The Commons health committee has warned real terms cuts to adult social care will almost inevitably translate into unfunded extra demand on the NHS. 

The committee's report - published as councils learned of their average 10 per cent cuts in central government funding - says instead the spending review will see fewer people eligible for local authority social care. 

The body, chaired by former health secretary Stephen Dorrell, says in its report on NHS spending the evidence "does not allow us to agree" with the Secretary of State's claim that the two-year-pay freeze will be enough to "sustain current eligibility levels for social care." 

The committee also uses its report to criticise the government for not setting out a clear "narrative" of how the planned £15-£20bn efficiency savings could be achieved. 

It says: "It is vital that these savings are made by efficiency gains rather than making cuts. Unfortunately, we do not believe that the government is providing a clear enough narrative on its vision of how these savings are to be made." 

"There is an urgent need for a credible plan to deliver the efficiency gain which is the central requirement of the spending review settlement for the NHS.  

"Many witnesses have drawn attention to the need for this plan and have expressed concern that it is not yet available. We share that concern." 

In a press conference introducing the paper Mr Dorrell said it was "disingenuous" of the government to keep using the £1.7bn figure for the cost of reorganisation because it had been calculated before the election and the white paper. 

HSJ understands an updated total for the cost of the re-organisation will be presented to the committee by Andrew Lansley tomorrow (Wednesday). Asked about the nine uses of the word "unprecedented" in the 41-page document and whether he thought the £15-£20bn target was possible Mr Dorrell said: "I can't say it's impossible it just means unprecedented." He added: "We are concerned over how much the efficiency gains will be based on tariff." 

The report said: "There is no guarantee that reductions in the tariff will always result in genuine efficiency gains, and there is a risk that the quality of services could suffer if changes are driven by reductions in the cost of the tariff alone." 

NHS chief executive David Nicholson told the committee earlier this year he expected 40 per cent of the total savings to come through hospital efficiencies driven by the tariff. 

The health select committee report was welcomed by the NHS Confederation and the Royal College of Nurses. 

NHS Confederation acting chief executive Nigel Edwards, said: "The committee has hit the nail on the head with the concerns it has highlighted in its report "All at the same time, NHS trusts are grappling with unprecedented efficiency savings, major management cuts and radical structural reforms." 

RCN chief executive and general secretary Peter Carter said: "This report echoes our fear about the current efficiency challenges. We fully support the committee's view that efficiency savings should not be about cuts, but achieving more with the same amount of money. Sadly, with 27,000 posts already ear-marked for cuts, this message is clearly not reaching NHS trusts."