NHS Must Be Given Financial Security To Move More Care Closer To Home Survey Reveals
A focus on short term NHS operational pressures and a lack of long-term financial security will stand in the way of health systems helping the government to achieve its ambition of delivering more care in the community and in primary care.
A major new survey from the NHS Confederation of integrated care system (ICS) leaders has found that while nine in 10 are committed to shifting more care out of hospitals, there are widespread concerns that a lack of long-term investment and planning is holding them back.
They support the government’s ambitions and want to increase investment in primary care and community services to prevent worsening ill health, as well as designing new models of care to keep patients out of hospitals. Without this, they will continue to be trapped in a short-term cycle of having to make budget cuts, rather than focusing on delivering care transformation.
ICS leaders warn that new directives on national priorities tend to focus on short-term performance and financial issues, which, while important, risk crowding out a concurrent focus on the longer-term changes they know are necessary to put the NHS on a more sustainable footing.
One of the most comprehensive surveys of ICS leader opinion, made up of chairs and chief executives across ICBs and ICPs and with responses from over 85% of England’s ICSs, found:
• Nine in 10 ICS leaders say their local system has made a strategic commitment to shift the allocation of resources to allow more people to be treated in their local community and access more care closer to home. But only 54% said they had made progress towards this.
• Nearly nine in 10 (87%) say they will not be able to meet their ambitions within their current budgets.
• Around 86% of leaders said they were worried the financial position of their local authorities will affect the delivery of their ICS’s ambitions.
• Only four in 10 leaders believe that accountabilities are well defined between ICSs and NHS England – this is despite ICSs having been established three years ago. This lack of clarity continues to cause confusion, especially when it comes to oversight of the performance of NHS providers.
One integrated care board chief financial officer told the NHS Confederation that a relentless focus on NHS finances “today” can inhibit “building for tomorrow” and several ICS leaders highlighted examples of where unclear accountabilities can lead to confusion and duplication.
These findings come after the Lord Darzi report highlighted that while a top-down reorganisation isn’t wanted or needed, the NHS has work to do to get a clearer accountability structure.
Kathy McLean, chair of the NHS Confederation’s ICS Network, said:
“ICS leaders are very positive about the impact they are having and the many examples in the report show the progress that is being made. They are committed to delivering their four purposes including shifting care closer to home and reducing inequalities in health outcomes.
“But as this report makes clear there are barriers that the government and NHS England need to help us overcome if this vision is to become a reality.
“Not only do they need more support to bring about these changes, but they need the freedom to focus on the long-term goals necessary to put the health and care system on a sustainable footing.
“ICS leaders accept that short-term performance and financial issues need to be addressed on behalf of their populations. But the focus on NHS finances risks crowding out the longer-term transformation ICSs were established to deliver.”
Sarah Walter, director of the NHS Confederation’s ICS Network, said:
“ICS leaders welcome the government’s commitment to transferring care closer to home.
“But they need the tools and support to make this happen and these aren’t yet in place. ICS leaders are still having to prioritise short-term funding and performance over the long-term changes they know are necessary to put the NHS on a sustainable footing.
“ICS leaders are positive about the impact they can make and want to make this shift, but it is difficult to move resources from acute trusts in particular when those trusts are struggling to meet demand with their current funding.
“ICSs and national government can be key delivery partners in making these changes, which are the only way to put the health and care system on a sustainable footing and improve the health and prosperity of the nation.”
