Back to first principles

The King's Fund has launched a new Commission on the Future of Health and Social Care in England. We talked to Richard Humphries, Assistant Director, Health Policy, to find out more.

Why do we need a review?

The post-war settlement of 1948 established the NHS as a universal service that was free at the point of use, and social care as a separately funded, means-tested service. Since then, massive demographic, social and technological changes mean that people are living for longer, often with multiple chronic conditions. They need long-term care co-ordinated across different services rather than single episodes of hospital treatment. The difficulty of separating health from social care needs also has big implications for how services are funded and who pays – especially when people find themselves on the borderline of the two systems.

The Commission will go back to first principles, fundamentally re-examining the post-war settlement and asking if it remains fit for purpose. It will raise significant questions about entitlements and the balance of responsibilities between the individual and the state, and explore whether – and if so how – the NHS and social care systems should be brought closer together.

Why now?

That's a good question. We know that the challenges facing health and social care are significant and urgent. Our latest quarterly monitoring report showed mounting pressures on the NHS and social care, with a worryingly high number of patients experiencing long waits in accident and emergency departments being a symptom of this.

Pressures from increasing demand also have an impact on funding; long-term forecasts suggest that spending on health and social care could consume as much as a fifth of our national wealth within 50 years, and we need to look at how sustainable this is. While the Care and Support Bill going through parliament provides a lifetime cap for social care costs of £72,000 and increases in the means-tested threshold, these reforms alone will not solve the challenge of funding social care in the future.

Our Time to Think Differently programme highlighted that we need new models of care to deal with the challenges of the future, giving greater emphasis to integrated care and supporting people in their own homes and communities. But can 21st-century needs be met within the tramlines established in the 1940s? That's why we are asking the Commission to consider whether there is a better way of determining people's entitlements to health, care and support.

Who is leading the Commission?

Kate Barker is chairing the Commission. As an experienced economist, Kate will provide the rigorous analytical approach needed to tackle an issue of this scale. She also brings experience of similar work, having conducted major reviews of housing supply and planning under the previous government.

It was very much a deliberate decision to appoint a chair who has an outsider's view of health and social care – we need fresh perspectives and new thinking to address these challenges.  

Who else is involved?

Kate will be supported by four commissioners: 

  • Geoff Alltimes, Chair of the LGA's multi-agency task group on health transition and former Chief Executive of Hammersmith and Fulham Council and NHS Hammersmith and Fulham
  • Lord Bichard, cross-bench peer and Chair of the Social Care Institute for Excellence
  • Baroness Greengross, cross-bench peer and Chief Executive of the International Longevity Centre UK
  • Julian Le Grand, Richard Titmuss Professor of Social Policy at the London School of Economics

Mark Pearson, Head of Health at the Organisation for Economic Co-operation and Development, will be the Commission's international adviser. From within the Fund, I will be the senior lead for the project and Nick Timmins, Senior Fellow, Health Policy, will be the Commission's rapporteur.

What are the next steps for the Commission?

It will issue a call for evidence, commission research and papers to inform its thinking, and test ideas and options with experts. The Commission will produce an interim report in early 2014 and a final report by September 2014.

How will the Commission influence the political agenda in the lead up to the next general election?

The Commission's work is timed to influence the party manifestos and the incoming government's agenda at the start of the next parliament. The interim report will aim to provide a strong indication of the Commission's thinking.

What do you hope the Commission will achieve?

The Commission is independent and so will determine its own recommendations. The terms of reference enable the Commission to consider all options, on the basis of 'nothing ruled in, nothing ruled out', so it is open to them to make radical recommendations or, equally, to conclude that little or no change is the best option.

My hope is that the Commission stimulates a meaningful debate and that, because of its independence and rigour, its recommendations will be an influential catalyst for change.

Find out more about the Commission into the Future of Health and Social Care in England