House of Lords Select Committee: long-term sustainability of the NHS: Evidence submission

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This evidence submission covers key factors in the long-term sustainability of the NHS, including resourcing, workforce, models of service delivery and integration, prevention and public engagement, and digitisation – and how these are likely to affect the future health care system.

  • The health and social care system is facing unprecedented financial pressures and will require fundamental change if it is to successfully respond to the challenges it faces over the next 20 years, including the needs of an ageing population, the changing burden of disease and rising public expectations.
  • As the Barker Commission recommended, a new settlement is needed that ends the historic divide between the health and social care systems by moving to a single, ring-fenced budget and a single local commissioner of services.
  • While there is scope to improve productivity, if increased funding is not forthcoming, the growing crisis in health and social care will become much worse, with patients waiting longer for treatment, quality of care compromised and access to publicly funded social care further restricted.
  • The UK spends less on health than countries such as Germany, France and the Netherlands, while public spending on social care will fall back to less than 1 per cent of GDP by the end of the parliament.
  • As the Barker Commission recommended, the long-term aim should be to increase spending on health and social care to the same level as in other comparable nations.
  • Increasing spending on health and social care is affordable and sustainable if hard choices are made about how to find the resources needed. The first step is for politicians to be honest with the public and to hold an open debate about how this should be paid for.
  • Demand for the future health and social care workforce is likely to exceed supply. An effective workforce strategy will be needed to address these challenges, while staff will also need to work differently, increasingly working across current professional boundaries.
  • New models of care, sustainability and transformation plans and the move to place-based systems of care offer significant opportunities to integrate care. However, genuine integration will be hard to achieve while the fundamental differences in funding and entitlements between the NHS and social care remain.
  • Unhealthy lifestyles have a negative impact on health and wellbeing and cost the NHS and the economy billions of pounds a year. The weakness of the childhood obesity plan highlights the need for a much bolder approach to improving public health that recognises the role that regulation and taxation have to play.
  • More needs to be done to strengthen the role of patients and service users as partners in their own care. The evidence shows that when people are involved in this way, decisions are better, health and health outcomes improve, and resources are allocated more efficiently.