The Department of Health has reported that the NHS achieved £5.8 billion of savings in 2011-12, virtually all of the forecast total of £5.9 billion. Most of the savings were generated through the pay freeze for public sector staff, and reductions in the prices primary care trusts pay for healthcare. NHS bodies also made savings by cutting back-office costs. However, there is limited assurance that all the reported savings were achieved. The NAO substantiated a total of £3.4 billion of NHS efficiency savings. Although the savings made by NHS providers as a percentage of operating costs are increasing, it is not clear what level of savings is sustainable over time. Changes to transform services take time to implement and the Department has always expected that these savings will predominantly come in the latter half of the four-year period. The NHS is seeking to maintain the quality of, and access to, healthcare at the same time as making efficiency savings. In 2011-12, the NHS performed well against headline indicators of quality, including waiting times and healthcare associated infection rates. The indicators focus mainly on hospital care and the Department faces a significant challenge in monitoring quality across the NHS as a whole. The Department does not know whether the demand for healthcare is being managed in ways that inappropriately restrict patients' access to care. Reducing demand and redesigning care pathways to treat patients in the most appropriate setting are key ways of generating savings

This report states that the values of the NHS 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. It is 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. There must be a much more joined up approach to commissioning health and care services. On 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; under-spending against budget of money allocated to the NHS has attracted adverse comment and the MPs call for a general review of the operation of Treasury rules; the NHS will not be able to rely on the present rate of paybill savings once the present restraints on public sector pay are relaxed in April 2013

An in-depth analysis of the NHS reforms ushered in by UK Coalition Government under the 2012 Health and Social Care Act. Essential reading for those studying the NHS, those who work in it, and those who seek to gain a better understanding of this key public service.

The first comprehensive 'bird's eye' account of public sector reform supported by references from over 400 official sources, this book is an invaluable guide to all those in the public, private and voluntary sectors grappling with the twin challenges of managing public spending austerity and the pressure in response to transform public services.

In recent years the pace of reform in health policy and the NHS has been relentless. But how are policies formed and implemented? This fully updated edition of a bestselling book explores the processes and institutions that make health policy, examining what constitutes health policy, where power lies, and what changes could be made to improve the quality of health policy making. Drawing on original research by the author over many years, and a wide range of secondary sources, the book examines the role of various institutions in the formation and implementation of health policy. Unlike most standard texts, it considers the impact of devolution in the UK and the role of European and international institutions and fills a need for an up-to-date overview of this fast-moving area. It features new case studies to illustrate how policy has evolved and developed in recent years. This new edition has been fully updated to reflect policies under the later years of New Labour and the Coalition government. Although written particularly with the needs of students and tutors in mind, this accessible textbook will also appeal to policy makers and practitioners in the health policy field.

Equity and Excellence : Liberating the NHS: Presented to Parliament by the Secretary of State for Health by Command of Her Majesty

The health systems we enjoy today, and expected medical advances in the future, will be difficult to finance from public resources without major reforms. Public health spending in OECD countries has grown rapidly over most of the last half century. These spending increases have contributed to ...

While the implementation of evidence-based medicine guidelines is well studied, there has been little investigation into the extent to which a parallel evidence-based management movement has been influential within health care organizations. This book explores the various management knowledges and associated texts apparent in English health care organizations, and considers how the local reception of these texts was influenced by the macro level political economy of public services reform evident during the period of the politics of austerity. The research outlined in this volume shows that very few evidence-based management texts are apparent within health care organizations, despite the influence of certain knowledge producers, such as national agencies, think tanks, management consultancies, and business schools in the industry. Bringing together the often disconnected academic literature on management knowledge and public policy, the volume addresses the ways in which preferred management knowledges and texts in these publicly funded settings are sensitive to the macro level political economy of public services reform, offering an empirically grounded critique of the evidence-based management movement.

The Government's fiscal consolidation programme is now expected to last longer than originally planned, and wide-ranging service reforms are being implemented. The role of financial managers is therefore critical to ensuring that opportunities to improve value for money are realized. The Finance Transformation Programme has been set up to develop the skills and capabilities of finance professionals, and qualified professionals are better represented at senior levels. However, given the importance and urgency of the challenges presented by fiscal consolidation and public service reform, further improvements will be needed to support sustainable public service delivery with fewer resources in the longer term. Government is a long way from ensuring that decision-making is routinely based on robust information. Departments often do not integrate financial management with their strategic and operational planning. Departments and other public bodies have generally managed within reduced spending limits up to now, but some of the savings they have made are more sustainable than others. In order to respond to financial and demand challenges, government needs to go further than controlling spending, by redesigning public services so that they operate permanently at lower cost. The NAO recommends that the Treasury ensure a more effective leadership to better enable and incentivise the finance profession to confront the challenges it faces. The Government's Finance Leadership Group should take responsibility for diagnosing the key current financial management challenges facing the finance profession and the wider civil service, and for addressing them quickly

The fact that there is another bill going through Parliament changing the management structure of the NHS means that there is a tendency for every comment about the NHS to be framed by the debate about the bill. But the NHS is well used to management change. In reality the key pressures which are building in the system arise from the fact that demand is continuing to grow at a time when health and social care budgets have stopped growing. This development has been well signposted. The implications were first highlighted by Sir David Nicholson in May 2009, and endorsed by both the previous government and the Coalition. This report is a review of progress within the health and care system towards meeting the 'Nicholson challenge'. The NHS funding challenge can only be met by rethinking and redesigning the way health services are delivered now, in order to deliver lasting long term benefits. The Committee's December 2010 report (HC 512, session 2010-11, ISBN 9780215555601) on health expenditure already expressed concerns then about the ability of the health service and local authorities to make the demanding efficiency gains required of them by the 2010 Spending Review, while maintaining quality of care. Both the NHS and local authorities are struggling to meet current targets in a sustainable, long-term manner that will maintain high quality, efficient care in the future. The need to provide high-quality and efficient services that meet local needs within the funding available must be addressed as a matter of urgency