Public expenditure on health and social care: terms of reference

12 September 2014

The Health Select Committee launches its latest inquiry into expenditure issues in the health and care system.

Dr Sarah Wollaston MP, Chair of the Committee, said

"Following years of minimal growth in health budgets and cuts to those in social care, services are under great strain at a time of unprecedented and escalating demand. This year, the Health Committee intends to widen its annual public expenditure inquiry, not only to set out the extent of the financial challenge but also to respond to wider public questions about the NHS and social care. Has the NHS been sold off and if so by and to whom? Has it remained true to the underlying and legally binding principle that the NHS is free at the point of use, based on need and not ability to pay?

We will be looking at the evidence around the history and extent of private, voluntary sector and social enterprise involvement in the NHS and social care alongside the evidence for their quality and patient experience. We will examine the wider effects of competition, including the potential impact of the Transatlantic Trade and Investment Partnership. We will try to set out the history and extent of management and PFI costs to the NHS as well as the income from treating private patients.

We aim to examine how the financial cake is divided across the NHS and social care as well as how the drivers within the system affect the delivery of care. We will also examine the future funding options for health and social care including international comparisons and the consequences of continuing the current financial squeeze on services for the people who depend on them."

Terms of reference

The Health Committee has produced a series of reports over the last four years on the response of the health and social care systems to the requirement to achieve 4% year-on-year efficiency gains to allow them to meet rising demand for care through a period of minimal real resource growth and, in the case of social care, of reductions in resources.

In its fifth and final inquiry into funding and expenditure this Parliament the Committee plans to consider, amongst other things:

Current issues

  • The current financial state of the health and social care systems, including particular pressures in the system (such as the financial position of NHS Trusts and Foundation Trusts and of CCGs)
  • The impact of the Better Care Fund on the health and social care systems, including whether all areas have appropriate plans for the introduction of the fund
  • The extent to which patient care and support services are provided (a) by NHS bodies (b) others and how has this changed over time
  • What types of NHS services are being provided by private sector, voluntary and social enterprises and what is the evidence around quality, costs and outcomes for those services
  • What changes there have been over time in the proportion of FT income provided by private patients, the uses to which this funding has been put and evidence of impact on NHS patient care
  • Implementation of the level playing field review
  • The effectiveness of the mechanisms by which resources are distributed geographically in the NHS
  • The impact of competition on the quality of NHS services
  • The nature and extent of management costs in the new NHS structure
  • What has been the cost of PFI agreements to the NHS over time

Longer term issues

  • The possible funding options for the NHS for the long term, including international comparisons
  • To what extent is it a realistic option to merge NHS and social care eligibility and funding as set out in the Barker Review
  • The potential impact of the extensive use of personal budgets on the funding and planning of health and social care services
  • The potential impact of the Transatlantic Trade and Investment Partnership (TTIP) on the NHS
  • Whether longer contracting periods are feasible and whether they would reduce costs and improve the quality and cost effectiveness of service

Written evidence must be submitted via the web portal and the deadline for submitting written evidence is midday on Friday 24 October 2014.

Further information 

Image: iStockphoto

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