House of Commons Committee of Public Accounts: Introducing Integrated Care Systems (8 February 2023)

Summary

Major new reform of the NHS will not work until Government addresses multiple chronic issues in the service, says the Public Accounts Committee (PAC) in a new report. The case has not been made for what improvements Integrated Care Systems (ICSs) will bring to patients, and by when. 

ICSs are the latest attempt to bring NHS and local government services together to join up services and focus on prevention. But the Committee says the reforms will founder if the major systemic problems in the NHS are not addressed by Government at a national level:  the elective care backlog has breached seven million cases for the first time; major workforce issues have hamstrung both the NHS and social care; constantly increasing demand; a crumbling NHS estate; and limits on funding.  

These challenges require national leadership but there is a worrying lack of oversight in the new system, and crucial national projects like the NHS Workforce Plan and capital funding strategy are repeatedly delayed – what the Committee calls 'paralysis by analysis'. The cost of overdue maintenance has reached £9 billion - £4.5 billion classed as high or significant risk - and there are questions about who gets to keep proceeds of any assets sold under ICSs.   

Not enough is being done to focus on preventing ill-health, and not enough joint working between government departments to tackle the causes of ill-health. The failure to ensure adequate NHS funded dental care risks creating more acute dental health problems.  

Content

• Read the full report (PDF)
• Read the report summary