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On 18 January, the National Audit Office (NAO) released the NHS financial sustainability plan.
The NAO’s annual report looked at figures from 2017-18 and found that the NHS is currently not sustainable and that the additional £20.5bn a year for the health service until 2023/24 – announced by Theresa May last year – and the much anticipated along term plan, which finally saw the light of day on 7 January, may not be enough to save it.
Within the report, the NAO outlines that there are many underlying problems in the NHS that need to be addressed in order for the plan to be successful, including large deficits at some trusts, staff shortages and growing patient waiting lists.
Here, Healthcare Leader takes a closer look at the sector’s reaction to the report.
The King’s Fund chief executive Richard Murray said the report has ‘laid bare’ the difficulties of achieving the ambitions inherent in the long term plan in the current climate.
He said: ‘Complex NHS finances are bedevilled by short-term fixes, fragile workarounds, and unrealistic expectations. It is striking that the NAO is unable to fully assess the financial health of the NHS because of these complexities.
‘The NHS long-term plan aims to stabilise the health service, but its success rests on important decisions that are yet to be taken.
‘The NAO report is right to highlight that the NHS funding settlement does not cover key areas of health spending such as public health, social care and doctor and nurse training. Those difficult decisions lie ahead.
‘NHS leaders have set out their ambition to focus on prevention and early diagnosis, but decisions on capital funding for diagnostic equipment won’t be made until the Government spending review later this year.’
Director of research and economics at the Health Foundation Anita Charlesworth said the publication of the long term plan is not equal to ‘job done’, especially when you take into account the ‘sustained’ cuts to public health, capital spending and workforce training budgets in recent years.
She said: ‘Unless the 2019 spending review provides funding increases at least equivalent to that received by NHS England, the NHS’s ability to deliver the commitments set out in the plan will be severely hindered.
‘The NHS has 100,000 fewer doctors, nurses and other health care professionals than it needs. Workforce shortages are the greatest threat to delivering high quality care to all those who need it.
But spending on training and education has fallen by 17% in real terms over the last five years. Cuts of this scale to investment in people undermine the future sustainability of the NHS.
‘It is essential that the Government takes heed of [the] clear, independent evidence and recognises that further investment is needed to shore up the health service and deliver the commitments outlined in the plan.’
The report highlighted staff shortages as a major concern, with the NAO saying that it’s possible some of the £20.5bn may not be used optimally, as expensive agency staff will be hired to make up the workforce shortfall.
There are also concerns that some of the money will go unspent, as even if commissioners have the right resources, healthcare providers may not have enough staff to deliver their plans.
Chief executive of NHS Providers Chris Hopson says: ‘The NAO is right to say that workforce shortages remain a significant risk to the NHS and its ability to deliver on this investment effectively.
‘The long term plan cannot be delivered while there are still over 100,000 staff vacancies across the NHS. We need urgent action on this and it is a major concern that we will have to wait until later in the year for a comprehensive workforce plan.’
Healthcare leaders have also expressed concern that, although the promised extra funding from the Government is welcome, it will not cover key areas of health spending.
Chief executive of NHS Confederation Niall Dickson said: ‘This [report] is a sober assessment. It is a reminder of the huge challenges facing the NHS in England. In spite of promised extra funding, the finances of our health system are in a precarious state.
‘The extra money from the Government is, of course, welcome but as the NAO highlights, it does not cover key areas of health spending such as education, public health and capital investment.
As we have also repeatedly pointed out, the NAO says this could affect the NHS’s ability to deliver the priorities of the long term plan. The same is true of social care funding.
‘All this says the NHS Long Term Plan is just part of the story.
To determine whether it can be delivered, we need to know the fate of those other vital areas of spending and it is regrettable that they have been delayed until the spending review, which will not kick in until 2020.’