Illustrated summary of the Barker Commission's final report

Comments: 10

The final report from the independent Commission on the Future of Health and Social Care in England examines the current health and social care systems and proposes a new approach that redesigns care around individual needs. The commission has concluded that this vision for a health and care system fit for the 21st century is affordable and sustainable if a phased approach is taken and hard choices are taken about taxation.

What do you think?

  • About the new settlement the commission is proposing?
  • How it could be achieved?
  • How it should be paid for?

Tweet using #barkercomm or comment on Chris Ham's blog, Now is the time to create a combined health and social care system.

This is an abridged version of the final report. Download the full version, including all 12 recommendations, here:


#42535 Su Glazier
Retired NHS worker (mental health)

On first brief consideration, I think these proposals seem excellent. There must also be lots of financial savings to be made on the present non-joined up system by having one integrated system. Over time this should eventually mean that things like very expensive hospital beds will not be blocked in their thousands and that people's care will be more streamlined and effective. A better system will be more expensive to set up and run but over time there is much scope for saving money by just having a rational system and short pathways.

#42538 terry bamford
Healthwatch Bexley

Integration can only be achieved if there is a level playing field between health and social care. That requires addressing the free at the point of access issue and the Commission has done so. But it has missed a trick by ignoring where the big savings in health can be made by addressing the wasteful divide between primary and secondary care- also the result of history and now compounded by CCGs' role.

#42539 Janet Portman
Retired Nurse. Public Governor of local hospital

I agree that we should have a more integrated system.
The proposal to increase National Insurance from wealthy people fine, but not from older people because they use the care system more. Older people have worked all their lives and paid National Insurance to cover their needs in old age. They may never have needed care before getting older. Why do we always have money for bombs, for killing innocent people and not have enough money for health. We should perhaps take a few billions from the Royal family. They are the ones who have never paid into the system. Why do we have money to bail out bankers who have been incompetent. We need to ensure care is available for those who need it. Taking more from the poor and middle will cause more ill health. Many studies have found that the greatest cause of ill-health is poverty.

#42545 Dex
Communications Manager
Healthwatch Leeds

the link for the summary isn't working?

#42547 Liz S

Yes please to a more integrated system.

The last 2 years of my elderly father's life were blighted by the daily battle we fought with different parties ... trying to understand the health and social care system, its processes and learning how to ask the right questions to the right people to get the help he so badly needed. Dementia is a terrible thing to witness ... we must be much better at helping sufferers and their carers. The current system is failing our elderly people.

The financing needs careful thought .... I agree some of the benefits (TV licence, winter heating allowance) need to be means tested, we see on TV wealthy pensioners who want to pay these benefits back but have no mechanism to do so.

My father only needed social care in the last 2 years of his 85 year life - but when he did need it - it was his lifeline. He paid for it all as his savings were above the threshold for financial assistance. I have no issue with us all paying for our own social care (via insurance if necessary).

We do need a joined up, fully integrated health and social care system that helps us all get the help we need, when we need it.

#42550 Joe Farrington-...

I can't get it to work either.

#42556 Anita Robinson
retired - formerly a teacher

A joined up service sounds like a great idea but the funding and how it is run seems like a recipe for further burgeoning red tape as all the areas separated at the moment are ridiculously hide bound by duplication and red tape. I have never understood why care for the elderly should be so very expensive - maybe if it were treated like a business for the benefit of its clients such as in a cooperative things would be simpler and more efficiently managed. Some people in health/social care work exceptionally hard with long hours whilst other sections hardly seem to know what it means to work hard. Proper leadership and good management is the key to bringing down costs through greater efficiency. Most elderly people are not wealthy and I am tired of hearing this bandied about as an excuse to charge older people more. Why is there not the drive to fundraise through a national lottery that exists where profit making is concerned? How many millions are given away with rollovers etc??? Our health and social care should receive every penny of additional funding that can be found but let us please spend it on the clients, not on a burgeoning sector of health and social care management professionals but on the actual front line carers instead.

#42604 Geoffrey rivett

While it is obvious that there is a problem with dementia and multiple diseases I'm the elderly and I am one of the healthy people in their eighties who will be taxed more for the needs of those less fit, I think that the report almost ignores the issue of. Twenty first century acute Illness service and perhaps the choice of chair made this inevitable. I do not see unitary commissions as helpful here and national specialist commissioning would surely be needed. I think the proposals might ease some problems and create others and I do not see prescription charges and my paying for my TV will create the resources needed. I see more future in vertical integration of health devices and questioning purchaser provider split than an attempt to integrate health and social care. I see few savings to be made there.

#43732 alison salmon
district nurse
suffolk community healthcare (serco)

As a nurse with 30 years experience I feel I have experienced most of the issues and cost implications discussed here. I have worked within both primary and and acute care more recently in discharge planning. This involved continuing healthcare assessment (CHC) and close working with ASC services. As a district nurse I experience the front line of complex social and health problems and have family experience of being in need of services also. I lay awake at night sometimes writing letters in my head about the issues in health and wasted resources.
I agree we need a joint budget as no one is purely health or socially affected by their needs, however we also need to reduce the layers of burocracy within all the systems in order to save money. We used to recognise complex cases, finish CHC, its unworkable and will always create dispute and appeals. The concept is too difficult for most to understand or agree with, it is also too open to interpretation.
I agree reduce prescription cost and review the ridiculous systems that give some people all prescriptions free, regardless of relation to the initial diagnosis, such as hypothyroidism. However I feel if we made everyone pay a small amount, it wound reduce the massive waste and cost that I see, even as little as 25p an item would make people more considerate when ticking that repeat box. In view of our ageing demographic and the percentage of prescriptions issued to the over 60s, we have to enforce a greater degree of responsibility, give people something for free and they wont respect it-fact.
In order to make hospital admissions shorter we must spend more on staffing and not making 'patients' of people, by enabling earlier. We also need more community based rehab facilities, we have to be realistic about the age and frailty of some people and they do need longer to recover their independence, and confidence, hospital admission is incredibly disempowering in itself.
Time to get off my soapbox, thank you for listening to my ramblings, as a proud hardworking nurse I salute the NHS and celebrate our countrys willingness to try and support people but agree it is time for change, but please let the government either take a back seat or talk to the professionals that are feeling unheard and frustrated by systems that hinder rather than help them provide their services.

#44966 Helen Watkinson

Just a very brief point, i have 2 members of my family who have a plethora of prescriptions for long term health care conditions, some items they do not need every month, but they keep ticking the box so that they do not have the nightmare of accessing their GP when they need them reinstated. Both have severe mobility issues and getting to the GP involves either myself taking time off, or paying a carer. I am sure there are thousands of others in the same boat. Sort out that one small issue and the potential savings are huge.

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