COMMONS

Public expenditure on health and care services report

19 March 2013

The values of the NHS are precious to all of us, but in future those values will only be reflected in practice if NHS and social care services are “re-imagined”.

The care provided by the health and social care system will break down if quicker progress is not made to develop more integrated health and social care services which focus on meeting the needs of individual patients, warns the Health Committee.

Chair of the Committee

Launching the report about public expenditure on health and social care services, the Chair of the Health Committee, Stephen Dorrell MP, said:

“It’s unlikely that public expenditure on health and social care services will increase significantly in the foreseeable future. This means that the only way to sustain or improve present service levels in the NHS will be to focus on a transformation of care through genuine and sustained service integration.

“Services should be designed to treat people rather than conditions. They need to respond to individuals rather than expecting individuals to find their way round a bewildering range of specialist departments.

“To make this ambition a reality, we need to develop a much more joined up approach to commissioning health and care services; we propose that responsibility for this process in a given area should be vested in the Health and Wellbeing Board.

“Joined up commissioning would ensure that resources are no longer treated as ‘belonging’ to a particular part of the system, but become shared resources to use more efficiently to develop and deliver a more flexible and responsive local health and care services.

“Moving to this approach must not however result in less overall funding for care services. We therefore propose that the Government’s commitment to protect real-terms funding for health care should be extended to cover local authority social care services and that these funds should be ring fenced at current levels in real-terms.

Conclusions

Commenting on a range of other issues, the Health Committee also concludes:

  • Measures currently being used to respond to the Nicholson Challenge too often represent short-term fixes rather than the sustainable long-term service transformations.
  • Changes in tariff payments within the NHS do not constitute ‘efficiency savings’ – they are simply internal transfers that only result in efficiency gain for the NHS if the NHS Provider changes the way care is delivered.
  • Under-spending against budget of money allocated to the NHS has attracted adverse comment. The MPs call for a general review of the operation of Treasury rules; in particular, they recommend that the rules on the use of reserves by NHS Providers should be abolished to encourage investment by Providers in necessary service change.

The NHS will not be able to rely on the present rate of pay bill savings once the present restraints on public sector pay are relaxed in April 2013. Furthermore, although pay restraint is undoubtedly key in the short term, the Committee does not accept this can be regarded as a sustainable form of ‘efficiency gain’.

The Committee says that “It is neither prudent nor just to plan for sustainable efficiency on the basis that NHS pay will continue to fall relative to pay elsewhere in the economy”.

Further information

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