With a nation desperate for action, politicians play the blame game.

Call To Action

A report has just been published by the Public Accounts Committee about what’s happening in the NHS, and it’s the sort of thing that wouldn’t usually attract much media coverage. After all, the Public Accounts Committee describe their role like this:

“The Public Accounts Committee examines the value for money of Government projects, programmes and service delivery.”

As you can imagine, their reports are often full of very dense detail, and (let’s be honest) this sort of thing can be quite boring to read. It certainly doesn’t lend itself to clickbait or exciting headlines. But this new report, entitled “NHS Financial Sustainability” (see what I mean?) is generating a lot of column inches because of its criticism of NHS leaders, and because of the defensive manner in which NHS England leaders have responded to the report.

It’s pricked my ears up too because I’m not sure that the criticisms within the report are fair..

The report, which can be found here, starts in a mild enough fashion. We’d probably all agree with the lines below…

“The NHS must be put on a financially sustainable footing if it is to deal with the multiple challenges it currently faces. These include an ageing population, increasing delays for ambulances and emergency treatment, and growing waiting lists for operations, all of which have led to public satisfaction levels with the NHS reaching all-time lows…”

But this is where any hint of conciliation end, and the tone changes swiftly as it goes on to say:

“Given the extent of these challenges, both the Department of Health and Social Care (DHSC) and NHS England (NHSE) seem complacent regarding the NHS’s finances. NHSE is also relying on the extremely optimistic assumption that it will achieve unprecedented productivity improvements of 2% each year by 2028–29, as part of the NHS’s recovery.

Both DHSC and NHSE tend to blame the NHS’s poor financial position on exceptional external factors, such as the Covid pandemic, inflation and industrial action.”

As the report goes on, it criticises financial planning within the NHS, which it says is:

“… severely hampered by delays in NHSE issuing planning instructions and approving final budgets”

They go on to criticise future projections about NHS productivity (essentially saying that NHS England is being too optimistic about potential future productivity), and also highlight the lack of progress that NHS England has made in three key areas. These are the areas that the new Labour government wants to focus on during this Parliament, namely the movement of “hospital to community”, “analogue to digital”, and “sickness to prevention”. The committee’s report is scathing about each of these current workstreams:

“Given the constraints on public spending, it is highly likely that refocusing attention from sickness to prevention cannot be achieved without re-allocating existing NHS funds in the same direction. Senior ICB (integrated care board) leaders report a continued lack of progress with the government’s long-standing aim to move towards preventing ill health rather than treating it” …

“NHSE’s long-held ambition to move more care from hospitals to the community has stalled”…

“Despite ambitions to improve productivity through the introduction of new technologies, the switch to digital in parts of the NHS has been glacially slow.”

Now, regular readers will know that I’m not uncritical of NHS England; as a campaigner I have had very negative experiences with the organisation on a number of occasions, and have found them to be terrible at engaging with stakeholders at key junctures. But that’s what makes this report even more surprising. NHS England is not usually the target of criticisms like these, and it’s interesting that fingers are being pointed at officials and healthcare leaders now.

Unsurprisingly, NHS England have not taken this report lightly. In fact they’ve hit back at the Public Accounts Committee quite aggressively. PoliticsHome described their action like this:

“NHS England responded with a strongly-worded statement accusing the report of containing “basic factual inaccuracies and a flawed understanding of how the NHS and the government’s financial processes work”.

The public retort from NHS England in the form of a press release can be found here if you’re interested.

With all of this back-and-forth and the “strong quotes” that are being given to the media from both sides, it can be difficult to know who’s in the right, and this can lead to a sense of unease. After all, does this report reveal important truths about NHS England? Should we be blaming healthcare leaders for the slow progress in the NHS, the lack of productivity, the problems? A situation like this often throws up more questions than answers.

But what is interesting about this report, and why I think it deserves attention, is that even if all of the things within it are true - that there’s a lack of proper planning, that there’s a lack of cohesion, that there are delays and stalled projects - then who is ultimately to blame for this? Is it the fault of government officials? Healthcare leaders? The clunky organisations struggling to pull things into place quickly enough as a new government gets going with their manifesto commitments?

Probably not. We need to be really honest about what’s happened to the NHS; the truth of the matter is that the national healthcare system has been pulled from pillar to post by successive governments for decades. It has endured and enacted a whole heap of “reforms”, all of which have been costly, all of which have involved enormous change and bureaucracy, some of which have been pointless or even harmful.

The truth of the matter is that the notion of “reform” is perennially attractive to politicians; they like to identify a thing, declare that it is broken, and then “fix it” in time for the next General Election. Many of these plans create more work than they fix. It is no wonder there is cynicism amongst experienced NHS staff; the eye-rolling amongst the workforce when they hear about more “reforms” is now constant and is well-earned.

The service itself is barely functioning in places, and this because of the actions of politicians. Buildings have been allowed to crumble, there is chronic understaffing, services have been cut and hospital bed pressures are sky-high. The service has lurched from crisis to crisis for over a decade, never with enough money, never with enough resourcing, and for all its faults NHS England has endured all of that too.

So if all of these criticisms of NHS England are true, then is it any wonder? Can an institution maintain its own efficiency and relentless progress while the service it runs goes through years of turmoil? Can officials really be expected to deliver consistent, excellent results when the NHS has been brought to its knees by politicians? Or are these criticisms, if true, simply the inevitable end-point of a decade and a half of managed decline of our public healthcare system, which is now impacting the people in charge of running the service? If the criticisms in this report are accurate, then no wonder, quite frankly. It would be extraordinary if NHS England wasn’t behaving sluggishly at this point.

Perhaps this was a report that needed to be written. I don’t doubt the responsibilities of the Public Accounts Committee and the importance of their work. But I would have hoped that the accompanying coverage would display more sensitivity from politicians about the long established challenges NHS officials have encountered for many years. I would have hoped that such strong criticisms didn’t need to be levied at, and then defended by, NHS England.

More broadly, I would hope that our new government would now choose to approach this situation with grace and nuance - reflecting thoughtfully on urgent priorities rather than pointing fingers. I’m not sure that’s going to happen though; I am deeply skeptical of Wes Streeting and his ability to manage such a serious and complex issue, and to put aside political games. But this report should be a wake up call, a call to arms for politicians to do things differently from now on, because NHS patients and staff deserve nothing less.