Source · Select Committees · Public Accounts Committee
Recommendation 29
29
Accepted
Require a comprehensive impact study to accompany all large policy changes and projects
Recommendation
Reports by this Committee and its predecessors have highlighted the risks to value for money raised by sudden policy changes that are not supported by sufficient funding and planning. In 2023, the Committee reported that the decisions made by the Department in planning the New Hospitals Programme could not be justified as no supporting documentation existed.64 In September 2025, we found that announcing projects or programmes too early, or where the design of the proposed changes are immature, presents serious threats to governance.65 Much greater emphasis should be placed on producing an impact study to accompany these large changes. 61 Q 3 62 Q 5 63 Q 7 64 Committee of Public Accounts, The New Hospitals Programme, First report of Session 2023–24, HC 77, 17 November 2023, paragraph 28 65 Committee of Public Accounts, Governance and decision-making on major projects, Forty-fourth report of Session 2024–25, HC 642, 4 September 2025, paragraph 1 16
Government Response Summary
The government agrees with the Committee’s recommendation and is prioritising record investment in the health and social care system, such that all the reforms and commitments that have been announced are affordable within the Department of Health and Social Care’s settlement, and will aim to ensure announcements are accompanied by a clear plan for delivery and affordability wherever possible and appropriate.
Government Response
Accepted
HM Government
Accepted
6. PAC conclusion: We are concerned that the Department for Health and Social Care and NHS England are still announcing major reforms without either delivery plans or secured funding. 6a. PAC recommendation: The Department should: • confirm to us that it will not announce unfunded commitments; 6.1 The government agrees with the Committee’s recommendation Recommendation implemented 6.2 The government is prioritising record investment in the health and social care system, such that all the reforms and commitments that have been announced are affordable within the Department of Health and Social Care’s settlement. 6.3 The NHS in England is receiving an over £15 billion real-terms increase in annual resource budgets by 2028-29 compared to 2025-26. As announced at the Autumn Budget 2025, the government is increasing DHSC’s capital budgets to £15.2 billion by the end of the Spending Review period (2029-30), to invest in the NHS and wider health infrastructure. 6.4 DHSC has worked closely with Treasury to ensure that plans for merging NHSE and DHSC are affordable and deliverable, with the Autumn Budget 2025 announcing £860 million of funding reprofiled from later to earlier years to support ICB and organisational integration, while maintaining the overall RDEL envelope over the SR25 period. The merger of NHS England into DHSC provides an opportunity to strengthen accountability and align strategic financial planning with delivery of the 10-Year Health Plan. 6.5 Announcements from the department, and at the Autumn Budget, support the core ambitions of the 10-Year Health Plan. The government will aim to ensure that announcements are accompanied by a clear plan for delivery and affordability wherever possible and appropriate, recognising that detailed funding arrangements cannot always be made publicly available at the time of announcement.