We have a new Cabinet, but experts are warning that the problems of funding and staffing the NHS will continue to become
more acute, writes James Douglas
Three Parliamentary watchdogs and think tanks have warned of increasing pressure on NHS funding with the prospect of more staff cuts and longer waiting lists. The cross-part public accounts committee (PAC) reported that the disproportionate growth in spending on specialised services poses a risk to the financial sustainability of the wider service.
In a new report the PAC concluded: “NHS England will need to make tough decisions” to stay within its budget for specialised commissioning and sets out a number of urgent recommendations.
NHS England took on responsibility for commissioning specialised services – of which there are nearly 150, covering a diverse range of disparate and complex services – in April 2013. But between 2013-14 and 2015-16, that budget increased from £13 billion to £14.6 billion, an average yearly increase of 6.3%. Over the period the budget for the NHS as a whole increased by 3.5% a year on average.
The PAC is concerned that NHS England and the Department of Health “painted an unduly healthy picture of the state of commissioning specialised services in England”, highlighting ongoing shortcomings in the collection of data and the potential impact this has on decision-making and efficiency.
The committee concluded that NHS England must take action to ensure new drugs and medical equipment are affordable; that services are delivered cost-effectively; and that demand for the specialised services it commissions is better managed.
Earlier, the King’s Fund said that staffing levels within the NHS will have to be cut if the government wants to bring NHS finances in England under control, adding that ministers must be honest about NHS spending plans at a time when patient demand is rising.
In the last financial year, trusts ran up a collective deficit of £2.4bn and the government’s aim is to cut that figure significantly by forcing hospitals and other trusts to stick to agreed spending limits.
But the King’s Fund warned that if the government wants to balance the health service books, then staffing levels will have to be reduced and waiting time targets relaxed, so patient care could be compromised.
Helen McKenna, senior policy adviser at the King’s Fund and one of the authors of the report, said: “Politicians need to be honest with the public about what the NHS can offer with the funding allocated to it.
“It is no longer credible to argue that the NHS can continue to meet increasing demand for services, deliver current standards of care and stay within its budget. This is widely understood within the NHS and now needs to be debated with the public.
“There are no easy choices, but it would be disastrous to adopt a mindset that fails to acknowledge the serious state of the NHS in England today.”
The Institute for Employment Studies for the Migration Advisory Committee also produced a wake-up call on NHS financing. It warned that a shortage of nurses in the UK will continue for years to come and could get worse. They blame the ageing workforce, poor planning by government and the risks from Brexit as key problems.
The report swiftly prompted the government to relax rules and grant up to 15,000 visas for nurses from outside the European single market over the next three years. But its publication was put off during the EU referendum, so it is only now that the full scale of the problem is revealed.
The report highlighted evidence showing the NHS was already short of nurses – with one in 10 posts unfilled. It said that as one in three nurses are over the age of 50, the NHS faces a retirement time bomb and warned the NHS will not have the nurses to plug the gaps.
It criticised workforce planning in the NHS, citing the 17% cut in nurse training places between 2009 and 2013. Since then the numbers have been increased but this has come too late, the report said.
The NHS has increasingly had to rely on recruiting nurses from abroad – over the past year more than a quarter of new recruits have come from overseas. Foreign nurses now make up 13% of the workforce with a third
of them coming from the EU.
Report author Rachel Marangozov believes nurses could be put off by the prospect of Brexit which, together with the other factors, means the recruitment of extra nurses from the rest of the world will “not be sufficient” to plug the gap in the workforce.
“The government needs to act now to ensure that the UK has a domestic supply of nurses to fill these future posts. This will require adequate and sustained investment in workforce planning,” she said.
Earlier this year a report by the cross-party Public Accounts Committee was also critical of nursing workforce planning.
There are around 360,000 nurses currently working in the NHS in England – with the Royal College of Nursing believing there is already a shortage of at least 20,000.
RCN general secretary Janet Davies said: “This report makes sobering reading and it is clear that without urgent action the UK is heading for a major nursing shortage. Thanks to years of short-term thinking, the UK is completely unprepared to deal with the challenges posed by an ageing workforce, increasing demand and now the uncertainty caused by leaving the EU.”
Ms Davies also warned that the plan to scrap nurse bursaries and make them pay for university courses – unlike other students they do not currently face fees to study – could make the situation even worse.
But a spokesman for Department of Health pointed out there were 11,000 more nurses on wards than there were in 2010 and training numbers are increasing.