The Treasury has asked Government departments to model fresh 3% and 6% cuts to their budgets, as part of the “efficiency review” announced last year to find £3.5 billion of savings by 2020. Speaking ahead of next Wednesday’s Spring Budget, Treasury minister David Gauke said there has been “considerable progress” towards this target, but that the Government will need to go further to ensure that departments are delivering “maximum value” for taxpayers’ money. Ring-fenced budgets for schools and the NHS will not come under review, the Treasury said, and savings made by local government cuts will be used to ease pressures on social care.

The announcement arrives amid growing pressure on the Government to resolve the financial difficulties facing health and social care. Speaking in a House of Commons debate on Tuesday, Public Accounts Committee (PAC) Chair Meg Hillier MP pointed out that the PAC, Health Committee and Communities and Local Government Committee are united in their view that the Government need to make funding for health and social care a top priority.

In other news, the House of Lords has voted to amend the European Union (Notification of Withdrawal) Bill to guarantee EU nationals’ right to stay in the UK after Brexit. The Government had hoped to see the Bill through the Lords without challenge and has indicated it will seek to overturn the amendment. The Bill will now return to the House of Commons, with any “ping pong” between the two Houses over its final wording likely to take place on 13th and 14th March.

Welsh Assembly debates public toilet provisions of Public Health (Wales) Bill

The Welsh Assembly has held its first debate on the Public Health (Wales) Bill, providing Assembly Members (AMs) with the opportunity to examine the general principles of the Bill before it is opened to amendment by the Health, Social Care and Sport Committee. The Bill’s provisions requiring local authorities to produce strategies for the provision of public toilets proved a key talking point during the debate, with AMs calling on the Welsh Government to go further and place a legal obligation on authorities to provide public toilets.

Opening the debate, Minister for Social Services and Public Health Rebecca Evans said that the Bill’s requirement for local authorities to prepare local toilet strategies “will encourage new and creative ways of addressing a complex public health issue”. She noted the Health, Social Care and Sport Committee’s concerns around access to information on toilet provision, and said her department will work to produce information to assist the public in locating local toilet facilities.

These statements did not satisfy members of the Health, Social Care and Sport Committee, who reiterated concerns raised in their report on the Bill. UKIP AM Caroline Jones described the Bill’s public toilet provisions as a one of her “biggest disappointments”. She said the fact that the Bill simply requires councils to prepare a public toilet strategy will do nothing to improve provision or allay the concerns of those affected by the lack of provision. She indicated that most stakeholders who gave evidence to the health committee felt that there should be a statutory duty placed upon local authorities to implement the public toilet strategies if there is to be real improvement.

Responding to the debate, Ms Evans said that local authorities will be expected to think about people passing through – not just the local population – when preparing their local strategies. She did not address Ms Jones’ concerns, opting instead to repeat her department’s commitment to improving access to information on public toilets. She suggested the Government work in partnership with AMs to develop a national map of public toilets, adding that officials are currently examining the infrastructure required to collect the appropriate data from local authorities and incorporate this into existing mapping tools.

Health visitor checks to remain mandatory

Public Health England has announced the continuation of the requirement for local authorities to commission five universal health visiting checks for families. These checks, which commence at 28 weeks of pregnancy and continue up until the age of two and a half, became mandatory when the commissioning of the Healthy Child Programme transferred from the NHS to local authorities in October 2015. The regulations which introduced mandation are due to expire this month, but a Public Health England (PHE) review found that all stakeholder groups, commissioners, providers and professionals wanted checks to remain mandatory.

Commenting on the announcement, Public Health Minister Nicola Blackwood said: “Health visitors support families to give children the best possible start in life, that’s why we have taken strong action to making these services mandatory across the country.” The Local Government Association welcomed PHE’s announcement, but raised concerns about delivering the checks in the future climate of reduced funding. Chairman of the LGA Community Wellbeing Board Cllr Izzi Seccombe said that cuts to councils’ public health grants threaten to undermine the work they are doing to “ensure all children have the best start in life”. She said: “If councils are to continue to deliver mandatory health checks the Government must commit to providing ongoing funding to support this vital service.”

Public Accounts Committee calls for “united effort” to tackle NHS challenges

The Public Accounts Committee has published the report for its inquiry into the financial sustainability of the NHS, calling for a “united effort” to tackle the financial sustainability challenges facing the NHS. The Committee emphasised the right of taxpayers to have “an honest, grown-up conversation about future finance and service provision”, which it says has been hampered by contradictory public statements from the Government and NHS England around the amount of additional NHS funding allocated for the rest of this parliament.

The report warns that efforts to restore financial stability are affecting patients’ access to services and their experience of care.  It said meeting day-to-day spending through “repeated raids” on the NHS’s capital budget reserved for long-term investments could have damaging consequences, adding that the Government must do more to convince the public that STPs are about delivering transformation and efficiencies, rather than “a cover for cuts in services”.

Committee Chair Meg Hillier argued that “the Government’s sticking-plaster approach is not sustainable, will not enable the NHS to get ahead of the problems it faces, and represents neither good value to taxpayers nor the best interests of patients.”

MPs including Ms Hillier and the Chairs of Health Committee and Communities and Local Government Committee reiterated many of these points during a House of Commons debate on Tuesday. Health Committee Chair Dr Sarah Wollaston pointed out that this is the third year in a row in which there have been transfers from capital to revenue budgets. She argued that this mechanism is unsustainable and risks undermining the transformation process.

Key recommendations outlined in the Public Accounts Committee’s report include:

  • The Department of Health, NHS England and NHS Improvement should publish an assessment of whether there is the “capacity in NHS bodies to deliver everything they are expected to within the agreed timeframes” by March 2017.
  • The DH, NHS England and NHS Improvement should set out a recovery plan by March 2017 which targets those NHS bodies and health economies in severe financial difficulty.
  • The DH and NHS England should report back to the Committee by July 2017 on what they have done to understand the association between financial performance and the impact on patient care.
  • In its analysis of the 44 STP footprints, due by the end of March 2017, NHS England and NHS Improvement should set out how they will support organisations to deliver real transformation in the areas where plans fall short.
  • The DH, NHS England and NHS Improvement should publish by March 2017 its assessment of whether there is the capacity in NHS bodies to deliver everything they are expected to within the agreed timeframes.

Stevens: STPs will end purchaser-provider split

NHS Chief Executive Simon Stevens has said the Sustainability and Transformation Plans (STPs) will end the purchaser-provider split in healthcare, during an evidence session with the Public Accounts Committee this week. Stevens told MPs that between six and 10 STPs are set to become Accountable Care Organisations (ACOs), which will “effectively end the purchaser provider split” and bring about “integrated funding and delivery for a given geographical population” for the first time since 1990.

Mr Stevens is understood to be in discussion with STPs including Frimley Health, Lancashire and South Yorkshire about the possibility of listing them as developing ACOs in the Forward View delivery plan due to be published this month. He also spoke of plans to appoint STP leads who will be responsible for the governance of organisations in their areas, including local CCGs and the local NHS England staff. However, he dismissed the suggestion that additional legislation or funding would be required to implement the STPs, stating that the Five Year Forward View delivery plan being drawn up by NHS England is predicated on existing arrangements. He also said that formal lines of accountability will remain the same for STPs.