2. Following the Spending Review settlement of 20
October 2010 the NHS does not face budget reductions on the scale
of other departments but the challenge facing the NHS is still
substantial. The settlement has left the health service needing
to make unprecedented levels of efficiency savings if it is to
maintain levels of care and improve the service it provides. Some
have argued that this process will be complicated, delayed or
even thwarted by the planned restructuring of the NHS.
3. There is even greater pressure on the social care
sector, which is also required to make unprecedented efficiencies.
The intensity of the pressure on social care could have an impact
on the ability of both services to realise the significant savings
that could result from better integration of health and social
4. The scale of the challenge is daunting, and the
risks of non-delivery are significant. Achieving these ambitious
aims will require leadership and innovation. In particular, delivery
of these objectives will be impossible without the active engagement
of the clinical and managerial staff in the NHS.
5. We believe there is an urgent requirement for
the Government to provide a clearer narrative on how this challenge
will be met; how services will be changed; and the model of care
that will be delivered.
6. In this inquiry, we have inevitably concentrated
on financial controls and efficiency gains. It is important, however,
to retain a focus on the experience of patients and clinicians.
Efficiency gains unavoidably involve change and it is important
that the process is managed in a way which retains the confidence
of patients and clinicians.
7. The Committee is conducting a parallel inquiry
into the future of commissioning which represents an important
part of this restructuring. We do` not therefore intend to comment
in detail on the White Paper proposals in this report, beyond
observing that a key consideration in its assessment of those
proposals will be their ability to facilitate the delivery of
the efficiency gains required by the Spending Review settlement.
8. Successful delivery of this efficiency gain is
fundamental to securing the core social policy objective of the
NHSequitable access to high quality healthcare; the size
of the NHS budget relative to total government expenditure also
makes it fundamental to the delivery of the Government's wider
economic policy objectives.
9. This Report is intended to present a snapshot
of the key implications and risks arising from the Spending Review.
It will provide an overall context for our subsequent inquiries.