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Government Accused of 'Paralysis by Analysis' on Integrated Care Plans

Flagship reforms to join up NHS and local government services are likely to fail until the Government gets to grips with systemic problems in healthcare, a parliamentary investigation found.

Funding issues, crumbling buildings, staffing shortfalls, and an elective care backlog need to be solved before integrated care systems (ICSs) stand a chance of succeeding, a report by the Commons Public Accounts Committee (PAC) warned. It also found that the Department of Health and Social Care (DHSC) was in the grip of "paralysis by analysis" in formulating its plans.

One Committee member, Anne Marie Morris MP, said while the ambition for ICSs was right, "the tool kit simply isn't there to deliver on it".

Joined Up Health and Care

ICSs are the latest attempt to bring the NHS, local authorities, and wider partners together, with a focus on longer term actions and preventative measures to improve population health. Introduced by legislation last year, 42 ICSs in England serve populations ranging in size from half-a-million to three-and-a-half million people.  

However, the spending watchdog said it was unclear what tangible benefits these bodies would create for patients, nor by how much or when improvements to population health would be seen.

Their capacity to bring about any change was hampered by long-standing issues in the NHS and the wider system, according to the report, which pointed to worsening NHS vacancy rates, standing at 9.7% last summer, and an "ongoing failure" by the DHSC to publish a national workforce strategy for dealing with the staffing shortfall.

Meanwhile, Government action to tackle workforce challenges in social care was set against a background of a 50% increase in vacancies last year, while the number of  people working in the sector fell in 2021-22 for the first time in at least 10 years, the report said.

Despite interdependency between the health and social care system, the Government's reforms did little to address "longstanding tension" caused by differences in funding and accountability, and their separate budgets represented a barrier for integration.

The report also highlighted the "increasingly decrepit" condition of the NHS estate and long delays in making decisions on capital projects. The PAC was told by the DHSC that it could expect a long-term strategy for capital spending in autumn 2020, then by autumn 2022, and now in early 2023.

The report also highlighted a "crisis" in dental care in some parts of England, and a failure by NHS England to produce adequate plans to address currently "threadbare" access to preventative or protective NHS dental care.

The PAC report found that while 77% of senior ICS staff considered that their body intended to invest in preventative measures, only 31% felt they currently had the capacity to do so.

'Government Seems Paralysed'

Commenting on its findings, PAC chair Dame Meg Hillier MP, said: "Far from improving the health of the nation, staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety. But Government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability.

"The ICS reforms have potential but there is no clear responsibility for ensuring that social care is properly integrated with health care 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. Government needs to get a grip on the wider, full-blown health and social care crisis it allowed to develop from long before the pandemic."

A spokesperson at the DHSC said: "Integrated care systems are a crucial part of the Government's 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 is right that there is transparency regarding spending across all parts of the health and care system. In November 2022 we announced an independent review into integrated care systems to look at their autonomy and accountability in the way they work.

"We are taking immediate action to reduce long waits for urgent and emergency care through our new recovery plan published last week, and we will publish a workforce plan this year focused on recruiting and retaining more staff."