The NAO found that the take-up rate for three and four-year-olds in early education has been sustained at 95 per cent since 2008, despite an eight per cent increase in eligible children. There are however, wide variations in take-up between local authorities. Take-up for children from the most disadvantaged families is lower than overall take-up.

The quality of nurseries, schools and other providers offering the free entitlement has been sustained overall since 2008-09, but access to high quality provision varies depending on where children live. According to NAO analysis of Ofsted data, the percentage of good or outstanding provision across local authorities in March 2011 ranged from 64 per cent to 97 per cent. Areas of highest deprivation are less likely to have high quality provision.

Children from disadvantaged families are much less likely to take up free nursery places, and also less likely to attend high quality nurseries that boost their achievement. While the best local authorities achieve almost 100 per cent take up of provision, in one local authority the take up rate was only 62 per cent.

Anand Shukla, Chief Executive of Daycare Trust said: “This should not come as a surprise to the Government, as Daycare Trust’s recent survey of Family Information Services revealed that nine in ten local authorities have cut their budget for family information, making it harder for parents to get the support they need to take up their entitlements. This is of particular concern for parents on low incomes who are less likely to use word of mouth to find out about local childcare services.”

She added: “We will only end this shocking postcode and income lottery by providing better information and outreach services.”

The Health Committee looked at the issues facing the future of social care and concluded that joined up services are crucial to meeting the needs of older people. It is impossible to deliver either high quality or efficient services when the patient is passed like a parcel from one part of the system to another, without any serious attempt to look at their needs in the round. While this is an obvious truth and has often been repeated, it is seldom acted upon.

The Committee found that the way healthcare is funded is a major barrier to improvement. The funding for NHS care, social care and social housing comes from different sources and attempts to join up these funds and to integrate services have been disappointing.

The Committee recommends that there should be joined up commissioning. The Government should place a duty on the new clinical commissioning groups and local councils to create a single commissioning process, with a single accounting officer, and a single outcomes framework for older people’s health, care and housing services in their area.

This would improve outcomes by making it easier to move money around the local health, housing and social care system. It will also play a significant part in delivering the Nicholson Challenge for the NHS of 4% efficiency saving every year over the next four years.

Growing demand, coupled with an unprecedented efficiency challenge, makes it more urgent than ever before to respond to the challenge of joining up services. The Committee looks to the Government to set out in its Social Care White Paper how this vital objective will be met.

The Committee’s recommendation for joint commissioning of services is supported by evidence presented to them by the Torbay Strategic Partnership which developed their approach with a grant of £250k from the Regional Improvement & Effiecient Programme to take forward the Total Place methodology. Total Place has now evolved into the Community Budgets initiative where pilot projects are bringing together all funding on local public services from the area into a single pot and allowing multi skilled teams to work across organisational boundaries to find innovative solutions. Torbay has demonstrated that their approach provides a better service at a lower cost.

The Committee’s report will provide a boost to Community Budgets, but it has also revealed that the Department of Health has little enthusiasm for moving control of budgets from Whitehall to allow spending decisions to be taken locally. Care Services Minister Paul Burstow told the Committee that he sees Care Trusts (such as Torbay) as “an experiment that […] did not really get out of the lab”.

The trials are organized by the Behavioural Insights Team in the Cabinet Office which has a remit to help local authorities, charities, government and private sector organisations to develop responses that encourage healthier behaviours. Some £21 billion is lost to fraud in the public sector while £7–8 billion is lost on overdue debt.

The Team draws on insights from behavioural science and behavioural economics which encourage behavioural change without resorting to legislation or costly programmes.

The trials are showing the effectiveness of the nudge approach. In a debt recovery trial £160m of tax debts were advanced over a 6 week period. Another trial brought in over £1 million from doctors in additional yield to HM Revenue and Customs, while a further trial saved Manchester City Council up to £240,000 in council tax discounts.

Overall, these trials showed effect sizes of up to 30 percentage points, underlining the key role that behavioural insights can play in tackling fraud, and debt. They demonstrate that even relatively minor changes to processes, forms and language can have a significant, positive impact on behaviour, and can often save the public time and money.

Traditional attempts to combat fraud and debt have made a number of assumptions about human behaviour. They have tended to assume that individuals rationally weigh up the personal costs and benefits of committing fraud by calculating the amount that they expect to gain, the probability of being caught and the magnitude of the punishment. But studies show that people can be encouraged to do the right thing by making the process easy, highlighting key messages or emphasising what most people are already doing.

Research also indicates that it is important to look at the system as a whole from an end user’s perspective in order to identify key points where people may be tempted to be dishonest. It is then possible to tailor interventions to that specific context in order to encourage honesty and compliance.

The Behavioural Insights Team drew on an experiment in Minnesota where people were told that their perception that many other people did not pay their taxes was incorrect. This increased rate of voluntary tax compliance. The Team have collaborated with HMRC and taxpayers in a locality were told that 9 out of 10 people in the area had already paid their tax. This resulted in substantial increases in tax repayments compared with the control group.

The warning was prompted by a report from the NAO on progress in cutting costs in central government. Margaret Hodge highlighted the weaknesses in the way departments are managed, including lack of vision of how they will work with less money and poor understanding of the relationship between spending and outcomes. There is also no consistent way to measure progress in seeking efficiency across government.

The NAO report reveals that departments cut spending by 2.3 per cent in 2010/11, but they need to cut a further 19 per cent over the four years to 2014-15. To achieve this saving fundamental changes will be needed to secure sustainable reductions on the scale required. A major difficulty in achieving this target is that there are gaps in departments’ understanding of costs and risks, making it more difficult to identify how to deliver activities and services at a permanently lower cost.

Looking behind the mandarin speak this means that gathering the low hanging fruits is relatively easy and quick and does not need much imagination. But once this harvest is over, cost cutting becomes a completely different ballgame.

The NAO was unable to find out how far spending reductions represented year-on-year changes in efficiency and whether front-line services were affected. It concluded that forward plans are not based on a strategic view.

Departments’ financial data on basic spending patterns is sufficient to manage budgets in-year, but information about the consequences of changes in spending is less good. Longer term reform is a Cabinet Office priority and departments will need to look beyond short-term cost cutting measures and make major operational change.

Amyas Morse, head of the National Audit Office, said today: “Government departments have been successful in cutting costs and managing within their reduced spending allocations for 2010-11. However, most departments will need to cut their spending by much more over the next four years. This will not be possible without their recognizing that short-term measures are not enough and that fundamental changes are needed.”

The findings of the NAO are in line with the Audit Commission’s findings relating to local goverment.

Some 150 councils have so far indicated that they will take the freeze grant offer. They include Hammersmith and Fulham, South Oxfordshire, Stratford-on-Avon, Tendring and Windsor and Maidenhead which will reduce their council tax.

Council tax bills more than doubled since 1997 until last year’s freeze. This is the second year the Government has offered support to freeze council tax to support local residents, families and pensioners.

The Government has set aside up to £675 million for local authorities in England to help keep council tax down. Last year’s freeze saved households up to an estimated £72 on a Band D bill, and this year’s freeze could potentially do the same.

This new support builds on the offer taken up by all councils last year boosting what they could get over four years to £3.3 billion if they hold council tax for a second year.

The level of concern at the lack of response to the offer is shown by Local Government Secretary Eric Pickles who said: “Every councillor still to decide (on the level of council tax) has an obligation to keep the living costs of their residents down and take the freeze money. A vote against a freeze is a vote for a punitive tax-rise when typical bills are already around £120 a month.”

The pension reforms just negotiated will make little or no difference to the long-term costs of public service pensions. The savings from higher pension ages are, on average, offset by other elements of the pensions becoming more generous. In general lower earners in the public sector will actually get a more generous pension as a result of the recently announced reforms. That is, they will be able to retire at age 65 with a higher annual pension than they would receive under current arrangements. This results from the move from final salary to career average schemes and the particular changes to accrual and indexation rules.

Conversely higher earners are likely to lose out. The move from final salary to career average relatively penalises those who see big increases in their earnings over time. By increasing the generosity to lower earners – a group less likely to have a good employer pension in the private sector – the reforms increase the difference between the public and the private sectors.

However, the taxpayer has already started to benefit from the move from RPI to CPI indexation of public service pensions, introduced by the government in the October 2010 Spending Review. This will substantially reduce costs.

On pay, the IFS study found that at the end of the two-year public pay freeze and the two year of 1% pay increases, public pay will return to where it was relative to private sector pay in 2008. This is because private sector pay reacted quickly to the recession. Pay in the public sector did not.

The IFS findings have been challenged. TUC General Secretary Brendan Barber said: “The big increase in contributions immediately reduces the cost of public sector pensions by taking a big chunk out of most public servants’ pay. But if you take the package as a whole there can be no doubt that many public sector workers may have to pay more, work longer and get a pension that will not keep up with the proper measure of the cost of living.

The Treasury dispute the finding that the proposed pension arrangements will not save any money.

The review looked at 25 local authorities and provides an early insight into how local government is coping with the severe contraction in grant income implemented after the 2010 Comprehensive Spending Review. It finds a strong likelihood that the contraction of local government service provision will be felt differently across England. Analysis of the patterns of spending cuts show greater cuts in the most deprived authorities, compared with the most affluent.

The report also points to conflict over whether the needs of vulnerable people should be prioritised. Only half the sample had adopted ‘protecting the needs of the most vulnerable client or communities’ as a principle guiding budgetary decision-making and just two suggested that ‘protecting deprived neighbourhoods’ was a priority.

The report suggests that the consequences of the cuts for disadvantaged people in the poorest areas will also quite possibly be overlooked. Councils are struggling to assess the impact of the cuts they make to services, due to lack of capacity. The authors believe that the cuts made by local government in future should be monitored to ensure that the needs of the poorest and most vulnerable people are addressed.

Julia Unwin, Chief Executive of the Joseph Rowntree Foundation, said: “This report is part of our programme looking at how disadvantaged people and places are coping in this time of austerity. This report finds that vulnerable people are being hit with the double impact of faster cuts, and lack of protection. While we accept that local authorities need to make spending cuts, it is essential that people in communities that are already struggling do not suffer more than others.”

Researchers also found that the most deprived authorities lost most spending power, especially in the first year, while some affluent areas faced only mild initial cuts. The front-loading of the cuts, the failure to target the needs of deprived authorities, and the design of the system all ensured that deprived authorities suffered harsher cuts.

The figures were released in response to the Health Select Committee’s accusations that hospitals are ‘salami slicing’ less headline grabbing services such as physiotherapy for elderly people, in attempts to find £20bn in efficiency savings. See Publicnet

Concerns shared on the nationwide feedback site, which brokers conversations between NHS trusts and patients and their carers, reveal a decline in levels of care across the country with bed shortages and lack of caring staff attributed to NHS spending cuts.

Speaking at the beginning of June 2011, a patient in the North West said: “I came to hospital in February with spinal injuries. The care I received at the beginning was good, but recently care has declined which I feel is due to staff shortages.

Similarly professionals at hospitals are also concerned about the effect that cuts are having on the delivery of service. A healthcare worker at Rotherham hospital, posting anonymously under the username Stressedhealthcarer in July 2011, said: “As a healthcare worker at Rotherham hospital, I am increasingly concerned about the standards of quality care. Due to bed closures patients are being constantly moved throughout their stay which I feel results in disjointed medical and nursing care.

“Senior management aren’t there to explain to disgruntled patients and visitors why their loved one has been moved for the fifth time – it’s left to already stressed and overstretched ward staff!”

Speaking about the impact of efficiency savings on patients’ experiences, CEO of Patient Opinion, Dr Paul Hodgkin, said: “We released these figures to raise greater awareness of the opinions of patients and their carers’ opinion who are being directly affected by the Government’s efficiency drive. “From what they tell us, patients are not opposed to making the NHS more efficient. But it is clear that patients want the NHS to work with their needs when making these cuts, rather than leaving people feeling uncared for and confused.”

The quality of teaching in these ‘non-association’ independent schools tends to be competent but seldom inspiring. The biggest single weakness is the high proportion of schools which do not have sufficiently robust arrangements for safeguarding pupils’ welfare, health and safety.

The proposals build on the current arrangements for inspection. Ofsted will continue to use a four point scale to make qualitative judgements. Detailed grade descriptors will seek to provide more consistency, openness and transparency and encourage independent schools to strive further for improvements to the quality of provision.

Ofsted currently gives independent schools two days’ notice of their education inspection but for inspection of care in boarding and residential special schools no notice is given. Ofsted intends to adopt a similar system for the education inspection of independent schools. Pupils, parents and carers have told Ofsted that inspection without notice is important as it lets the inspectors see the school as it really is.

The views of the pupils themselves, as well as parents, carers, staff and local authorities who use the services of independent schools are highly valued by inspectors who follow up the issues they raise. These views will continue to be an important feature of inspection.

Among independent children’s homes which are registered education providers there is a comparatively lower proportion that makes good or outstanding educational provision. The new framework will focus on the educational progress and achievements of looked after children and look critically at what schools are doing to close the gap between their achievements and other pupils.

The health service is required to make savings of £20b over four years. But these savings must be achieved against a background of demographic pressures, rising public expectations and medical advances. Evidence to the Committee suggested that NHS organisations are focusing on trimming existing processes rather than developing new ways to deliver services. They are squeezing services to get through the first year. A common practice is to salami slice budgets.

The Committee believes that there is a need to do things differently. New ways of working need to be developed. This will involve significant change in the care model.

Evidence presented to the Committee on social care portrayed the system as close to collapse, if not fundamentally broken. It is not able to properly respond to the demands on it. Councils are making savings by the expedient of artificially reducing demands on the service by restricting eligibility. Savings have also been made on other local authority functions and by forcing down the price paid to contractors for services. In each case, the scope for further efficiencies is severely limited.

Integration of health and social care services provide opportunities for greater efficiency savings, but evidence from the Audit Commission shows that integration and working more closely with the NHS was one of the least common ways of achieving savings. There is progress on joint commissioning and pooled budgets, but the two services are separately funded. One is local authority funded, subject to a means test, and the other is NHS funded, not subject to any means test and free.

The Committee believes that the health and social care bill currently before Parliament is complicating the push for efficiency gains. It is creating disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings.