“The government must show more urgency in addressing regional health funding imbalances, MPs have warned.
The Public Accounts Committee has also expressed concern about the Department of Health and Social Care’s lack of planning for staffing and medical equipment after Brexit, in a report out today.
The MPs noted there was “significant regional variation” in funding of NHS providers and clinical commissioning groups. DHSC’s 2017-18 annual report and accounts suggest an improvement in finances when taken as a whole but this “masks the underlying deficits at local level”, the PAC report said.
MPs said the department was performing a “balancing act” by offsetting NHS providers’ deficits with a surplus from NHS England’s finances. In 2017-18, 101 of 234 NHS providers were in deficit, although this was mitigated by NHS England’s surplus, the report said. Although, 75 of the 207 CCGs reporting an overspend in the same year.
PAC chair, Meg Hillier, said the number of CCGs overspending was “concerning”.
She added: “The Department of Health and Social Care must show far more urgency in getting to grips with regional funding imbalances and demonstrate it understand the effects these have at the frontline.”
The report was also critical of DHSC’s planning for Brexit, especially around staffing and medical equipment.
It said there is a “lack of a clear plan” for recruiting staff post-Brexit and added: “We are not reassured by the department’s assertion that it has not seen a large exodus of staff since the referendum and that the number of people from the EU working in the NHS has increased.”
Health bodies recently warned that the NHS workforce shortfall could jump from 100,000 at present to almost 250,000 by 2030 without effective planning.
Despite the NHS procuring 56% of medical consumables (gloves, dressings, syringes) from, or via, the EU, DHSC is not putting specific contingency measures in place to stockpile this type of equipment, the PAC revealed.
Hillier said: “The department’s lack of clear Brexit planning could threaten the supply of medical equipment. Staff shortages could deepen. The potential consequences for patients are serious.
“These and other uncertainties are amplified by the continued absence of the government’s promised 10-year plan for the NHS, its promised plans for social care, and its promised plans for immigration.” A DHSC source has confirmed to PF the social care green paper and NHS 10-year plan are now likely to be published in the new year, rather than by the end of this year, as originally intended.
Regional variances in staff vacancies could also be overlooked, the PAC noted. The NHS examines vacancy rates at a national level – rather than a local level – which “hides underlying disparities in specific specialisms and local areas and does not allow them to fully understand the impact of staff shortages,” the report said.
The report also expressed concern that the NHS staff pay rise announced earlier this year would not be distributed fairly. By funding pay awards through the National Tariff the PAC is concerned that NHS Providers in more affluent areas will receive “disproportionately higher share of funding” because the tariff accounts for the cost of operating in different geographical locations.
DHSC has been contacted for comment.”
“Buses are the most common mode of public transport, accounting for 60% of all trips.
But on the buses, passenger numbers are falling.
There were 9% fewer journeys on local bus services in Britain in the first three months of this financial year than in the same period a decade ago.
The Campaign for Better Transport says this is partly down to cuts to the amount local authorities England and Wales are spending on buses.
In the past seven years, council spending on buses has fallen by 45%, according to figures released to the campaign group under the Freedom of Information law.
Outside London, buses are largely run by private companies, which make their money from passenger fares. Then, local councils pay subsidies to plug the gaps, often in rural areas where running a route is more expensive or less lucrative for companies.
Areas where running a bus service is the least lucrative for private operators will rely most on council subsidy – and so be most effected by the cuts.
In 2017-18, there were 11 councils in England that spent nothing at all on running bus services.
This has meant 3,000 routes being reduced or scrapped since 2010-11.
There are significant differences in fares, too.
Between September 2017 and September 2018 in London, fares rose by 0.4% – in the capital, buses are still public and regulated.
In other metropolitan areas in England where fares are left to the free market, there was an average 2.4% increase, while in non-metropolitan areas fares rose by 7.9%.
But if bus cuts and fare rises leave some people unable to get around, don’t councils have a duty to do something about it?
In fact, councils have very few specific obligations around buses, making them an easy target for councils as the cuts bite.
There are specific things they legally have to do, for example provide transport for children otherwise unable to get to school.
They also have to make sure there are concessionary fares for older and disabled people. Although this is partly funded by central government, the grant has been falling, leaving councils to make up the difference.
But other than that, they are not obliged to fund buses and ensure everyone has access to them.
What do councils have to do?
It’s possible a council could be challenged in the courts under equality legislation if it could be shown to be disproportionately restricting certain groups of people.
But legal guidance suggests it would be difficult to challenge a council if it could show it had assessed the needs of a local area and the impact of removing a bus service, particularly on elderly and disabled people.
If after this assessment, councils decide they need to make cuts because of a lack of funds, this would be likely to be legal.
But councils can’t let bus cuts leave a community that needs transport with no transport service at all.
And in some areas, councils have used community transport services – often minibuses driven by volunteers – to fill the gaps.
There could be other reasons for the fall in passenger numbers, though.
For the past couple of years, passenger numbers have also been falling in London, despite its relative protection from cuts.
Mayor Sadiq Khan has suggested this could be driven by fewer people going out, as Netflix and Deliveroo make staying at home easier and more tempting.”