News / Calls for independent body to monitor NHS performance

21 March 2024 Richard Gardham

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A new independent body should be set up to monitor NHS performance and to inform the setting of NHS budgets for the medium and long term, according to a commission of experts.

The BMJ Commission on the Future of the NHS, put together by the journal and involving current and former healthcare practitioners, leaders, thinktanks and academics, was set up to define a vision for the NHS. 

John Appleby

The commission’s latest report, written by former Nuffield Trust research director John Appleby (pictured) and fellow commissioners Gillian Leng and Martin Marshall, called for the creation of an Office for NHS Policy and Budgetary Responsibility. This independent body would produce an annual report on the performance of the NHS, which would include population health outcomes, access and waiting lists, as well as patient and public satisfaction and an analysis of expenditure. The report added that the body should also produce an analysis on the future of healthcare every five years, ahead of a general election. This would cover the next 10 years of the NHS’s operations, and cover expected demographic change, technological advances and ways to increase productivity.

It also called for a ‘very long-term indicative view’ to be produced, covering the next 50 years of spending pressures. The report stressed that such measures would help the NHS to ‘to find and justify a sustainable long-term future funding path’.

Such responsibilities falling to an independent body would go some way towards depoliticising the NHS, as well as enabling the service to take a more long-term view and aligning its spending with population change and demand, something health bodies have criticised politicians for falling short on in recent times. Earlier this week, the Health Foundation’s REAL Centre released a report stating that between 2022/23 and 2024/25, when adjusted for population size and ageing, the planned NHS England budget will have decreased by an average of 1.6% per year in real terms.

The BMJ Commission report also called for an ‘immediate financial intervention in the NHS to boost funding’, stressing that if spending had increased at the long-term average from 2010/11 to 2022/23, UK NHS spending by 2022/23 would have been some £32bn (or 15%) higher than actual current spend. While the authors of the report admitted that catching up on such a shortfall will take some time, they added that a start could be made through a real increase of 4% for 2024/25, which would be equivalent to around £8.5bn at 2022/23 prices.

The commission also highlighted the shortfall in capital funding in recent years and called for a catch-up on investment for NHS infrastructure.

However the report backed the current approach to financing the NHS – through taxation, national insurance and some charges to patients, as switching to a social health insurance model would be costly and bring with it upheaval. The taxation system also has overwhelming public support, it added.

Matthew Taylor, chief executive of the NHS Confederation, said the report it highlighted how the announcements in the chancellor’s spring Budget didn’t go far enough to plug the gap in NHS funding and stressed that the service will remain under-resourced if the current system remains in place when it comes to deciding on its funding.

‘We have been calling for further investment in capital for some time, but the scalable productivity gains the government is hoping for can only come to fruition if it deals, head on, with the elephant in the room – the NHS’s dilapidated estates and crumbling infrastructure.

‘Ultimately, the fear is that the government has backed the NHS into a corner with both its funding and performance expectations. So, whilst going all out to achieve against those, the risk is that the health service will simply not be able to deliver with the resources it has been given.’

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