Cuts to NHS and social care services likely, says health select committee

The likelihood of cuts to health and social care services, and the destabilising effect of the Coalition’s market-driven NHS reforms, were endorsed today in a remarkable health select committee report. The committee, with a coalition majority and chaired by ex-Tory health secretary Stephen Dorrell, was reporting on implications and risks from the Spending Review.

The likelihood of cuts to health and social care services, and the destabilising effect of the Coalition’s market-driven NHS reforms, were endorsed today in a remarkable health select committee report. The committee, with a coalition majority and chaired by ex-Tory health secretary Stephen Dorrell, was reporting on implications and risks from the Spending Review.

The report demolishes the case that the coalition has delivered a real terms increase in the NHS budget, given the diversion of NHS funding to social care and recent OBR inflation estimates:

“The government’s commitment to a real terms increase in health funding throughout the Spending Review period will not be met. This emphasises the fact that the settlement, although generous when compared to other departments, represents a substantial challenge to the NHS.”

Reviewing the efficiency savings set for the NHS at between £15-20 billion over the next four years, representing a requirement for the NHS to deliver 4 per cent efficiency gains, for four years running, the committee says:

“There is no precedent for efficiency gain on this scale in the history of the NHS, nor has any precedent yet been found of any healthcare system anywhere in the world doing anything similar.”

Yet the coalition’s reform plans are getting in the way, argues the committee:

“… efforts to meet the spending challenge in a coherent way are being complicated by the lack of a clear ‘narrative’ from central government…

“Numerous witnesses pointed to the additional risks created for the NHS by the proposed restructuring of NHS management.”

The report says there are a number of signs that cuts were being passed off as efficiency gains and cites reports that health trusts were:

“… warning that their plans rely on huge cuts and spending all contingency funds.”

Other trusts were reportedly ceasing to offer IVF treatment to new patients, stopping minor surgery at GPs’ clinics, and delaying non-urgent hospital treatment.

There is also concern about social care services, and the knock-on impact of the local authority cuts for the NHS. The report refers to “uncertainty” for social care spending levels, given a 26 per cent real reduction in local government budgets over the CSR period, the removal of ring-fencing for social care grant funding, and a

“… generally accepted figure for an ageing population of 4 per cent cost increase per year.”

It sounds a clear warning that:

“… it is widely accepted that when failures occur in adult social services, the burden falls on the NHS in the form of poor health outcomes, avoidable hospital admissions, delayed discharges and so on.”

There is an open challenge to the assurances given by health secretary Andrew Lansley, with the committee:

“… therefore unable to conclude that councils could sustain care levels without reducing eligibility criteria [for social care].”

Overall the report adds further pressure on Mr Lansley, given the scrutiny role for the health reforms given to cabinet fixer Oliver Letwin by Number 10, and the delay to the publication of the coalition’s Health Bill.

Against this background, Paul Corrigan has highlighted the progressive increase in public support for the NHS since 1997. The British Social Attitudes survey published this week finds that the proportion of people satisfied with the NHS had gone up from 34% in 1997 to a record high of 64% in 2009. Whereas in 1997, 50% were either “quite” or “very” dissatisfied with the NHS, now it is 19%.

The BSA report says:

“Increased satisfaction partly reflects the fact that people recognise and value the improvements that have taken place within the NHS, particularly in relationship to waiting times.”

Having lost an argument on tuition fee increases, health and care cuts are increasingly the next rallying point against the coalition’s public service reforms.

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