An Analysis of Value for Money and The NHS Five Year Forward View

This report provides an in-depth analysis of value for money in the context of the NHS Five Year Forward View (2015), including a legislative history and its impact on health and social care. It examines how health and social care services are costed and delivered, with specific reference to Hammersmith & Fulham Joint Health and Wellbeing Strategy 2016-2021. The report also discusses direct payments, funding sources for registered care homes, and the use of data analysis tools. It highlights trends in national government spending on housing and social care, and provides examples of how the council is making optimum use of available resources to deliver qualitative services, including abolishing charges for home care services.

: BUSINESS ANALYSIS AND
PLANNING

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................3
MAIN BODY..................................................................................................................................3
Legislative history and context of value for money and The NHS Five Year Forward View
(2015)...........................................................................................................................................3
Health and social care services are costed and delivered............................................................8
Direct payments’ and ‘funding sources for registered care homes’..........................................10
Knowledge and usage of data analysis tool...............................................................................10
CONCLUSION..............................................................................................................................21
REFERENCES................................................................................................................................1

INTRODUCTION
Health and social care are organisation that are responsible for delivering qualitative
services to the people in the society for improvement in their health and well-being. Government
spend lot of money on delivering health and social care facilities to individual so that they can
have good health ahead in future. Likewise, it emphasis on providing equal access to healthcare
facilities to elderly, young individual through investing the fund in social and health care.
United Kingdom is place having 62,262,000 population and GDP of $2.260 trillion Great
Britain Pounds. It provides public healthcare to all the resident that is around 58 million people,
such as 18% of citizen income tax is being utilised in healthcare services. This report depict
crucial information related to Hammersmith and Fulham is a London borough in West
London that has been formed in 1965.
There are many international corporations have offices in the borough. It has represented
crucial information related to legislative history in context of value for money, relevant
legislation The NHS Five Year Forward View’’. Furthermore, it also included detailed of their
impact on health and social care. health and social care services are costed and delivered’. Such
as the cost of specific services user group, Government requirements for application, access. At
last represent depicted detail of direct payments’ and ‘funding sources for registered care
homes’.
MAIN BODY
Legislative history and context of value for money and The NHS Five Year Forward View
(2015)
Value for money
It can be defied as the value which can be derived from every purchase of the sum of money
spent. This means it is concerned with the value that can be derived from the spending of every
sum of money. It is not only based on the minimum purchase price it is also concerned with the
efficiency and effectiveness of purchase. This is a highly important concept right from past to the
present wherein all the project and the establishment based on project is concerned with the
value of money (Muda and Hasibuan, 2018). This means with the spending of every single
money the value in terms of benefit will be derived and need to be obtained from it. This is
counted as major concept with respect to the government of England under which they enable

services with respect to providing of quality services (Zhao and et.al., 2022). This means
enabling value for money that with respect to the amount spend on the infrastructure the
adequate value or the efficiency will be grabbed.
The NHS Five Year Forward View (2015)
The forwarded view that was developed by NHS also based on the value for money
model under which various schemes and policies have been made in the context of maximising
the value of money. The scheme made by NHS are focussed towards the concept of value for
money under which maximum benefit will be taken from the use of money (Humphrey and
Cleaver, 2018). The scheme of integration under which hospital and primary care provider to
form the Primary and Acute Care System that will provide the services of hospital and general
services too.
Likewise, a new approach i.e. Integrated Personal Commissioning (IPC) an approach that
blend the funding of health and social care for meeting the needs of individual with complex
need. In the same way the Integrated Care pioneers which combine the NHS, GP and social care
services that work for improving the services for patient. Through this Greenwich saves £1m for
local authority (The NHS five year forward view, 2020).
This clearly shows and reflect that the working and policies of making an integration of
budget and services by NHS is a true example and evidence of value for money. This means with
the integration of budget and the services the NHS make value for money under which efficient
services have been enabled by NHS with a true value of money. This would also be right to said
that the NHS Five Year Forward View is a true step towards the concept of value for money.
However, it is to be noted that with the making of stipulation in NHS Five Year Forward
plan the aspect of health and social care would be affected in terms of affecting the services of it
(Reynolds and Mortimore, 2018). As the major aspect that need to be considered with respect to
the pan is the enabling of services in such manner that will lead to save the cost or make value of
money. Thus the stimulation wound be made in such a manner that it will lead to value for
money towards the NHS along with enabling of services.
The cost saving and value for money is the major concept that is looked by the NHS. The
NHS has made clam down the temporary staffing cost along with improving the efficiency and

productivity. NHS has made a great progress over the past year in cutting around £700 million
from trust bill for the staff of agency i.e. from £3.7 billion of 2015/16 to £3 billion in 2016/17.
Likewise, the more trust has been set up in order to cut the agency and temporary cost of staff in
2017/18 with a reduction of £150 million with respect to reduction in medical locum expenditure
(Funding and efficiency, 2022). The lowering of cost in respect to NHS is already lower than
other major countries. the NHS has made a cut in the cost of corporate services and the
administration. With the method of consolidation of services in terms of the NHS work towards
the saving of cost and thus act towards the direction of value for money under which with the
merging of services the NHS made a reduction in its administrative and other services. With the
making of resolution, the aim was set in order to make a reduction of cost with the identification
and investigation of the incident earlier with the providing of opportunity to resolve the dispute
in a less adverbial manner. Likewise, with respect to make challenge towards the overcharging,
fraudulent and excessive claim the cost and expenses with respect to patient care would be saved
by NHS (Funding and efficiency., 2022).
Trend of National government towards housing/social care:

Figure 1Spending towards social care
Source: Social care 360: expenditure, 2020
From the above graph it can be said that the spending made by local authorities or the
government in respect to adult social care is slightly start coming at the level in 2019/20. This is
because before the year 2019-20 the spending made by the government towards the concerned
sector is low and negative which later in 2019-2020 start recovering and ranging high. In the
same way it can also be said that in actual term the increase was recorded as £22.2 billion in
2018/19 which raise in 2019/20 and become £23.3 billion (Social care 360: expenditure, 2020).
With this the spending of the government fall by 55% between the year 2010/11 and 2019/20
with a resulting fall of 29% in spending power.

Figure 2Spending per person
Source: Social care 360: expenditure, 2020
The above graph shows the shows that the total expenditure in 2019/20 with regard to adult
social care returned same as 2010/11. While on the other hand the gross current expenditure
remains low and the figure are well below 2010/11 on a per person basis (Social care 360:
expenditure, 2020). The above graph also shows that the total expenditure made by the
government towards the per person is low and showing a declining phase from 2010/11 to
2014/15 but after that the expenditure per person raise and become equal to 2010/11.

Figure 3Spending made in home care
Source: Social care 360: expenditure, 2020
On the other hand, with a raise in more than 10% since the year 2015/16 the spending
made in home care 2019/20 is still below the minimum price which is recommended by UK
Homecare Association. This can be evidenced from the graph that in 2019/20 the spending was
17.48 while in 2018/19 it was 17.27 (Social care 360: expenditure, 2020). This shows that a rise
in 10% rate was not followed in case of 2019/20.
Health and social care services are costed and delivered
Hammersmith & Fulham Joint Health and Wellbeing Strategy 2016-2021 that has been
implemented in the borough with an motivate to enhance the Health and social care of individual
that are being living within the society. Currently, there are around 80600 household having
464000 median house price and 189850 residents living within the borough. There are 8 live
birth each days and 2-3 death each day. Furthermore, the Unemployment rate in borough is 3.1%

and it ranked 55 th most deprived borough in England out of 326. At the same time, there is
Annual flows in and out of the borough around 17000 or 19000 (Pollock and et.al., 2020).
In the borough, the economic cost of mental illness is £105.2 billion each year as per the
Department of Health and it have 6 th highest population that is being suffering mental health
issue. With advancement in treatment and care of long term condition that are being face by
people of Borough. Such as, diabetes, hypertension and cardiovascular disease. Greater
proportion of resources are being in care and treatment for the people, likewise 77% of inpatient
bed days, 68% of outpatient and 55% of GP appointments. The cost pressure on health and social
care system has been continuously increasing between 2011 and 2018 that is around £5 billion to
the annual costs because of more number of disease within the society (Omerov and et.al., 2020).
Moreover, it is estimated that out of £10, £7 is spent on health and social care, especially in
treatment of long-term conditions. In another words, it is estimated that 15 million people living
across England are being suffering from LTC that will increased by 18 million till 2025.
Recently the council of Hammersmith & Fulham has agreed to make extra payment of
around £3.4million for adult social care. This is only contributed through making optimum use of
available resources, cutting the wastage and negotiating better with the suppliers to get material
at reasonable price in order to delivered qualitative services to individual. This funding will
contribute H&F Council to effective support the most of the vulnerable resident of the borough
while freezing council tax. At the same time, Hammersmith & Fulham is only of the council in
the country that have taken significant steps for abolished all charges for home care services for
both disabled and older people residing within the borough (McFadden and et.al., 2021). Hence
the council is feeling proud to have record of cutting council tax with an motivate that the
resident of borough have relieve that their bill wont go up in future scenario.
In addition to this, the council have get additional grant of £900,000 for adult social care
that has lead in providing more access to qualitative services to adult for their overall well-being.
At the same time in order to support the disable people the council has focus on funding the
Independent Living Fun that has been cut by Government in July 2016. For example, one of the
patient named Victoria, has stated that the extra funding and abolishing home care charges has
huge impact on their life. As she has been etraplegic wheelchair so it has much supported her. It
also added that the access to social care is right of each and every individual within the society.

Furthermore, it specified that it lead in providing personal assistance for overall improvement in
health and well-being (Greenhalgh, 2018). Likewise, in 2015, it has emphasis on abolishment of
charges pertaining to home care, cut down the slashed charges for other service. For example, it
has reduced it from £4.50 to £2 for services that are meals on wheels. At the same time, the
council has focus on providing continuous wages to all care staff with an motivate to ensure
quality of services that are being offered to individual living within the borough. Hence it can be
interpreted that the Hammersmith & Fulham council meets all the costs of care in the home for
residents. In another words people does not have to personally contribute their amount in health
and social care.
Direct payments’ and ‘funding sources for registered care homes’
Direct payment can be defied as the payment which is made by the government in order
to support the carer or the registered care homes. With the option of direct payment, the
government made direct contribution towards the registered care home. This is made in respect
to the local community or in order to support the local community need.
However, in respect to funding the registered care home the major funds would be
collected from the private pay and the local authority. Here the role of NHS is low which means
the funding made by the NHS. This means that the funding made by the NHS in respect to the
registered care home is less while making it compared with the private or the local authority. It is
to be noted that with respect to the funding the concept which is to be followed is related with
the value for money (Fleming and et.al., 2019). This means with respect to the investment which
is made with a consideration towards the raising the efficiency and value of money.
Knowledge and usage of data analysis tool
Excel is one of the major data analysis tool that is used for analysing the gathered data.
Excel is a software program that allows the users to make organization, formation and analysis
with the use of calculation through the use of spreadsheets system. The excel is mainly used for
organizing, filtering along with visualizing the large set of data in an easy and presentable
manner. It is used in calculation as well as in research for analysing the trends and inferring the
results. Under excel the data would be present in the form of graph and charts which is further
helpful in analysing the data and drawing the interferences (Fleming, P and et.al., 2019). With
the use of excel the data would be analysed in an adequate manner because under excels the data

would be presented in an organized manner that will be used for data analysis. Also in excel,
with the use of various features like the graphs and charts the data and the concerned trends will
be analysed in an adequate manner that will assist in drawing the interferences and conclusion in
relation with the gathered information and data (Rayat, 2018). As with the use of excel the data
will be presented in the form of graph and charts that will lead to play an important role in
analysing it because of the presence of trends and visual presentation.
From the above image it can be presented that the overall funding that has been raised for
disable people in Hammersmith and Fulham borough is 1083747 in 2019 while the funding in
2020 is 949173. The Funds at 1 April 2019 is 163711- 217254 while the funding at 31 march
2020 was 285878 between 217254 respective.

Health deprivation
and disability
score
Rank of health
deprivation and
disability score (out
of 32,482 with 1
being the most
deprived)
Rank of health deprivation
and disability score (%
E01001955 (White City) 1.13 3478 10.7
E01001957 (White City) 0.84 5779 17.8
E01001958 (White City) 0.84 5779 17.9
E01001878 (Old Oak) 0.81 6155 19.0
E01001940 (William Church) 0.78 6449 19.9
E01001944 (Edward Woods) 0.73 6912 21.3
E01001875 (Old Oak) 0.67 7577 23.3
E01001961 (White City) 0.61 8194 25.2
HEALTH DEPRIVATION AND DISABILITY SCORE
Mean 0.80125

Standard Error 0.05517626
Median 0.795
Mode 0.84
Standard Deviation 0.15606203
Sample Variance 0.024355357
Kurtosis 2.813711415
Skewness 1.303918652
Range 0.52
Minimum 0.61
Maximum 1.13
Sum 6.41
Count 8
From the above analysis it can be interpreted that HEALTH DEPRIVATION AND
DISABILITY SCORE, have the mean is 0.80125, median of 0.795 and mode is 0.84, hence it
clearly represents that on an average 0.80125 are suffering from disability and maximum in
two place such as E01001957 (White City) and E01001958 (White City).
RANK OF HEALTH DEPRIVATION AND DISABILITY SCORE (OUT OF 32,482
WITH 1 BEING THE MOST DEPRIVED)
Column1
Mean 6290.375

Standard Error 502.5215
Median 6302
Mode 5779
Standard
Deviation 1421.345
Sample Variance 2020223
Kurtosis 1.71291
Skewness -0.8784
Range 4716
Minimum 3478
Maximum 8194
Sum 50323
Count 8
From the above analysis it can be interpreted that RANK OF HEALTH DEPRIVATION
AND DISABILITY SCORE (OUT OF 32,482 WITH 1 BEING THE MOST DEPRIVED) is
mean is mean is 6290.375, median is 6302 and mode is 5779. Hence E01001957 (White City) and
E01001958 (White City) are two cities that have more rank in health deprivation as well as
disability score. And on an average 6290.375 are facing disability for which health care services
are being added.
RANK OF HEALTH DEPRIVATION AND DISABILITY SCORE (%)
Column1
Mean 19.3875
Standard Error 1.54323842
Median 19.45
Mode #N/A
Standard Deviation 4.364937408
Sample Variance 19.05267857

Kurtosis 1.802725689
Skewness -0.915283537
Range 14.5
Minimum 10.7
Maximum 25.2
Sum 155.1
Count 8
From the above analysis it can be interpreted that RANK OF HEALTH DEPRIVATION AND
DISABILITY SCORE (%), mean is 19.3875, median is 19.45 that means on an average
19% are being suffering from issue of health and disability issue in Hammersmith and
Fulham borough.
CAPITAL FINANCE OF 2019-20
The 2019/20 capital programme was financed as follows:
CAPITAL FINANCING 2019/20 £m 2018/19 £m
Capital Receipts 8.808 5.701
Major Repairs Reserve (MRR) 13.159 8.172
General Fund Revenue Account 0.644 -
Capital Grants and Contributions 29.232 14.324
Council and School Reserves 0.581 1.777
Increase in Capital Finance Requirement (CFR) 60.463 25.712
Housing Revenue Account 0.174 -

The above table has clearly depicted crucial information related to different source through
which the fund has been raised by council during 2019-20 and 2018-19 for health and social
housing sector. Likewise, in 2019-20 capital reciept of 8.808 and 5.701 respectively gained,
while Capital Grants and Contributions is around 29.232 and 14.324 in 2019-20 and 2019-18.
From Council and School Reserves, it has got 0.581 and 1.777. At last, in General Fund
Revenue Account and Housing Revenue Account only in 2019-20 the amount has been received
around 0.644 and 0.174 (STATEMENT OF ACCOUNTS 2019/20). Hence there are different
source from which the council have accumulated necessary fund in order to promote health and
social care in borough for health and well being of individual within the society.
CAPITAL EXPENDITURE IN 2016-17
Capital budgeting or the actual capital expenditure (outturn) In 2016/17 is totalled £70.6
million so the expenditure on the basis of service area can be illustrated in detailed as follows:

DEPARTMENT 2016/17
£'000
2015/16
£'000
Adult Social Care 315 1,392
Children's Services 12,655 19,039
Environmental
Services
13,345 9,644
Housing and
Regeneration
3,922 12,023
Housing Revenue
Account Programme
40,294 53,592
Total 58531 95690
From the above figure it can be stated that there are various expenditures that has been made
by council within the borough. Such as, in 2015-16 the expenditure is 1,392 while in 2016-17 is
315 thus decreased by 1077. In children services was 19,039 that become 12,655 so total

difference is around 6384, while in Housing and Regeneration it was 12,023 that become 3,922
hence difference of 8101 (STATEMENT OF ACCOUNTS 2016/17). On the other hand, in
Housing Revenue Account Programme the expenditure made in 2015-16 was 53,592 and in
2016-17 was 40,294 therefore the decrease in overall expenditure is amount to 13289.
NET EXPENDITURE BUDGET of 2016-17
DEPARTMENT BUDGET ACTUAL OVER/ (UNDER) SPEND
Children’s Services 54,963 55,747 784
Adult Social Care 60,119 62,009 1,890
Housing & Regeneration 11,194 11,604 410
Likewise, around 54,963 is budget of Children’s Services while actually 55,747 has been
spent so 784 is overspent. In Adult Social Care, the budget is around 60,119 and expense made
62,009 hence the over expenditure is 1,890. At last, it can be interpreted that the Housing &
Regeneration budget was 11,194 but 11604 has been spent which is 410 more as compared to
others. Hence it can be summarised that Gross Operating Expenditure as per budget is 197,199

and spent 197,001, while the Total Net Expenditure budget and actual were equal 153,319
(STATEMENT OF ACCOUNTS 2016/17).
ACTUAL EXPENDITURE MADE IN 2018-2019 AND 2019-2020
DEPARTMENT 2019-2020 2018-2019
Adult Social Care 2.019 0.215
Children's Services 0.577 2.14
The Economy Department – Housing and
Regeneration 19.222 7.927
The Economy Department - Housing Revenue
Account 21.183 12.21
The above table and graph explain the actual expenditure made in 2018-2019 and 2019-
2020 was vary. This is evidence from the above graph that the expenses made towards the adult
social care in 2018 was 0.215 while in 2019 it become 2.019. This shows an in increase towards

the expenses and funds towards the concerned sector. Likewise, in the case of housing and
regeneration the expenses which is spend in 2018 was less while making it compared with the
2018. This is because in 2018 it was 7927 while in case of 2019 it become 19222. This shows a
high rise in the expenses and the spending towards the concerned sector (STATEMENT OF
ACCOUNTS 2019/20, 2020).
However, on the other hand the amount which is spend over the children service is decline
in 2019 because in 2018 it was 2.14 while in 2019 it become 0.577. This shows that the amount
of expenses decline. However, on an overall basis it can be right to said that the spend amount
towards the health and the social care is high.
FUNDING IN 2019-20
While looking towards the 2019/20 it was noted that the funding made in respect to social
care was over spend. Likewise, in respect to the children services and public is over spend. This
can be shown as follows:
DEPARTMENT BUDGET ACTUAL
OVER/ (UNDER)
SPEND
Children’s
Services 54.484 62.644 8.16
Social Care 57.448 59.277 1.829
Public Service
Reform 4.707 5.742 1.035

As per the above table and graph it can be clearly interpreted that the actual expenses
made over the children services, social care as well as public service reform is high in
comparison of the budgeted. As the actual expenses over the social care was made at 59277
while the budgeted amount is 57448 (STATEMENT OF ACCOUNTS 2019/20, 2020). On the
other hand, the spending made towards the public service is also under spend because its
budgeted amount was 4707 while the actual amount spend is 1035. This shows that the amount is
less spend. This means that the spending made by the concerned government towards the
Hammersmith & Fulham sectors is overspend. This means that the funding made towards the
concerned sector over spend and raises.
REVENUE BUDGET OF 2016-17
The council of Hammersmith & Fulham has set revenue budget by including the all the
expenditure related to day-to-day activities from staff salaries, cost of running refuse vehicles
and building maintenance. The budget of 2016/17 includes - Council Tax freeze not levying 2%
of adult social care, net revenue budget £144.2 million funded from Council Tax, revenue
support grant given by government having gross budget of £642 million. At last saving of £15.4
million off-setting cost pressures and grant losses (STATEMENT OF ACCOUNTS 2016/17).
While in 2016/17, the revenue that has been outturn is General Fund under-spend of £0.2 million
that transferred to earmarked reserves and Efficiency Reserve General Fund at 31 March 2017 of
£83 million.

REVENUE GENERATED in 2016-2017
FUNDED BY: BUDGET ACTUAL
Formula Grant 38,453 38,453
Localised NDR 59,100 59,100
Council Tax 55,766 55,766
Total Funding 153,319 153,319
From the above graph, it can be interpreated that in the borough there are three sources
from which reveneu has been gathered such as formula grant, localised NDR and council tax that
is around 38,453, 59,100 and 55,766 respectively, hence the total funding is 153,319. So, there
was no additional budget or funding sources has been added in the development of health and
social care despite of more expenses.
Furthermore, the statement of Accounts represent that the ring-fenced Housing Revenue
Account of social housing represent that surplus of £1.6 million has been generated, after
transfers to earmarked reserves (STATEMENT OF ACCOUNTS 2016/17). Hence, this surplus
has been transferred to HRA working balance.

Figure 4: Funding and expenditure in 2019-20
(Source: STATEMENT OF ACCOUNTS 2019/20, 2020)

Figure 5: Funding and expenditure in 2018-19
(Source: STATEMENT OF ACCOUNTS 2019/20, 2020)
From the above two image it can be clearly interpretated that income and expenditure
statement of children services is 72,343 and 58,168, social care is 48272 and 51345, local
authority housing 13008 and 6336 in 2018-19 and 2019-20 respectively. While funding for 2018-
19 in children services is (14254), social care is (1997) and local authority housing is (19479),
but for 2019-20, children services it is (5338), social care (1734) and local authority housing
(13639). Hence it has helped in learning that overall funding has been decreased in 2019-20 as
compared with 2018-19 in children services and local authority housing, while in social care it
has been increased 5840.

CONCLUSION
From the above report it can be conclude that the trends in respect to the expenses made
by the local authority or the Government of England towards the Social care housing may vary
and changes from time to time. This means with respect to the expenses the made towards the
concerned sector vary in terms of inclining or declining trend. In the same way the as per the
above statistics the trend towards the 2019 and 2020 is remain same like that of 2010 in case of
total expenditure made towards the people per day. Likewise, various steps in respect to NHS
and other policies have been taken that has led to the reduction of expenses and a rise in the
value for money. Every step has been taken with a focus that the high efficiency has been
derived from the spending of money. At last it can be concluded that the council has contributed
a lot in making improvement in health and social care housing that lead in providing equal access
to all resources
RECOMMENDATION
The above analysis has contributed in finding certain recommendation that must be used
by the council to improve the health condition of people. Such as:
1. First and foremost, it must need to focus on providing equal access to health and social
care housing facilities to the individual living in the society for necessary improvement
in their health and well-being. As Hammersmith & Fulham is borough that have huge
population but limited health and social care that are ready to provide health care
services to individual.
2. Secondly emphasis must be lay on enhancing the overall capital budget for the health
and social housing care sector so that the sufficient amount of capital is available for
providing necessary support to people. The reason is overall budget is more as compared
to expense made by council so it will contribute in meeting expense effectively.

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STATEMENT OF ACCOUNTS 2019/20., 2020. [Online]. Available from <
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Social care 360: expenditure., 2020. [Online]. Available from
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