Thoughts on PAC and HSCC from today (29/1/25)

A bit of a policy heavy read, so please bear with me!

Today the Public Accounts Committee (PAC) have published a report (https://committees.parliament.uk/committee/127/public-accounts-committee/news/204820/future-of-the-nhs-health-officials-out-of-ideas-and-remarkably-complacent-pac-finds/#:~:text=Public%20Accounts%20Committee-,Future%20of%20the%20NHS%3A%20Health%20officials%20out%20of,and%20remarkably%20complacent%2C%20PAC%20finds&text=Report%20finds%20lack%20of%20fresh,financial%20position%20continues%20to%20worsen.) on NHS finances and management, there has also been a Health and Social Care Committee this morning (https://parliamentlive.tv/event/index/3a2dc85a-9e8e-4b8a-a954-cee999cb11a6)

Over my many years in NHSE I had to write or respond to questions for both of these committees so have watched many HSCC and PAC meetings.

I will start with the PAC report, this makes for interesting reading, in 23/24 the NHS overspent by ￡1.4bn. This is not shocking and also reflects on the point they make about Cap to Rev transfers destabilising the NHS in general

If we then look at the area of Digital Transformation. Given that this is one of the key deliverables for this Government. PAC identify that the NHS lags behind OECD countries in Cap investment particularly in Digital. They also note that the NHS relies on outdated technologies, including faxes and pagers. I remember standing next to Beverley Bryant at NHS Expo and the "Bonfire of the Faxes" back in 2016!

They also identify leadership; NHSE and DHSC recognise that?digital transformation is key to improving productivity, but?repeatedly prioritise immediate financial pressures over long-term technology investments. Julian did point out that we are already exceeding the 2% productivity target for the year.

The above are just some of the points I have seen and there are many more about Digital. If I now move my attention to the HSCC meeting. This is a long 2 hour meeting and Amanda Pritchard, Julian Kelly and Duncan Burton presenting to committee.

I was disappointed with this meeting. I appreciate that this may be due to the fact the Operational and Planning Guidance is being released tomorrow, and the 10-year plan is being written. Overall I got the feeling that members of Committee were frustrated by the lack of answers.

There looks to be a direction that Julian Kelly is wanting to reduce ring fenced funding. This is interesting but I feel that appropriate ring fencing can have impacts it time bound with meaningful outcomes and support to deliver.

Around Digital, to be honest this was a bit disappointing. My hearing is that the NHS App is going to save the NHS, if we add that into EPR coverage and the ability to transfer data and people use the FDP. I am being slightly flippant but that were obviously the lines they wanted to present. PAC did state that those with an EPR are 13% more productive than those without. Julian stated that Primary Care is well covered by an EPR, while it maybe being able to use that data is very problematic and interoperability, as many here will appreciate is a huge problem.

There was a push to ask why there was not a substantive Director of Transformation in NHSE Amanda and Julian were very supportive of Vin, but did not answer the question at all. Not wanting the read into this and Vin a really good, but we do need consistency and Dr Tim Ferris is providing advice in the background on digital spend, Is this not undermining?

My final takeaway was Continuous Improvement. I am obviously very supportive of this and the commitment to delivering change in this way, but I have to say that I was not convinced.

In summary, I am not surprised by what was said in the PAC report and I am disappointed in what was said at HSCC. I really hope that the teams who have worked hard on the Operational and Planning Guidance and those working on the 10-year plan are able to give systems the direction that they crave and need following this difficult winter, and the fact that the upcoming 5-year spending review is unlikely provide significant funding.