What next for health and social care in England?

The King's Fund is today launching a major review of health and social care under the leadership of an independent commission chaired by Kate Barker. The context for the review is a population in which people are living longer but often with long-term conditions, such as diabetes, heart failure and dementia. An increasing number of people have both health and social care needs, and the division between the NHS and social care that was established in 1948 means it is not always possible to meet these needs in an effective way.

We have therefore asked the Commission on the Future of Health and Social Care in England to consider whether the boundary between health and social care should be redrawn by revisiting the post-war settlement and asking fundamental questions about whether it is still fit for purpose. This includes examining how the NHS and social care are funded and organised, and what the alternatives might be to current arrangements. We have also asked the Commission to consider the different entitlements to these services, and whether now is the time for these to be changed. This includes addressing the thorny question of the role of the state and individuals in paying for health and social care.

Recognising the importance of these issues, the Commission will work over a period of 15 months, producing an interim report early in 2014, ahead of its conclusions and recommendations in September 2014. It will be supported by Richard Humphries and Nick Timmins in the Fund and will draw on internal and external expert analyses. The Commission will also be issuing a call for evidence early on in its work and will be engaging with stakeholders to test ideas and options as they emerge.

The decision to establish the Commission grew out of our work on the future of health and social care in our Time to Think Differently programme. In this programme we have argued that new models of care are needed in which there is less emphasis on hospitals and care homes and greater priority is given to supporting people in their own homes and in the community. Care in future also needs to be much more integrated – with boundaries between physical and mental health, primary and secondary care, and health and social care broken down. The Commission will be exploring whether radical changes are needed to make a reality of these new models of care.

The financial and service pressures currently affecting health and social care add urgency to the Commission's work. With the prospect of several years without growth in the NHS budget and further cuts in the funding of adult social care, it is essential that all options for using scarce public resources more effectively are considered. This includes looking beyond health and social care to ask whether other forms of public spending could be drawn on to meet growing needs for support, as well as reviewing the balance between public and private funding of care. The experience of other countries will be used to inform the Commission's thinking on this.

The broad scope of the Commission sets it apart from similar reviews already underway. The commissioners have been given a free rein. They could conclude that radical changes are needed, but equally they may decide that it would be preferable to make the existing system work better. The Commission will succeed if it produces evidence to inform debate ahead of the 2015 General Election and is able to influence the decisions of the next government on what needs to be done to secure health and social care for the future.