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Editor's blog Wednesday 20 October 2010: CSR - the facts and the figures

The Treasury CSR document is here.

The DH summary document is here.

The text of Chancellor George Osborne's speech to the House of Commons is here.

Spending to rise from £104 billion to £114 billion by 2014-15 (2.4% a year, working with 1.9% inflation). That includes capital, which may be unlikely to be spent.

Kings Fund chief economist Professor John Appleby writes that in real terms, the settlement represents 0.4% real growth over four years - i.e. less than 0.1% per annum. Appleby also suggests that this will amount to £104 million a year.

In context is only just over half the proposed £200 million annual budget for the National Cancer Drugs Fund, which begins in 2011-12 (an interim NCDF budget of £50 billion has been opened this month). However, the DH statement points out that the NCDF's budget is now expressed as "up to £200 billion".

Health Service Journal's Sally Gainsbury reports that the DH confirm that the £1 billion extra funding from NHS to social care has been raided from the DH's capital budget. £800 million goes next year.

The Times' David Rose noticed that the Labour government's plans for free prescriptions for long-term conditions and one-to-one cancer nursing both go, and also spots that "one-week maximum wait for cancer diagnostics will also not be taken forward".

Andrew Lansley's DH statement: "“The Spending Review reinforces our historic commitment to protect health spending and means that funding for the NHS will increase in real terms in every year of this Parliament.  Due to the deficit and the increasing demands on NHS and care services we have had to make difficult decisions about where this money is spent and we have to make every penny count.”

“That is why we have chosen to invest in supporting social care and reablement – honouring our commitment to protect the most vulnerable in our society. And ultimately a better integrated health and care system will mean a more efficient system that delivers savings in the longer term – as more people live independently and are discharged from hospitals sooner.”

“NHS organisations have already started a wide-ranging efficiency drive to make savings that can be redirected into patient care.  And we also want to see a 33 per cent real terms cut in the administration budget, saving around £1.9 billion.  But that is not enough. The NHS budget will have to stretch further than ever before in these difficult times – and so reform isn't an option, it's a necessity in order to sustain and improve our NHS.  The proposals I set out this summer will cut waste and bureaucracy and put patients and doctors in control to build a high-quality health service”.

NHS to give £1 billion for social care over the period. Bye-bye surplus.

Lines from the CSR document
"£2 billion a year of additional funding by 2014-15 to support social care ... combined with a programme of reform and efficiency savings, such as greater use of personal budgets, this will mean local authorities will be able to improve outcomes and will not need to reduce eligibility for services".


"Table 1 - Departmental programme and administration budgets resource departmental expenditure limit excluding depreciation
NHS (health)
Baseline 2010-11  - £98.7 billion
Planned 2011-12  - £101.5 billion
Planned 2012-13  - £104.0 billion
Planned 2013-14  - £106.9 billion
Planned 2014-15  - £109.8 billion
Cumulative real growth 1.3%"

(Depreciation in Resource DEL is drawn from departmental resource accounts and follows International Financial Reporting Standards. This currently differs from National Accounts depreciation, which is used in the calculation of PSCE by the Office for National Statistics)


"Table 2: Departmental Capital Budgets (Capital DEL)
NHS (Health)
Baseline 2010-11  - £5.1 billion
Planned 2011-12  - £4.4 billion
Planned 2012-13  - £4.4 billion
Planned 2013-14  - £4.4 billion
Planned 2014-15  - £4.6 billion
Cumulative real growth -17%"


"public service workers and the public (were asked) to suggest money-saving ideas. Over 100,000 suggestions were submitted. These proposals have influenced Spending Review decisions ... the Government will ... ringfence funding for a Public Health Service to improve the health of the whole population and particularly pockets of ill health and health inequalities ... (and) build closer links across health and social care. The Government will aim to break down the barriers between health and social care funding through new approaches including reablement services provided by the NHS ... no longer require Primary Care Trusts to deliver hard copies of “Your Guide to NHS Services” to every household, saving up to £2.5 million a year"


"sharing responsibility by changing the role of the state and how services are provided ...  Increasing the diversity of provision helps share that responsibility across society, and drives innovation and efficiency by increasing competition and consumer choice. The Government will pay and tender for more services by results rather than be the default provider; look to set proportions of specific services that should be delivered by non-state providers including voluntary groups; and introduce new rights for communities to run services, own assets and for public service workers to form cooperatives"


"Ringfencing of all local government revenue grants will end from 2011-12, except simplified schools grants and a new public health grant"


"The Spending Review announces that the Government will look to significantly extend the use of personal budgets across a range of service areas including special education needs, support for children with disabilities, long term health conditions and adult social care".


"In line with its values of freedom and responsibility, the Government has abolished the top-down performance management system of Public Service Agreements. The Government will replace these traditional bureaucratic levers with a system of democratic accountability. The new Transparency Framework will provide information on performance and spending to allow the public to form their own view of whether they are getting value
for money.

"Later this year, each Government department will publish a business plan setting out the
details of its reform plans, including its:
• vision and priorities to 2014-15;
• structural reform plan, including actions and deadlines for implementing reforms over the next two years; and
• contribution to transparency, including the key indicators against which it will publish data to show the cost and impact of public services and departmental activities. This section will be published for consultation to ensure that the Government agrees the most relevant and robust indicators in time for the beginning of the Spending Review period in April 2011"


"The Government will pay and tender for more services by results, rather than be the default provider of services. The use of simple tariffs and more innovative payment mechanisms will be explored in new areas, including community health services ... and the Government will look at setting proportions of appropriate services across the public sector that should be delivered by independent providers, such as the voluntary and community sectors and social and private enterprises. This approach will be explored in adult social care, early years, community health services, pathology services".


"to bring external investment and expertise into the public sector and share the responsibility and risks of reform, the Government will work with the financial sector, the voluntary sector and community groups to develop innovative equity investment opportunities in public services"


"2.10 The Department of Health (DH) settlement includes:
• real terms increases in overall NHS funding in each year to meet the Government’s commitment on health spending, with total spending growing by 0.4 per cent over the Spending Review period;
• an additional £1 billion a year for social care through the NHS, as part of an overall £2 billion a year of additional funding to support social care by 2014-15;
• a new cancer drugs fund of up to £200 million a year;
• expanding access to psychological therapies;
• continued funding for priority hospital schemes, including St Helier, Royal Oldham
and West Cumberland; and
• capital spending remaining higher in real terms than it has been on average over the last three Spending Review periods.

2.11 The settlement increases overall NHS funding in real terms every year, with a total increase of 0.4 per cent in real terms over the Spending Review period – meeting the Government’s commitment on health spending. The NHS will need to make efficiencies to deal with rising demand from an ageing population and the increased costs of new technology. The NHS has already committed to make up to £20 billion of annual efficiency savings by the end of the Spending Review period through the Quality, Innovation, Productivity and Prevention (QIPP) programme. To ensure spending is focused on priorities, some programmes announced by the previous government but not yet implemented will not be taken forward. This includes free prescriptions for people with long term conditions, the right to one-to-one nursing for cancer patients, and the target of a one week wait for cancer diagnostics.

"2.12 Productivity in the NHS fell over the last decade. To ensure value for money, the reforms set out in Equity and Excellence – Liberating the NHS1 will give GPs power to commission the care their patients need and promote patient choice and provider competition to deliver a higher quality and more efficient health service. The Department will abolish Primary Care Trusts and Strategic Health Authorities by 2013, removing whole tiers of NHS management, saving money and empowering frontline professionals. The Government will also ring fence funding for public health to improve the health of the whole population, with a premium for tackling pockets of particular ill health and reducing health inequalities. Greater diversity and efficiency of providers will be encouraged, with patients able to use independent providers paid for by the NHS. The number of Arms Length Bodies will also be reduced from 18 to a maximum of 10 by 2013.

"2.13 Overall, the capital budget will remain higher in real terms in each year than the average yearly spend over the last three Spending Review periods. The budget also reflects a number of factors, including falls in IT spending in line with the extra £0.7 billion of savings identified over the Spending Review period in the NHS National Programme for IT. Spending will be prioritised on essential maintenance and equipment as well as priority hospital schemes including St Helier, Royal Oldham and West Cumberland.

2.14 Social care plays a vital role in helping to keep people healthy and independent. It also supports some of the most vulnerable people in society. The Spending Review therefore makes available sufficient resources for local authorities so that they do not need to reduce access to services, and can fund new approaches that improve outcomes for those receiving social care:
• the current DH grant to local authorities for social care, the Personal Social Services grant, will increase by £1 billion pounds in real terms by 2014-15. To reduce administrative burdens and increase flexibility for local authorities, this grant will be merged into local government formula grant; and
• the NHS will set aside funding growing to £1 billion by 2014-15 within their settlement to fund new ways of providing services, including reablement services provided by the NHS. This will help to break down the long-standing barriers between health and social care, leading to benefits across the health and social care system.

"2.15 This funding will also enable local authorities to deliver the necessary efficiency savings, reforms and service improvements that will release savings and put social care services on a stable footing for the entire Spending Review period.

"2.16 The Government recognises that more needs to be done to ensure that the social care system is fair and sustainable in the long term and has asked Andrew Dilnot to lead a commission on the funding of long term care, due to report in July 2011."


"2.37 The Local Government settlement includes:
• significant devolution of financial control to councils, by removing ringfencing around all revenue grants except simplified schools grants and a new public health grant, the number of separate core grants simplified from over 90 to fewer than 10, and more than £4 billion of grants rolled into formula grant;
• funding in all four years of the Spending Review to enable local authorities to freeze their council tax in 2011-12;
• an additional £1 billion a year for Personal Social Services grant, which is rolled into local government formula grant as part of an overall £2 billion a year of additional funding to support social care by 2014-15;
• the first community budgets in 16 local areas, to pool departmental budgets for families with complex needs, from 2011-12;
• overall resource savings in Local Government DEL to councils of 28 per cent over the four years;
• the Spending Review settlement means that while on average, central government funding to councils decreases by around 26 per cent over the next four years, councils’ budgets decrease by around 14 per cent once the OBR’s projections for council tax are taken into account; and
• retaining the important flexibility of prudential borrowing, with a forecast that total capital expenditure by local authorities will fall by 30 per cent by 2014-15"


"2.41 To enable local government to support social care, providing support for some of the most vulnerable people in society, the Government is providing £1 billion of additional funding through the NHS budget to support joint working between the NHS and councils. In addition, Personal Social Services grant for social care has been increased by £1 billion to £2.4 billion a year by 2014-15, rolled into formula grant".


"2.45 The first community budgets will be run in 16 local areas from April 2011 for families with complex needs. These will pool departmental budgets for local public service partnerships to work together more effectively, help improve outcomes, and reduce duplication and waste. All places may be able to operate these approaches from 2013-14. Councils and their partners will also have greater flexibility to work across boundaries in health, policing, worklessness and child poverty.

"2.46 The Government is ending the previous top-down performance framework for councils. Local authorities and their partners will be able to cease reporting any of the 4,700 local area agreement targets, and those that are kept will not be monitored by Government. In implementing the new Transparency Framework, the Government will work with councils to reduce the amount of data local government is asked to collect by central government, and develop a single, comprehensive list, to be reviewed annually."


"2.49 The Department of Health will increase spending on health research in real terms. Within this, additional funding will be made available to support the translation of research into practical applications, including the development of new medicines and therapies. To complement this, BIS will ensure that Medical Research Council expenditure is maintained in real terms. In addition, £220 million of capital funding from the Department of Health has been allocated for the UK Centre for Medical Research and Innovation, subject to approval of the final business case."