation plans (STPs) are the best hope for delivering essential changes to NHS services, but we agree there is a huge amount of work to do, and lost ground to make up, in making the case for change to the public. Also, there must be absolute alignment between NHS England and NHS Improvement, both nationally and regionally, in their approaches to taking STPs forward. 

"There is no doubt that many of the plans need significant work, but where a convincing case for change has been made, ministers and local politicians should back NHS leaders in implementing essential and often long-overdue changes to services. The committee is right that the financial pressures facing the NHS are affecting patients’ access to care and, with finances set to get even tighter over the next couple of years, we expect this to get worse. The government must either find additional resources for health and social care or be honest with the public about the level of service it can expect with the funding currently provided."