An NHS spokesperson said: “The report from the PAC contains basic factual inaccuracies and a flawed understanding of how the NHS and the government’s financial processes work.
“While NHS productivity is now improving at double pre-pandemic levels – far from being complacent, NHS England has repeatedly been open about the problem and the actions being taken to address it, including in the December public board meeting, and we will be publishing further improvement measures later this week in planning guidance.
“Reform is part of the NHS’ DNA and has ensured performance improvements for patients in the past year, including innovations such as virtual wards – despite the huge challenges the NHS has faced, including capital starvation, unprecedented strikes and a fragile social care sector.
“Lord Darzi’s report was clear many of the solutions can be found in parts of the NHS today, and we are working closely with the government to drive this innovation forward as we develop the ambitious 10 Year Health Plan to build an NHS which is fit for the future.”
Background
NHS “complacency” on productivity
- The NHS is far from complacent about productivity. We regularly discuss the challenges with productivity at our board meetings, including at our most recent December board meeting.
- Examples of where we have been open about productivity include:
- NHS England Board meeting in September – Amanada Pritchard said, “we have ongoing productivity challenges in the NHS and further progress to make”.
Community shift stalling
- NHS investment in primary medical care and community services increased faster than overall integrated care board (ICB) spend in 2023/24.
- The NHS continues to improve mental health services in the community. In 2023/24 the NHS increased investment in mental health by £1.3 billion compared to 2022/23, and saw 425k adults in transformed mental health community services, exceeding the annual target of 370k.
Earlier allocations
- It is incorrect to suggest it is within NHS’ power to avoid delays to budgets. As Julian Kelly said during his PAC appearance, “we clearly try to give early informal indications of what people should be expecting, but we actually need to know what our budget is in order to be able to give a budget.”
- NHS England’s publication of annual priorities and planning guidance for the NHS, alongside ICB financial allocations, is subject to cross government clearance.
- NHS England publishes the guidance as soon as clearance is granted, and in recent years this has happened the very same day.
Tech spend falling
- NHS England and DHSC consistently prioritise resources to support patients and frontline services – however, it is not accurate to say spending adjustments were made specifically to mitigate ICB’s spending deficits – decisions were made on a range of factors and to support various priorities, including staff pay deals.
- While we accept there is much further to go on technology – we have made real progress in improving our digital offering to patients and digitising the NHS itself. For example – patients at 95% of GP surgeries in England can use all the features of the NHS App and over 92% of practices allow patients to use the app to register.
NHS England’s payment mechanisms can mean that local systems do not receive financial recognition when they prioritise hard-to-reach patients.
- NHS allocations for primary care are adjusted to reflect their deprivation, so areas with more deprived groups get additional funding to support outreach. ICB allocations are also increased for deprivation to help tackle health inequalities.
- NHS investment in lung scans is benefitting deprived populations most – the Targeted Lung Health Check programme, which seeks to diagnose lung cancer at an early stage has now invited nearly 30% of the eligible population. The Rapid Cancer Registration Dataset shows that people from disadvantaged backgrounds are now most likely to be diagnosed with lung cancer at an early stage when it is more treatable.
- The NHS is investing in early intervention in mental health: Half of pupils in England will have access to Mental Health Support Teams as of Spring 2025 – exceeding the original commitment to cover 20%-25% of the country.
