Major NHS reform faces significant challenges due to systemic issues and lack of clear plans.

The Public Accounts Committee (PAC) has released a report warning that the latest NHS reforms, particularly the introduction of Integrated Care Systems (ICSs), will not succeed unless the Government addresses deep-rooted issues plaguing the National Health Service. These reforms aim to better integrate NHS services with local government efforts to focus on prevention. However, the PAC argues that without clear evidence of patient benefits or a timeline for improvements, these changes are unlikely to resolve the fundamental problems within the system.

The Committee highlights several critical areas that must be addressed for the reforms to succeed. Chief among them is the massive backlog of elective care, which has now surpassed seven million cases. The NHS and social care workforce are struggling with severe shortages, and demand for services continues to rise at an unsustainable rate. The estate in which NHS services are delivered is also deteriorating, with the cost of necessary maintenance reaching £9 billion, half of which is classified as high or significant risk.

The report also stresses that national leadership is crucial to addressing these challenges, but the new ICS framework lacks adequate oversight. Key national projects, such as the NHS Workforce Plan and capital funding strategy, have been repeatedly delayed, leading to what the Committee describes as “paralysis by analysis.” This lack of decisive action on these issues poses a significant risk to the success of the reform and to the health of the nation.

Furthermore, there are growing concerns about the governance of ICSs, particularly regarding the management of proceeds from the sale of NHS assets. These unresolved issues add further uncertainty to an already strained system. The PAC also points out that not enough is being done to focus on preventing ill-health, an essential element of the reforms.

In addition, the report raises alarm over the underfunding of NHS dental care. The lack of adequate access to NHS-funded dental services could lead to more severe dental health problems down the line, exacerbating existing pressures on the healthcare system.

The PAC concludes that the Government must provide a clear strategy for how ICSs will lead to tangible improvements for patients and the healthcare system at large. Without this, the much-needed reforms will fail to meet their objectives, leaving the NHS vulnerable to further decline.