Select committee inquiry
Public Expenditure 2
Closed
What the inquiry looked at
“In December 2010 the Committee published a report into Public Expenditure (Second Report of Session 2010–11, HC 512). The Report concluded that the October 2010 Spending Review had set a highly challenging context for the delivery of health and social care services in the period to 2014, with both sectors being asked to make significant and difficult efficiency gains. The Committee returned to the subject in its inquiry to evaluate progress towards reaching the 4% year-on-year efficiency gains required of the NHS by the ‘Nicholson Challenge’, and to assess the ability of adult social care services to meet the demands made upon them. The Committee was supported in its inquiry by a National Audit Office study of plans being made by NHS bodies to enable them to meet the Nicholson Challenge, and the results of its own survey of local authority funding of social care.”
The committee's words, from the inquiry page on parliament.uk ↗.
What the government said
13th Report - Public Expenditure - Volume II (Volume II: additional written evidence)
No government response is linked to this report.
13th Report - Public Expenditure (Volume I: Report, together with formal minutes, oral and written evidence)
The government responded on 27 February 2012.
Read the government's response ↗ Read the report ↗ Report an error
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 20 July 2011 to its close on 1 April 2012.
- Report 2 reports
- Government response 27 Feb 2012
What it recommended 0 recommendations · 15 conclusions
1The evidence submitted to the Committee is unambiguous.
Concluded (the committee's words)
The evidence submitted to the Committee is unambiguous. The Nicholson Challenge can only be achieved by making fundamental changes to the way care is delivered.
2While the separate governance and funding systems make full-scale integration a challenging prospect, health and...
Concluded (the committee's words)
While the separate governance and funding systems make full-scale integration a challenging prospect, health and social care must be seen as two aspects of the same service and planned together in every area for there to be any chance of a high quality and efficient service being provided which meets the needs of the local population within the funding available. We would like to see best practice in this rolled out across the Health Service and underperforming commissioners held to account for failure to engage in this necessary process of change.
3At a time when all NHS bodies are being required to make efficiencies and need...
Concluded (the committee's words)
At a time when all NHS bodies are being required to make efficiencies and need to plan strategically to reshape services it is unhelpful for the Department of Health to require them to make bids for capital funding to short deadlines and without adequate preparation
4It remains too early fully to assess the types of savings being made in 2011–12,...
Concluded (the committee's words)
It remains too early fully to assess the types of savings being made in 2011–12, the first year of the QIPP programme. The Government remains confident that savings are on track. Nevertheless, we have heard strong concerns from the NHS Confederation, the Foundation Trust Network and the King’s Fund, among others, about the ability of NHS organisations firstly to meet their saving plans and second, to do so in a manner that is sustainable and releases further savings in future years. We are concerned that there appears to be evidence that NHS organisations are according the highest priority to achieving short-term savings which allow them to meet their financial objectives in the current year, apparently at the expense of planning service changes which would allow them to meet their financial and quality objectives in later years.
5The Nicholson Challenge can only be achieved through a wide process of service redesign on...
Concluded (the committee's words)
The Nicholson Challenge can only be achieved through a wide process of service redesign on both a small and large scale. These changes should not be deferred until later in the Spending Review period: they must happen early in the process if they are to release the recurring savings that will be vital in meeting the challenge. In the meantime, we are concerned that savings are being made through “salami-slicing” existing processes instead of rethinking and redesigning the way services are delivered.
6The reduction of the tariff is intended to encourage service redesign.
Concluded (the committee's words)
The reduction of the tariff is intended to encourage service redesign. This link needs to be made much more explicit if there is to be a proper understanding in the NHS Public Expenditure 31 and among the wider public of the scale of service change which is needed to meet the Nicholson Challenge.
7The reorganisation process continues to complicate the push for efficiency gains.
Concluded (the committee's words)
The reorganisation process continues to complicate the push for efficiency gains. Although it may have facilitated savings in some cases, we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings.
8The overall picture of social care is of a service that is continuing to function...
Concluded (the committee's words)
The overall picture of social care is of a service that is continuing to function by restricting eligibility, by making greater savings on other local authority functions and by forcing down the price it pays to contractors for services. In each case, the scope for further efficiencies is severely limited. The Government’s response to the Dilnot Commission’s proposals due in the first half of this year will, we hope, set out how a sustainably funded system will continue into the future. The challenge for local authorities and the Government is to continue to provide a meaningful service until a new system is in place.
9In spite of Government assurances, local authorities are having to raise eligibility criteria in order...
Concluded (the committee's words)
In spite of Government assurances, local authorities are having to raise eligibility criteria in order to maintain social care services to those in greatest need.
10It is deeply concerning that £116m of the £648m intended to be spent through the...
Concluded (the committee's words)
It is deeply concerning that £116m of the £648m intended to be spent through the NHS on improving the interface between health and social care is being spent on sustaining existing eligibility criteria. This suggests that this money (which was intended to support greater integration of services) is in fact being used to maintain the existing system. To the extent that this is true it is a lost opportunity to promote the necessary process of service integration.
11ADASS has found that 82% of councils are only providing care to those whose needs...
Concluded (the committee's words)
ADASS has found that 82% of councils are only providing care to those whose needs are assessed as significant or higher. The Permanent Secretary at the Department of Health told us that the settlement was intended to “hold the position steady” until a new funding system for social care was developed. The tightening of eligibility criteria demonstrates that the settlement is not sufficient to achieve this.
12A January 2012 joint report by the King’s Fund and the Nuffield Trust, on the...
Concluded (the committee's words)
A January 2012 joint report by the King’s Fund and the Nuffield Trust, on the integration of health and social care, called on the Department of Health and the NHS Commissioning Board to “develop a consistent and compelling narrative that puts well-co-ordinated care for people with complex needs at the heart of what is required of local NHS and social care organisations” and to set “a clear, ambitious 32 Public Expenditure and measurable goal linked to the individual’s experiences of integrated care that must be delivered by a defined date”.
13Although the Committee welcomes the continuing interest and support for the priority accorded by the...
Concluded (the committee's words)
Although the Committee welcomes the continuing interest and support for the priority accorded by the NHS Future Forum to greater service integration, it found precious little evidence of the urgency which it believes this issue demands—on both quality and efficiency grounds. It is a question to which the Committee will return in its Report on Social Care. In the meantime it calls on the Government and local authorities to set out how they intend to translate this aspiration for greater service integration into the reality of patient experience.
14Early reports from the Health Service are that the transfer of money from the NHS...
Concluded (the committee's words)
Early reports from the Health Service are that the transfer of money from the NHS to be spent on social care has been effective. That effectiveness may be because there was a very straightforward control mechanism: the money had to be spent by agreement. We do not underestimate the importance of this transfer, but the fact remains that it represents just 1% of annual funding for the NHS. Clearly there is scope to extend transfers of this kind
15The Committee believes that, as a matter of urgency, the Department of Health should investigate...
Concluded (the committee's words)
The Committee believes that, as a matter of urgency, the Department of Health should investigate the practicalities of greater passporting of NHS funding to social care.