NAO criticises government over COVID-19 NHS preparations
12 June 2020: The National Audit Office says there are important lessons to be learned in an initial report on how the NHS and adult social care services have responded to the pandemic.
The National Audit Office (NAO) has published a report looking into how the Department for Health & Social Care (DHSC) readied the NHS and adult social care services in England for COVID-19.
The report highlights how well-known issues in the relationship between adult social care and the NHS have been brought into sharp relief by the coronavirus pandemic. These continue to exist despite twelve government white papers, green papers and consultations, and five independent reviews on integration between the two services over the past 20 years. Poor integration between the health and social care systems in England has made it even more challenging to deal with the emerging problems posed by the crisis.
Although the speed of the government’s response was hampered by factors beyond its control, such as in the supply chains for beds, ventilators, personal protective equipment (PPE) and testing capacity, there are many lessons to be learned on how to improve readiness for the next pandemic.
Financial pressures since 2010-11 on the NHS and local government have meant that where additional money has been provided it has been used to address immediate challenges rather than investing in the long-term sustainability of services. The NAO comments that “a realistic, costed and prioritised plan will give them the best chance of succeeding.”
Most importantly the full facts on costs and performance in responding to the pandemic have yet to emerge. The NAO stresses the importance of sticking to the principles set out in HM Treasury's Managing Public Money, with a rigorous assessment of the effectiveness and cost-effectiveness of this emergency response essential to being better prepared in the future. Transparency will be key to ensuring lessons are learned.
The key themes running through the report are avoiding making the same mistakes again and – unsurprisingly – that long-term investment might have avoided a lot of the problems that have been experienced.
Over the last few months, a great deal of money has been spent on keeping the NHS and adult social care in full functioning mode, with an additional £6.6bn allocated to the NHS in April and £3.2bn to local authorities to pay for adult social care amongst other local services.
The implications of various measures taken in response to the crisis, such as increasing bed capacity by cancelling non-critical operations, have yet to be understood, especially the long-term impact on the ongoing health of the population and what that might mean for costs in the future.
The dispersed nature of adult social care in England has made it difficult to collate data and assess it. Provider organisations have reported significant and rising costs from resourcing PPE, and greater workforce costs from more overtime and extra agency staff. Falling income and rising costs could impact providers' financial resilience for some time to come.
Lack of data is also highlighted by the fact that the government doesn’t know how it is progressing against the aim of attracting 20,000 people into social care over three months, nor does it know how many NHS or care workers have been tested in total during the pandemic. This makes it difficult to assess success and to make valid policy decisions going forward.
Alison Ring, director for public sector at ICAEW said: “The report does not assess the value for money of the measures adopted by government nor the effectiveness of its response – that will be the subject of a report to come that will no doubt provide an even more interesting read.
“Despite that, what is clear is that more long-term investment, and better integration between health and social care services, might have put us into a much better starting position to cope with a major crisis.
“These are important lessons that need to be reflected on by government and society. How can we deliver effective health and social care services at a reasonable cost, at the same time as building in the resilience that is needed to be ready for a future pandemic?”