The report says the Government's NHS ambitions ‘run counter to officials' lack of ideas or drive to change'.

Sir Geoffrey Clifton-Brown, chair of the committee, said: ‘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.'

The MPs say senior health officials appeared ‘unambitious' about taking the radical steps required to implement the Government's 10-Year Plan and did not appear to prioritise its ‘three big shifts': hospital-based to community care; analogue to digital; and treating ill heath to prevention.

Health officials are accused of ‘letting slip a golden opportunity' by taking significant decisions to implement long-term health reform.

The report says the long-term ambition to shift care from hospitals has ‘stalled', adding the switch to digital has been ‘glacially slow' in parts of the NHS.

PAC adds assumptions of annual productivity gains of 2% by 2028-29 are ‘unconvincingly optimistic' and calls on Government to give local health bodies earlier certainty about how much they will have.

The report makes seven recommendations.

• DHSC, NHSE and the Treasury to publicly commit to issue guidance and meaningful indicative budgets to systems no later than Christmas and NHSE should approve ICB final budgets at least a month before the start of each financial year
• DHSC and NHSE to take a more planned and disciplined approach to ensuring that enough funding is allocated to those activities that can make the NHS fit for the future, particularly preventing ill health, community healthcare and digital technology. They should measure, track and report what they spend in these areas, and what they are achieving, so Parliament and the public can assess progress over time and should take actions to strengthen longer-term strategic financial planning
• NHSE to set out in detail which specific actions and initiatives it expects to contribute to the unprecedented increase in productivity it has committed to, and by how much. This should include specific measures to address poor staff retention and sickness rates, which contribute to low productivity
• NHSE to review current payment systems and processes to ensure they incentivise local systems to work with those most in need of help
• DHSC, NHSE and the Treasury to define what counts as health prevention spending for the whole of Government within the next six months and track that spending annually, using 2024-25 as a baseline year
• NHSE should ensure that, year on year, a greater proportion of its funding is spent in the community, in line with its own policy ambition. In any review of Continuing Healthcare funding and the Better Care Fund, DHSC and NHSE should not make changes that will see these community-based funds redirected to hospitals
• alongside its Treasury Minute response, NHSE to write back to the committee setting out its plans to reduce the reliance of NHS providers on paper within 18 months, including key milestones, and the proportion of NHS institutions it expects to be paperless at each milestone. A specific deadline should be set to end the use of fax machines within the NHS.

 

NHS England and DHSC response

An NHS England spokesperson said the report contained ‘basic factual inaccuracies and a flawed understanding of how the NHS and the Government's financial processes work'.

Far from being ‘complacent', NHSE said productivity was ‘double pre-pandemic levels' adding it had ‘repeatedly been open about the problem and the actions being taken to address it'.

On the claim the community shift had stalled, NHSE said investment in primary medical care and community services increased faster than overall ICB spend in 2023/24. NHSE said investment in mental health increased by £1.3bn in 2023/24 with 425,000 adults in mental health community services, above the target of 370,000.

NHSE added it was ‘incorrect' to say it is within its power to avoid budget delays. Giving evidence to the committee, chief financial officer, Julian Kelly, said ‘we actually need to know what our budget is in order to be able to give a budget'. NHSE said publication of annual priorities was ‘subject to cross Government clearance' and was published as soon as cleared.

Regarding falling technology spending, NHSE said it was ‘inaccurate' to say spending adjustments were made specifically to mitigate ICB's spending deficits. NHSE said there had been ‘real progress' in improving its digital offering, highlighting 95% of GP surgeries in England can use all the features of the NHS App and over 92% of practices allow patients to use the app to register.

Finally, NHSE said payment mechanisms can mean that local systems do not receive financial recognition when they prioritise hard-to-reach patients, adding ICB and primary care allocations were adjusted to reflect their deprivation, so areas with more deprived groups get additional funding to support outreach and tackle health inequalities.

An NHS spokesperson said: ‘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.'

A Department of Health and Social Care spokesperson said: ‘We have been consistently clear that fixing the broken NHS and ensuring it is fit for the future requires urgent and radical reform.

‘This will be a challenge, but health leaders in the NHS have said they will meet this task, and we will work with them to deliver it as part of our Plan for Change, as we shift healthcare from hospital into the community, from sickness to prevention and from analogue to digital.'