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
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.
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
- 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
- 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
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.
The Committee also conducted its own survey of local authority
spending on social care.
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
The name that has been given to the objective of generating 4%
efficiency gains year on year for four years. Back
National Audit Office, Briefing for the House of Commons Health
Committee - Delivering Efficiency Savings in the NHS, December
2011 http://www.nao.org.uk/publications/1012/nhs_savings.aspx Back
The results of the survey and the questions posed to local authorities
are included as an annex to this Report. Back