NHS integrated care at risk from longstanding failings, warn MPs

A shake-up of Britain’s NHS aimed at ensuring health providers and local government work together more closely risks failure unless longstanding deficiencies in the service are addressed, MPs warned on Wednesday.

Parliament’s public accounts committee, which scrutinises public spending, said it was unclear what “tangible benefits” the overhaul would bring for patients and identified “a worrying lack of oversight” over how the new arrangements would work.

“Integrated care systems”, in which all the organisations delivering care in an area co-ordinate to plan services, have been operating informally for several years in some areas. They aim to prevent people from getting sick, or ensure they are treated before their conditions escalate, potentially easing pressure on hard-pressed hospitals. They became statutory bodies after legislation was passed by parliament in July.

However, the MPs said the huge problems confronting the NHS — including a record backlog of non-emergency treatment, gaping staff shortages in both health and social care, increasing demand and limits on funding — mean ICS may founder.

In a separate analysis published on Wednesday, economists Max Warner and Ben Zaranko, of the Institute for Fiscal Studies think-tank, concluded that waiting lists are likely to “more or less flatline over 2023” and start “falling meaningfully” only from mid-2024.

All these challenges required national leadership “but there is a worrying lack of oversight in the new system”, said the PAC report. It added that crucial national projects such as an NHS workforce plan and a capital funding strategy had been repeatedly delayed.

The MPs also raised concerns about the dilapidated state of NHS buildings, which have a repairs and maintenance backlog estimated to cost about £9bn.

Dame Meg Hillier, who chairs the committee, said the ICS reforms had potential “but there is no clear responsibility for ensuring that social care is properly integrated with healthcare or that patients will see the difference on the ground. Changes will not succeed if they are imposed on the NHS in its current state,” she added.

The MPs said they were “still unclear on what specific benefits ICSs are expected to achieve and are concerned it would take another three to 10 years for them to significantly improve population health outcomes”. They gave the example of 77 per cent of senior ICS staff saying they intended to invest in preventive measures, while only 31 per cent felt they currently had the capacity to do so.

The committee members urged the health department to write to them within six months and set out what “specific, measurable benefits” it expected to result from the move to the new integrated care systems “including a clear description of the benefits, relevant metrics, and the timeframe for achieving them”.

Sarah Walter, director of the ICS Network at the NHS Confederation, said the introduction of the new systems was overwhelmingly supported by the sector. But she added they had never been intended as “a silver bullet that will solve all the entrenched challenges facing the NHS and social care”.

“Judging their success on this, and after only seven months since entering the statute books, would be unfair as we know these macro issues require additional investment and support at a national level,” she said.

The government said ICSs were a crucial part of its “vision to bring together the NHS and local government to work jointly on improving health outcomes for people in their communities and tackle inequalities in access to care”.

It added that it was taking “immediate action to reduce long waits for urgent and emergency care” through a recovery plan published last week and would publish a workforce plan this year “focused on recruiting and retaining more staff”.