Public Expenditure

The Health Committee has issued an invitation to submit written evidence for its inquiry into Public Expenditure. The deadline for submitting written evidence closed at noon on Wednesday 29 September 2010.

One of the reasons why Select Committees were established was to provide more detailed scrutiny of the government’s spending plans for each department than is possible in general political debate.

This is more than usually important in the Department of Health this year for three reasons:

o The Coalition Agreement states that “we will guarantee that health spending increases in real terms in each year of the Parliament”. The Committee wishes to examine the implications for the NHS of this commitment.

o Despite the commitment to real increases, it is clear that the resources available to the NHS will grow significantly more slowly than they have in recent years. The Committee wishes to examine the implications of this development.

o Partly as a consequence of the commitment on health spending, it is expected that social care spending plans will be significantly reduced. The Committee wishes to understand the implications of this development both directly on social care services and indirectly on related health care services.


Terms of Reference


The inquiry will focus on the service impact in the short and medium term of the decisions being taken in the current public expenditure process; it will not concern itself in this inquiry with management structure – except to the extent that structure may distort decision making.

The inquiry will examine the following areas:

Strategic Assessment

o What level of commitment is national government making to the NHS, and how does it compare with long term trends of demand, cost and efficiency?

o What are the implications of the “£15–20 billion efficiency challenge” described in the Revised Operating Framework for the NHS as “absolutely critical for the future”?

o What commitment is the government making on capital expenditure as opposed to revenue expenditure?

o What level of commitment is national and local government making to Social Care, and how does it compare with long term trends of demand, cost and efficiency?

o What are the implications of the government’s plans for the interface between the NHS and Social Care?

Centrally funded health services

o What proportion of the health budget is “top-sliced” (ie reserved for central disbursement by the Department of Health or NHS – and not allocated to PCTs)?

o What services are procured from this “top-sliced” budget, and how do the government’s plans for those services compare with long term trends of demand, cost and efficiency?

Resource Allocation within the NHS

o How is the formula for allocation of NHS resources between PCTs constructed and reviewed?
o What arrangements exist to “cushion” resource shifts implied by the allocation formula?

o What is the impact of this system on the budget allocations of a representative sample of PCTs?

Locally commissioned health services

o What are the implications of the government’s top-slicing decisions for the budgets for locally commissioned health services? How do the resulting budgets compare with long term trends of demand, cost and efficiency?

o What proportion of locally commissioned health services are absorbed by services which are:

  • Demand-led according to nationally prescribed formulae?
  • Driven by demand for emergency or urgent care?
  • Available for elective or non-urgent services?

o What scope exists for locally commissioned health services to manage demand, cost and efficiency to increase the resources available, in particular, for elective and non-urgent services?
Social Care Resource Allocation

o What is the expected impact of the local authority settlement on social care budgets?

o How does the local government funding formula reflect differential demand for social care services in different areas?

o What is the impact of this system on the budget allocations of a representative sample of social service departments?

Social Care Services

o What scope exists for social care services to manage demand, cost and efficiency within constrained budgets?

o What are the implications of social service budgetary pressures on the interface between health and social care services in a representative sample of areas?

While this is an extensive list, it is not intended to be exhaustive and comments on any other relevant aspects of the government’s public expenditure plans for health and social care would be welcome.

The Committee invites short written submissions from interested organisations and individuals. The deadline for submitting written evidence is noon on Wednesday 29 September 2010.

Guidance on submitting written evidence

It assists the Committee if those submitting written evidence adhere to the following guidelines:

Each submission should:

  • state clearly who the submission is from, ie whether from yourself in a personal capacity (eg Submission from Miss Dee Dee Lee) or sent on behalf of an organisation (eg Submission from Insert Name Ltd);
  • be no more than 3,000 words in length;
  • as far as possible comprise a single document attachment to the email;
  • begin with a short summary in bullet point form;
  • have numbered paragraphs; and
  • be in Word format with as little use of colour or logos as possible (Reports are published in black and white).

A copy of the submission should be sent by e-mail to and have the ‘Name of the inquiry’ in the Subject line. Please note that the healthcommem mailbox is for submissions of evidence only, not for general correspondence which should continue to be directed to the healthcom inbox.

Please supply a postal address so a copy of the Committee’s report can be sent to you upon publication.

It would be helpful, for Data Protection purposes, if individuals submitting written evidence would send their contact details separately in a covering email in a block of text laid out vertically (not horizontally). See example below:

eg: Miss Dee Dee Lee
Westminster House
7 Millbank
SW00 0XX
Tel: 0000 000 0000 / Mob: 00000 000000

You should also be aware that there may be circumstances in which the House of Commons will be required to communicate information to third parties on request, in order to comply with its obligations under the Freedom of Information Act 2000.

Though there is a strong preference for emailed submissions, those without access to a computer should send a hard copy to: Committee Assistant, Health Committee, Committee Office, House of Commons, 7 Millbank, London SW1P 3JA

A guide for written submissions to Select Committees may be found on the parliamentary website at: Commons: Guide for Witnesses.

Please also note that:

• Committees make public much of the evidence they receive during inquiries. If you do not wish your submission to be published, you must clearly say so. If you wish to include private or confidential information in your submission to the Committee, please contact the Clerk of the Committee to discuss this.
• Material already published elsewhere should not form the basis of a submission, but may be referred to within a proposed submission, in which case a hard copy of the published work should be included.
• Evidence submitted must be kept confidential until published by the Committee, unless publication by the person or organisation submitting it is specifically authorised.
• Once submitted, evidence is the property of the Committee. The Committee normally, though not always, chooses to make public the written evidence it receives, by publishing it on the internet (where it will be searchable), by printing it or by making it available through the Parliamentary Archives. If there is any information you believe to be sensitive you should highlight it and explain what harm you believe would result from its disclosure. The Committee will take this into account in deciding whether to publish or further disclose the evidence.
• Select Committees are unable to investigate individual cases. For up-to-date information on progress of the inquiry visit: