Plans to radically reform the health service are at risk because senior leaders of both NHS England and the Department of Health and Social Care (DHSC) are “complacent” and lack dynamism, MPs have said.
In an excoriating report the public accounts committee (PAC) warns that officials in England have neither the ideas nor the drive to implement the health service transformation required by Keir Starmer and Wes Streeting.
The influential cross-party Commons committee did not identify individuals by name. But it reached its conclusions after questioning in November five top-level civil servants including Amanda Pritchard, NHS England’s chief executive, and Sir Chris Wormald, the DHSC’s then permanent secretary, who has since become the new cabinet secretary.
“The scale of government’s ambitions is great but senior officials do not seem to have ideas, or the drive, to match the level of change required, despite this being precisely the moment where such thinking is vital,” the PAC said in its report on the health service’s financial sustainability.
Their lack of energy and urgency risks wasting “a golden opportunity” to modernise how the NHS works and thus improve the country’s health, the MPs said.
Sir Geoffrey Clifton-Brown, the PAC’s chair, amplified its criticisms in remarks which stressed its longstanding concern about “systemic issues plaguing the NHS” and officials’ ability to fulfil the Labour government’s “transformative ambitions” to address them.
“We were aghast 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.
“Given the position of the NHS, forcing this committee to wade through treacle by mouthing the same platitudes of incremental change is simply not going to cut it.”
The report also highlighted a “lack of fresh thinking and decisive action within NHS England and DHSC” and accused health officials of being “out of ideas”.
The two bodies are working closely together to draw up the 10-year plan to overhaul the NHS and deliver the prime minister’s pledge to make it “fit for the future”. That is expected in May.
It will outline how the government intends to deliver its promised “three big shifts” in the NHS – from analogue to digital, from hospital to community-based care and from treatment to prevention, which are essential to save it from soaring costs and the relentless rise in demand for care.
But the PAC said that, based on the evidence it took, “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”.
Streeting, the health secretary, has previously spoken of his shock at the lack of joined-up working between his department and NHS England. They are now collaborating much better, officials say.
The PAC also voiced concern that:
The longstanding ambition to provide more care out of hospitals has “stalled”.
The NHS is making “glacial progress” in embracing modern methods of communication, with fax machines and paper records still in use.
NHS productivity is falling, despite there being a fifth more staff than before Covid.
NHS England’s pledge that it will save 2% of its annual budget through better productivity by 2028/29 is doubtful and shrouded in “remarkable complacency”.
NHS England disputed the PAC’s findings. “The report … contains basic factual inaccuracies and a flawed understanding of how the NHS and the government’s financial processes work,” a spokesperson said.
The NHS has doubled productivity savings from 0.9% pre-pandemic to 1.8% and acknowledged that the 2% ambition is “incredibly challenging”, sources pointed out.
The DHSC 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.”
