The social care green paper will not be a “panacea” for chronic problems in the system, is likely to propose only minor legislative change, and be based on the assumption that limited sums of new money are available.

That was the warning from Department of Health & Social Care permanent secretary Chris Wormald yesterday, as he told the Public Accounts Committee how, even with the previously announced extra resources for NHS England, financial pressures across the care system would require “tough decisions about where the marginal pound is spent”.

Pressed on how the green paper would address social care’s funding pressures and improve service integration, Mr Wormald said: “We will set out a vision of how the system could be better and intensely practical steps that are do-able without enormous legislation for which we don’t have parliamentary time and without enormous sums of money we don’t have.”

The committee was told by those giving evidence, including NHS England chief executive Simon Stevens and Ministry for Housing, Communities & Local Government director general Jo Farrar, that funding levels for social care would be considered as part of the spending review in 2019-20.

Mr Wormald later added: “Even with that extra resource, and this I am sure Mr Stevens would agree with, that still leaves us with difficult trade off decisions given the level of pressures both on health and social care budgets.”

Committee members highlighted the barriers to integrating health and social care outlined in a report by the National Audit Office in February, such as misaligned financial incentives, workforce challenges and information sharing.

Responding, Mr Wormald said “we are not seeing the green paper as a panacea” that would “change the world”, adding these issues would be addressed by leaders in areas “sitting down in rooms and having a really great conversation about how we can do [integration] better locally”.

He added: “We are not saying there is a huge amount of money coming that will solve every problem, we are saying we hope there will be a sustainable funding package that will allow us to make progress on transformation. But there will still be tough decisions to take about which priorities we fund and when.”

Mr Stevens said reductions in delayed transfers of care shows “we have turned the corner” on the issue. He added the “next stage on the journey” would be to reduce the “large group” of patients that remain in hospital for more than 21 days by half.

Ms Farrar told the committee that those councils which were told they could have better care fund money withheld due to poor performance on delayed transfers of care targets announced in July last year were all now “making progress”.