Health and social care services are facing a huge financial challenge over the next decade – the question is whether they can respond by delivering more efficient and effective care and, if so, how best to make this happen. This project is examining the scale of the longer term financial challenge and how it can best be met.


Adam Roberts, Nuffield Trust, outlines the main funding pressures facing the NHS from 2010/2011 to 2021/2022


We are examining the key strategic challenges facing the NHS over the next decade – how to meet the needs of a growing and ageing population and the need to improve the quality of care and health outcomes within a health care budget that will grow at a much slower rate than the past decade.

This project is bringing together research and evidence on the efficiency and effectiveness of health and social care to answer these key questions:

  • What is the scale of the financial challenge facing the NHS and social care system over the next ten years?
  • Can the NHS in England meet the challenge by delivering more efficient and effective health and social care?

The programme will include a careful assessment of potential demands on the health care system over the next decade and will consider health and social care in an integrated way.

This project is examining how the NHS in England can meet the key challenge of improving patient care within a constrained budget

The programme is empirically based and consists of two phases:

  • Phase 1: Late 2011 to autumn 2012: Assessing the scale of the financial challenge;
  • Phase 2: Autumn 2012 to 2013: Rising to the challenge: the scope for productivity gains.

Programme outputs

The first output from phase one of the programme is a report undertaken by the Institute for Fiscal Studies (IFS) and funded by the Nuffield Trust.

The report: NHS and social care funding: the outlook to 2021/22 (4 July 2012), maps the longer term financial challenge facing the health service. It examines what can be expected once the unprecedented four-year period of broadly flat real-terms NHS spending ends in 2014/15, and it also assesses the likely outlook for social care spending.

The report considers some scenarios for spending on the NHS and social care in England and sets out what they might imply for other public service spending and taxation.

The second output from phase one of this programme: A decade of austerity? The funding pressures facing the NHS from 2010/11 to 2021/22, (3 December 2012) is based on new modelling carried out by the Nuffield Trust and looks at the future pressures on NHS services in England.

The findings are released alongside new Ipsos MORI polling data – commissioned by the Nuffield Trust – which shows that the NHS is the number one area the public want to be protected from cuts.

Together, the research suggests that even if health is protected from future cuts in public spending, it is unlikely that funding increases will return to historic levels. With demand for health care rising due a number of factors, without continued productivity measures there will be a substantial gap in the funding required to meet future needs.

A further research report: Care for older people: projected expenditure to 2022 on social care and continuing health care for England’s older population by the London School of Economics, commissioned by the Nuffield Trust, was also published in December 2012. It focuses specifically on the challenge of funding care for older people until 2022.

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Project outputs

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