Karin Smyth MP reflects on the way ahead following the Commons public accounts committee’s inquiry into the financial sustainability of the NHS

It’s winter, and so the state of the NHS inevitably has hit the headlines.

For my Bristol South constituents, it’s a huge ask to find a way through the reality of NHS financial sustainability. Even as Bristol South MP, a former NHS manager and a member of the Commons public accounts committee, it’s a challenge.

Add to that the numerous conversations I’ve been having over many months with NHS leaders in Bristol, and with former colleagues across the country. Spoon in the politics and seeing the wood for the trees is tricky. But I’ll give it a try.

Over the summer, autumn and in advance of Wednesday’s PAC meeting, I’ve worked closely with the National Audit Office and parliamentary colleagues to get beneath the headlines, to understand the numbers and to make sure we track the various inquiry responses the committee has received.

PAC’s discussions– involving NHS England chief executive Simon Stevens, Chris Hopson from NHS Providers and others – made headlines. But have they moved us on?

I believe they have. But importantly the task now is to ensure that the inquiry session and the evidence it provided helps us move forward in a constructive way. My Labour colleague Caroline Flint MP said earlier this week that we need to be a bit more “grown up”.

At PAC I returned to our sessions in September. Then it was recognised that money had been invested in the Five Year Forward View but that it was not what was asked for in years two, three and four, which meant there was a steeper mountain to climb.

From the Department of Health’s perspective success was contingent on reducing demand and adopting healthier lifestyles and, from NHS England’s, on social care keeping up with demand and the continued availability of preventive health services.

Yesterday I asked “How is demand going?” I pressed officials on why since 2014, when the Five Year Forward View plan was produced, demand has increased, as everyone from the prime minister down is saying we are now busier than ever? I didn’t get an answer.

I did get a clear answer to the question “Is social care keeping up with demand?” The answer is “no”.

Adding to queries around basic assumptions underpinning the plan we have had no re-assessment of the implications that we ended last year in a worse financial state than anticipated. There is:-

  • less money this year than planned
  • no allowance for seven-day working, and
  • no consideration of the impact of Brexit (mainly on the drugs bill and workforce-related risk)

So, with assumptions not met, I asked the Department of Health if they were asking the NHS for a refresh of the plan because it is not now financially fit-for-purpose. Chris Wormald, the DH’s permanent secretary, said he didn’t accept my premise. But Simon Stevens jumped in to say that yes, that is what they are doing!

We went on to be reminded that NHS England has to produce a financial plan at year-end. This year they will do a two-year plan, based on where we are to date in the Five Year Forward View, as well as the cumulative implications of the 44 NHS sustainability and transformation plans. This will happen at the end of March. A “refresh” of plans will be published and no doubt reviewed.

But we need to be clear: you do get what you pay for. And we have fallen behind comparable countries in terms of our level of funding

Most agree the vision is the right one. But if the money is fixed and the circumstances of the plans have changed then we do need an explicit acknowledgement in March of the real choices now being faced by staff in the NHS and by patients as they seek help.

Headlines come and go, but the NHS is so pivotal to our society that various committees, MPs, informed journalists and think tanks will continue to work diligently. They will examine the government’s position that the NHS has the funds it needs. The politics will continue unabated.

We can all be grown up. But we need to be clear: you do get what you pay for. And we have fallen behind comparable countries in terms of our level of funding. Huge efficiencies have been gained and there are more in the system but this cannot overcome the scale of underfunding of social care and our NHS.

The PAC meeting is a significant landmark: a staging post in a long, difficult but important part of the process. But let us be clear: the next few weeks of bad weather, the summation of the STPs, and the NHS England financial refresh to be published in March won’t be the end. Far from it.

Karin Smyth is MP for Bristol South