The government will fail to keep health and social care afloat without radical action, warns CIPFA


CIPFA, the Chartered Institute of Public Finance and Accountancy, claims that unless there is urgent and radical reform of the health and social care system, the sector will be unable to cope with future pressures.

The Institute gathered the concerns of leading experts as part of CIPFA’s Public Finance Perspectives series which has been launched today at CIPFA’s Health and Social Care Integration Conference.

They expressed that the sector is facing increasing uncertainty due to Brexit and its implications for the health and social care budget, research capacity and employment prospects.

The future of the social care system was also identified as one of the biggest concerns. In order for the NHS to remain sustainable, social care must function well. Yet it is faced with severe cost pressures which reduce the services it can provide. This has a knock-on effect on the NHS, as it has to accommodate patients whose needs are not being met by the social care system.

Under-investment in public health is also compounding the issues being faced by health and social care. According to Public Health England, long-term lifestyle conditions now take up 70% of the NHS budget, and this is expected to rise in the next few years. But, at a time when there is great opportunity to make long-term savings through preventative public health measures, the Comprehensive Spending Review in 2015 cut expenditure in this area.

Taking these issues into account, it is likely that health and social care budgets will be stretched to breaking point unless urgent action is taken. CIPFA believes that an independent commission should be set up to seriously examine the options available to balance demand and supply.

The commission should introduce a ‘golden ratio’ which could pledge a minimum 10% of GDP to health and social care spending. This would reduce the unpredictability of politically driven funding decisions, while relating spending logically to what the country can afford.

Unless spending is aligned in such a way, the public will likely see an increase in the rationing of services, significant tax rises or charges for using the NHS and social care.

Rob Whiteman, CEO of CIPFA, said:

“Without radical transformation, the government will struggle to ensure the NHS and social care system will be sustainable for future generations.

“Indeed, the concerns of leading experts that CIPFA has gathered clearly demonstrate that the sector is already creaking under the strain.

“To protect services, the severe financial stress the sector is under must be confronted with great urgency.

“This means tough and politically unpopular choices will have to be made to bring the health and social care system back to good health.

“CIPFA believes that a commission must be set up to explore these difficult decisions. It should also introduce a golden ratio of GDP spend on healthcare to protect funding from the unpredictability of short-sighted political decisions.”


For media enquiries contact the CIPFA press office on T: 020 7543 5600 or email E:

A copy of Public Finance Perspectives is available upon request.

Notes to editors

About Public Finance Perspectives

Public Finance Perspectives is produced by CIPFA and Public Finance. It is designed to stimulate discussion on key public finance and policy issues. These essays, by leading public sector practitioners and experts, examine the future of health and social care in the face of an ageing population, financial constraints and Brexit.


The Chartered Institute of Public Finance and Accountancy (CIPFA) is one of the leading professional accountancy bodies in the UK and the only one which specialises in the public services. It is responsible for the education and training of professional accountants and for their regulation through the setting and monitoring of professional standards.

Uniquely among the professional accountancy bodies in the UK, CIPFA has responsibility for setting accounting standards for a significant part of the economy, namely local government. CIPFA’s members work (often at the most senior level) in the public service bodies, in the national audit agencies and major accountancy firms. They are respected throughout for their high technical and ethical standards and professional integrity. CIPFA also provides a range of high quality advisory, information and training and consultancy services to public service organisations. As such, CIPFA is the leading independent commentator on managing and accounting for public money.