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Integration

'NHS Long-Term Plan' integration efforts hindered by funding systems, says NAO

The National Audit Office says the ‘NHS Long-term Plan’ is “prudent” but a full assessment of its targets will depend on funding for social care and other, non-NHS England parts of the health service.

NHS funding systems “do not support” partnership working and integration, the National Audit Office (NAO) has warned.

The NAO’s concerns followed the publication of the ‘NHS Long-Term Plan’, part of which laid out plans to create integrated multidisciplinary teams of “GPs, pharmacists, district nurses, community geriatricians, dementia workers and [allied health professionals], such as physiotherapists and podiatrists/chiropodists”.

However, in its annual report on the financial sustainability of the NHS, published on 18 January 2019, the NAO said: “The current funding flows in the NHS are complicated and do not support partnership working, integration and the better management of demand.

“We have previously reported that NHS England and NHS Improvement could do more to create the right incentives for NHS bodies to collaborate.”

It continued: “NHS England and NHS Improvement have taken action intended to address this, including changes to centrally managed support funds announced in the ‘NHS Long-Term Plan’.”

As part of the plan, which was published on 7 January 2019, the NHS committed £4.5bn to setting up the multidisciplinary teams.

The NAO report added that although the plan “sets out a prudent approach to achieving the priorities and tests set by the government, in return for its long-term funding settlement, but a number of risks remain to the delivery of the plan”.

Among these risks, the NAO lists “the existence of substantial deficits in some parts of the system, offset by surpluses elsewhere, coupled with growing waiting lists and year-on-year increases in waiting times”.

As a result, the NAO recommends testing whether local plans to manage demand are realistic and identifying risks in the long-term plan.

Amyas Morse, comptroller and auditor general at the NAO, said: “The plan we have seen so far seems to be based on prudent assumptions, but we will really be able to assess whether the ambitions set forth are supported by funding when we can see the results of the spending review for the non-NHS England parts of the health service, and the funding for social care.”

Niall Dickson, chief executive of the NHS Confederation, said the extra money from government “did not cover key areas of health spending”, such as public health.

He added that to determine whether the long-term plan 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”.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206029

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