Public Expenditure - Health Committee Contents

1  Introduction

1.  One of the Committee's first inquiries at the beginning of this Parliament was into expenditure on health and social care in the light of the Spending Review settlement. As we said at the time:

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.

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 care...

Successful delivery of this efficiency gain is fundamental to securing the core social policy objective of the NHS—equitable 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.[2]

2.  One year on, we have reviewed what progress has been made in order to assess how the health and social care systems are coping in these more stringent financial conditions. Our terms of reference for this inquiry were to examine:

  • The plans being made by NHS bodies to enable them to meet the Nicholson Challenge[3]
  • Where changes are being proposed, and whether the NHS is succeeding in making efficiency gains rather than cuts
  • The cost of the continuing reorganisation of NHS structures in line with the provisions of the Health and Social Care Bill
  • The impact on the provision of adult social care of the 2010 Spending Review settlement and the removal of ring-fencing for social care grants
  • The impact on NHS plans of decisions currently being made by local authorities
  • The ability of local authorities to make the necessary efficiency savings
  • The use of the additional £1bn funding for social care made available through the NHS budget
  • Progress on making efficiencies through the integration of health and social care services
  • Progress on, and implications of, changing the tariff structure

3.  Our key priority has been to examine the extent to which health and social care authorities have been able to do more with the same level of real resources or whether they have had to reduce the quality of services provided in order to make ends meet.

4.  The Committee took oral evidence from the Secretary of State, Rt Hon Andrew Lansley MP, Sir David Nicholson, Chief Executive of the NHS, Una O'Brien, Permanent Secretary, and Richard Douglas, Director General of Policy, Strategy and Finance, Department of Health, Professor John Appleby, Chief Economist, The King's Fund, Dr Judith Smith, Head of Policy, Nuffield Trust, Mike Farrar, Chief Executive, and Jo Webber, Deputy Policy Director, NHS Confederation, and Councillor David Rogers, Chair, Community Wellbeing Board and Andrew Cozens, Strategic Adviser, Children, Adult and health Services, Local Government Group. We also received 35 written submissions. In addition, the National Audit Office prepared a briefing for the Committee on the delivery of efficiency savings in the NHS.[4] The Committee also conducted its own survey of local authority spending on social care.[5] We are grateful to all of those who contributed to our inquiry.

2   Health Committee, Second Report of Session 2010-12, Public Expenditure, HC 512, 14 December 2010, paras 2, 3 and 8. Back

3   The name that has been given to the objective of generating 4% efficiency gains year on year for four years. Back

4   National Audit Office, Briefing for the House of Commons Health Committee - Delivering Efficiency Savings in the NHS, December 2011 Back

5   The results of the survey and the questions posed to local authorities are included as an annex to this Report. Back

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© Parliamentary copyright 2012
Prepared 24 January 2012