The health and social care system needs fundamental change if it is to meet the needs of patients, a senior committee of MPs has warned.

The “Nicholson Challenge” – NHS chief executive Sir David Nicholson’s goal of achieving up to £20 billion in efficiency savings in the system during the four years to 2014-15 – requires the health and care system to deliver fundamental change so that services are joined up and focused on the needs of patients, says Conservative MP Stephen Dorrell, chair of the Commons Health Committee.

However, what the Committee heard during its recent inquiry into health and social care spending “indicates that, while many of the straightforward savings have been made, we have not seen the transformation of care on the scale which is needed to meet demand and improve care quality.”

“The NHS budget is static, and the social care budget is falling. In these circumstances, the successful integration of high-quality health and care services represents a substantial and growing challenge,” he said.

The situation is not being helped by the current fragmented commissioning structures, say the MPs. They recommend that, as Health and Wellbeing Boards (HWBs) have been established to allow commissioners to look across a whole local health and care economy, their role should be developed to allow them to become effective commissioners of joined-up health and care services.

They also repeat their recommendation, first made a year ago, that the current level of real-terms funding for social care should be ring-fenced. 

“Alongside the government’s commitment to maintain health spending at current levels in real terms, this would give certainty about budgets for a whole health and care economy and provide a firm financial basis for HWBs to plan and implement transformative service change,” they say, and warn: “without stronger commissioners and ring-fenced health and care funding, we believe there is a serious risk to both the quality and availability of care services to vulnerable people in the years ahead.”

The Committee report also points out that 48% of NHS Trusts are forecasting a deficit in the current financial year, and that at the beginning of this period 19 Foundation Trusts were in breach of their terms of authorisation.

“The fact that the numbers of NHS Trusts and Foundation Trusts reporting underlying deficits continues to grow represents evidence that the pace of change has not been sufficient to meet the challenge,” they say.