Commission on the Future of Health and Social Care in England

The commission was asked whether the post-war settlement, which established separate systems for health and social care, remains fit for purpose.

Latest

Final report

Download the final report from the Commission on the Future of Health and Social Care in England. Its 12 recommendations set out a vision for a more integrated health and social care service, simpler pathways through it and more equal treatment for equal needs.

Download the final report

Illustrated summary

Doctor and patientGet the gist of the final report and recommendations in three and a half minutes. Our illustrated summary is the perfect introduction to the commission’s work.

Illustrated summary of the final report

Written overview of the final report

Launch event

As well as the commission’s chair, Kate Barker, we were delighted to host Bobby Duffy of Ipsos Mori, political commentator and broadcaster Steve Richards and expert by experience Becky Huxtable at the report’s launch.

What this will mean for patients

The original call for evidence included real stories to illustrate how the current divide between health and social care affects people's lives. We've updated these to show how the stories would be different if the commission's recommendations were implemented:

Chris Ham blog

One of the great merits of the commission’s report is that it rises above the immediate pressures facing public finances to show that additional public funding is affordable.

Read Chris's blog about the commission's final report

Guest blogs

In the run-up to the launch of the final report we asked three other organisations to contribute to the debate. Each author focused on one of the possible options for funding future health and social care considered in the commission’s interim report.

About

About the commission

Huge social, demographic and technological changes have taken place since the NHS and social care systems were established in 1948. People are living longer, often with multiple long-term conditions, while the boundaries between health and social care are becoming increasingly blurred.

Despite this, services are still largely based on an outdated model of care founded on single episodes of treatment in hospitals, with social care provided under a separate system. With the NHS and social care facing unprecedented challenges, it is time to ask whether the post-war settlement, which established separate systems for health and social care, remains fit for purpose.

Kate Barker on the commission

We spoke to Kate Barker about her reasons for accepting this role, why now is the time to reconsider the boundaries of health and social care, and what she hopes the commission will achieve.

Why did we establish this commission?

The challenges facing health and social care are significant and urgent. The commission's final report will inform the debate on the sustainability of the current NHS and social care funding models and ensure that questions about funding are addressed alongside analysis of how best to meet the needs of 21st-century patients and service users. It was published in time to influence the party manifestos and inform the incoming government's agenda at the start of the next Parliament.

What questions was the commission seeking to answer?

The commission asked whether the post-war settlement – which established the NHS as a universal service, free at the point of use and social care as a separately funded, means-tested service – remains fit for purpose. It explored whether, and if so how, the settlement should be re-shaped by bringing the NHS and social care system closer together.

It also asked:

  • Does the boundary between health and social care need to be redrawn? If so, where and how? What other ways of defining health and social care needs could be more relevant?
  • Should the entitlements and criteria used to decide who can access care be aligned? If so, who should be entitled to what and on what grounds?
  • Should health and social care funding be brought together? If so, at what level (ie, local or national) and in what ways? What is the balance between the individual and the state in funding services?

Download the final report from the commission

View the illustrated summary of the final report

What is the relationship between the commission and The King’s Fund?

The commission was independent of The King's Fund and determined its own recommendations. The interim and final reports were from the commission, not The King's Fund. The King's Fund met the costs of the commission, agreed its terms of reference and appointed its members.

How is the commission different to previous reviews?

Various reviews of the management and funding of health and social care have been conducted in recent years including separate reviews of NHS and social care funding by The King's Fund. What set this commission apart from other reviews past and present is that it fundamentally re-examined the terms of the post-war settlement under which the NHS and social care systems remain separate, with different entitlements, funding and legal frameworks.

The commissioners

Commission members were chosen for their knowledge, experience and independence, not to represent particular interests.

How the commission worked

The commission was independent of The King’s Fund and determined its own recommendations. In addition to regular meetings, it called for evidence and commissioned research and papers to inform its thinking. It tested ideas and options with experts, including stakeholders, patients, carers and people who use care and support services.

The interim report from the commission was published on 3 April 2014. The final report was published on 4 September 2014.

Kate Barker, Chair

Kate BarkerA business economist, former member of the Bank of England's Monetary Policy Committee and now a holder of a number of non-executive posts

Kate Barker is a business economist. She is presently a senior adviser to Credit Suisse and a non-executive director of Electra Private Equity plc, Taylor Wimpey plc and the Yorkshire Building Society. She is also a non-executive member of the Office for Budget Responsibility, and a senior visiting fellow in the Department of Land Economy at the University of Cambridge. 

Kate was a member of the Bank of England's Monetary Policy Committee (MPC) from 2001 until May 2010. During this period, she also led two major policy reviews for the government, on housing supply and on land use planning. Before joining the MPC she was Chief Economic Adviser at the CBI.

Geoff Alltimes

Geoff AlltimesChair of the Local Government Association's multi-agency task group on health transition and former Chief Executive of Hammersmith and Fulham Council and NHS Hammersmith and Fulham

Geoff chairs the LGA multi-agency task group on health transition. He was previously Chief Executive of Hammersmith & Fulham Council and NHS Hammersmith and Fulham. He chaired the NHS Future Forum Patient Involvement and Public Accountability workstream and was joint co-lead on the integration workstream in the second phase of the Future Forum.

Lord Bichard

Lord BichardCross-bench peer and Chair of the Social Care Institute for Excellence

Lord Bichard was founder director of the Institute for Government in 2008 and held the post until 2010. He was previously Chief Executive of Brent and Gloucestershire Local Authorities and in 1990 became Chief Executive of the Government's Benefits Agency. In 1995, he was appointed Permanent Secretary of the Employment Department and, subsequently, the Department for Education and Employment.

Michael received a Knighthood in the Queen's Birthday Honours 1999. In May 2001, he left the Civil Service. He was appointed Rector of The London Institute, the largest Art and Design Institute in Europe in September 2001, which became University of the Arts, London in May 2004.  In January 2004, he was appointed by the Home Office to chair the Soham/Bichard Inquiry. He was Chair of the Legal Services Commission 2005–2008 and Chair of the Design Council 2006–2011.

He is currently Vice-Chair of Shakespeare's Globe Trust, a board member of the River and Rowing Museum Foundation and Henley Business School Strategy Board. He is Senior Adviser to Ten Professional Services (2010–) and Deputy Speaker, House of Lords (2012–). He is Chairman of Film Club Limited, Chair and a trustee of the CNAA Art collection Trust. He has been a governor of Henley Management College, Chair of the Board of Companions of the Chartered Management Institute, a member of the Guild of Educators, Chairman of Rathbone Training Limited and a governor of Langley Academy.

Baroness Greengross

Sally GreengrossCross-bench peer and Chief Executive of the International Longevity Centre UK

Baroness Sally Greengross has been a crossbench (independent) member of the House of Lords since 2000 and chairs five All-Party Parliamentary Groups on dementia, corporate social responsibility, intergenerational futures, continence care and ageing and older people (Co-Chair). She is the Vice Chair of the All-Party Parliamentary Group on choice at the end of life, and is Treasurer of the All-Party Parliamentary Group on equalities. Sally is Chief Executive of the International Longevity Centre, UK; Co-President of the ILC Global Alliance; and was a commissioner for the Equality and Human Rights Commission from 2006–12.

Baroness Greengross was Director General of Age Concern England from 1987 until 2000. Until 2000, she was joint Chair of the Age Concern Institute of Gerontology at King's College London, and Secretary General of Eurolink Age.

Baroness Greengross is Chair of the Advisory Groups for the English Longitudinal Study on Ageing (ELSA) and the New Dynamics of Ageing (NDA). She is President of the Pensions Policy Institute and Honorary Vice President of the Royal Society for the Promotion of Health. Baroness Greengross is Patron of the National Association of Care Caterers (NACC) and Patron of Care & Repair England. She holds honorary doctorates from eight UK universities.

Julian Le Grand

Julian Le GrandRichard Titmuss Professor of Social Policy at The London School of Economics

Julian recently completed a two-year secondment to 10 Downing Street as senior policy adviser to the Prime Minister. He is an Honorary Fellow of the Faculty of Public Health Medicine and a Founding Academician of the Academy of Learned Societies for the Social Sciences.

Julian has acted as an adviser to the World Bank, the World Health Organisation, the Treasury and the Department of Health. He has been Vice Chairman of a major teaching hospital, a commissioner on the Commission for Health Improvement, and a non-executive director of several health authorities. He is currently a member of the Group of Societal Policy Analysts advising President Jose Barroso of the European Commission.

He was one of Prospect magazine's 100 top British public intellectuals, and one of the ESRC's 10 Heroes of Dissemination. He writes regularly for the national and international press and appears frequently on television and radio (including as a member of Radio 4's Any Questions? panel and a presenter of Analysis).

Mark Pearson, international adviser

Mark PearsonThe Commission will also draw on the expertise of an international adviser, Mark Pearson.

Mark is Head of the Health Division at the Organisation for Economic Co-operation and Development (OECD) where he helps countries to improve their health systems by providing internationally comparable data, state-of-the-art analysis and appropriate policy recommendations on a wide range of health policies.

Mark gave evidence to the US Senate on health reform during their recent deliberations. Prior to this, he headed up work on social policy at the OECD for many years, giving policy advice to governments on how best to integrate income transfers with social and employment services. Mark has written a number of books for the OECD and initiated the renewal of the OECD social indicators programme.

Before moving to Paris, he was employed by the Institute for Fiscal Studies in London, and he has been a consultant for the World Bank, the IMF and the European Commission.

Resources

The commission was independent of The King’s Fund and determined its own recommendations. Here are some resources that relate to its work.

Related slidepack

The shifting nature of the health and social care divide

Nicholas Timmins looks at the shifting nature of the funding divide in England's health and social care systems, from pre-NHS to the current day.

Related publications

Spending on health and social care over the next 50 years

Front cover of Spending on health and social care over the next 50 years: why think long term? reportThis report considers the drivers of spending on health and long-term care, and asks whether spending must or should consume such large proportions of GDP in the future, and the fiscal feasibility of this.

Paying for social care: beyond Dilnot

Paying for social care: Beyond Dilnot front coverThis paper discusses the history of social care reform and considers the present and future funding pressures on the system.

Related projects

Time to Think Differently

It is time to think differently about health and social care. We must transform the funding and delivery of services to meet the challenges of the future. This requires new thinking and radical change. Find out about our work on the future of health and social care.

Engagement

Engaging with the commission

The commission engaged with stakeholders, patients, carers and people who use care and support services during its work. This diagram provides an overview of the different activities that took place.

Experts by experience panel

The Commission on the Future of Health and Social Care in England convened a group of ten experts by experience – people who use or have recently used health and social care or care for someone who has – to provide advice.

The experts included: Heather Hughes, John Lish, Claire Jones, Dominic Stenning, Sally-Ann Marciano, Brian Gumbley, Clenton Farquharson, Becky Huxtable, Eleni Chambers (not pictured) and one member who wishes to remain anonymous.

Stakeholder opinions

We have spoken to a number of stakeholders in health and social care, the third sector, patients and carers at our engagement events during the commission's work. What do they think are the key issues that the commission must consider?

Dominic Stenning, member of the experts by experience group

Dominic StenningDominic agreed with the commissioners that a new settlement for health and social care funding is required, and asked them to consider mental health too.

Watch Dominic's video

Michelle Mitchell, MS Society

Michelle MitchellMichelle explained why integrated health and social care is necessary, that social care should be free at the point of need, and that more money must be provided for social care in order for this to happen.

Watch Michelle's video

Claire Jones, occupational therapist and member of the experts by experience group

Claire JonesClaire agreed with the commissioners that a new settlement for health and social care funding was necessary, particularly with changes to demography and the increasing pressures on social care.

Watch Claire's video

Marc Bush, Healthwatch England

Marc BushMarc gave his response to the commission's interim report, and highlighted the importance of involving service users and patients in the commission's discussions.

Watch Marc's video

Sarah Pickup, Hertfordshire County Council

Sarah PickupSarah asked the commissioners to make a compelling case for why any changes are required, and what would happen if we don't make these hard decisions.

Watch Sarah's video

Sandie Keene, ADASS

Sandie KeeneCommissioning health and wellbeing care together, including funding all care from one pot, was the one change to health and social care that Sandie Keene believed would make most difference to service users.

Watch Sandie's video

Alan Rosenbach, CQC

Alan RosenbachAccording to Alan Rosenbach, we need to move human and financial resources out of institutional care and into the community.

Watch Alan's video

Juliet Mountford, British Red Cross

Juliet MountfordJuliet emphasised the importance of a person-centred approach to health and social care in the future, removing the barriers between commissioners, providers and the voluntary sector to provide high-quality care for service users.

Watch Juliet's video

Heléna Herklots, Carers UK

Heléna HerklotsHeléna believed that the focus must shift from individual patients onto families, carers and patients, and that we must recognise that carers can also be experts in particular areas of care.

Watch Heléna's video

David McCullough, Royal Voluntary Service

David McCulloughDavid stressed the important role that volunteers will play in delivering health and social care in England.

Watch David's video

Julia Scott, College of Occupational Therapists

Julia ScottJulia hoped that other services that affect how a population lives – housing, travel etc – will be considered in the final report.

Watch Julia's video

Eve Richardson, National Council for Palliative Care

Eve RichardsonEve believed that the biggest issue currently facing our health and care service is that the current system is not fit for purpose for our growing ageing population.

Watch Eve's video

Rachel Noble, British Dental Association

Rachel NobleRachel wanted to see the health and social care system taking a more holistic approach to caring for a patient.

Watch Rachel's video