Pandemic preparation requires action on finance and staffing

by Seamus Ward

19 May 2021

The government must put the NHS and local government on a sound financial footing and tackle workforce pressures in health and social care to ensure services are better prepared for a future pandemic, the National Audit Office said.

Gareth DaviesIn a document that brings together learning from 17 NAO reports on Covid, the auditors said that, like many countries, the UK was not as prepared for the pandemic as it could have been. And while there are many ‘impressive’ examples of national and local responses to urgent needs for healthcare and economic support, there was also a lot of new learning.

The report divides this learning into six themes, including finance and workforce pressures. The NAO said the response to the pandemic was made more difficult by financial and staffing issues. Future governments’ ability to respond to emergencies would be strengthened by ensuring the NHS and local authorities are financially sustainable, building spare capacity in key services, and examining the long-term spending implications of some pandemic-related commitments.

Challenges in ensuring financial sustainability included building resilience and maintaining readiness for emergencies, the report said. Both the NHS and local government have been under financial pressure since 2010/11. Local government spending power fell by almost 29% in real terms in the decade to 2019/20 and public health grants decreased by £500m between 2015/16 and 2018/19. Council finance directors believe authorities’ finances will not bounce back quickly.

Health has received additional funding, but at times it has been used to address immediate needs rather than the long-term sustainability of services, the NAO added.

Staff shortages

Existing workforce issues – including trust vacancy rates of 11% in nursing and 7% in medical staff – had exacerbated the difficulty in responding to the pandemic. More than 18,000 NHS staff were redeployed in clinical and support roles by the end of April 2020, including 10,000 students and 8,000 returning retired or former health professionals. Planning for future emergencies meant building in spare capacity and flexibility for when the service needs to redeploy staff, the NAO report said.

It added that government must consider which Covid-related spending commitments are likely to be retained in the long term, and what this will mean for financial sustainability. Overall, the government had committed an estimated £372bn for the pandemic response by the end of March 2021, including £62bn for the job retention scheme, £38bn for NHS Test and Trace and £18bn for personal protective equipment. Some of this will only be needed in the short term, but some liabilities are likely to remain in the medium and long term.

There was significant uncertainty surrounding some spending commitments, such as the vaccine programme, which may need to be repeated regularly with a knock-on effect on NHS England and NHS Improvement staffing and budgets, the NAO said.


The five other themes were:

  • Risk management – identifying the range of consequences of major emergencies and being clear about risk appetite
  • Transparency and public trust – ensuring objectives are well known so progress can be measured; providing clear documentation to support decision-making, particularly when other measures such as competition are not in place
  • Data and evidence – improving the accuracy, completeness and interoperability of datasets, sharing data, monitoring programmes, and systematically gathering information from end users and frontline staff
  • Co-ordination and delivery models – effective communication across national and local government and public sector bodies; clear responsibilities; integrating health and social care and putting social care on an equal footing with the NHS
  • Supporting and protecting people – understanding the pandemic effect on inequalities and acting on this, and supporting frontline workers to cope with the physical, mental and emotional demands of responding to the pandemic.


Gareth Davies (pictured), the head of the NAO, said: ‘Covid-19 has required government to respond to an exceptionally challenging and rapidly changing threat. There is much to learn from the successes and failures in government’s response and this report is our initial contribution to that process. Applying these lessons is not only important for the remaining phases of the current pandemic but should also help better prepare the UK for future emergencies.’

NHS Providers chief executive Chris Hopson welcomed the report, saying it ‘rightly highlights the government’s lack of preparedness for a pandemic and the impact of its chronic underinvestment in the health service’.

He added: ‘The NHS went into this pandemic with 100,000 staff shortages in the trust sector alone, and now staff are even more stretched and burnt out. A fully costed and funded workforce plan would protect staff wellbeing and help build flexibility into the system, so we must see a commitment to this work.

‘Just £1bn in non-recurrent funding has been promised to the NHS to date to help clear the backlog for non-urgent operations, alongside £325m for diagnostics equipment. The NAO rightly recognises that further Covid-19 related funding will be needed.’