Select Committee on the Long-term Sustainability of the NHS
The Long-term Sustainability of the NHS and Adult Social Care

Report of Session 2016-17 - published 5 April 2017 - HL Paper 151



Chapter 1: Introduction

Headline after headline

Beyond the here and now

The inquiry and the Committee’s work

Chapter 2: Service transformation

The case for service transformation

Box 1: Demographic and Disease Change

Figure 1: Proportion of the population in the UK aged 85 in 1994, 2014 and (projected for) 2034

The vision

Service transformation: the current situation

The Five Year Forward View

Sustainability and Transformation Plans


Box 2: Greater Manchester Health and Social Care Devolution

Achieving service transformation

Changes to models of care

Integrating health and social care

Chapter 3: Workforce

Workforce strategy

The aspiration

A sound evidence base

Health Education England

Overseas workers and Brexit

Skill mix and training

Skill mix and evolving roles

Regulation, morale and pay

The role of regulation

Morale, pay and retention

Chapter 4: Funding the NHS and adult social care

NHS funding

NHS funding sources

Alternative funding models

Generating additional sources of funding

NHS funding levels

Health spending beyond 2020

Figure 2: Office for Budget Responsibility: Long-term projections for health spending (as a % of GDP)

Social care funding

The current situation

Short-term responses

Aligning health and social care funding

Figure 3: Yearly change in real terms spending on the NHS and adult social care in England, 1994–2014

Figure 4: Difference between percentage change in spending on the NHS and adult social care, 1994–2014

Longer-term solutions for adult social care

People’s ability to pay for care

Other funding streams

Table 1: Social care systems in Japan, Germany and England

Chapter 5: Innovation, technology and productivity

Innovation and technology

The effective use of data

Productivity and variation

Leadership and management

Chapter 6: Public health, prevention and patient responsibility

Preventable ill health: causes and costs

Inaction on public health and prevention

Mental health


Cuts to public health

Patient responsibility

Chapter 7: Towards a lasting political consensus

A culture of short-termism

Building political consensus and engaging the public

The case for a new body

An Office for Health and Care Sustainability

Summary of conclusions and recommendations

Appendix 1: List of Members and declarations of interest

Appendix 2: List of witnesses

Appendix 3: Call for evidence

Appendix 4: Hypothecation

Appendix 5: Note by the Specialist Adviser, Emma Norris:
An audit of independent and semi-independent public bodies and implications for a new health and social care body

Appendix 6: List of acronyms

Evidence is published online at and available for inspection at the Parliamentary Archives (020 7129 3074).

Q in footnotes refers to a question in oral evidence.

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