Now is the time to create a combined health and social care system

NHS England’s chief executive, Simon Stevens, recently told the Health Select Committee that merging two leaky buckets does not provide a watertight solution. It is for this reason that the growing problems in the NHS and social care cannot be solved by the Better Care Fund or any of the other short-term solutions on offer. Nothing less than a fundamental reform of the funding of health and social care services and citizens’ entitlements to publicly funded support is required to address these problems.

The impending crisis in the NHS and social care led The King’s Fund to set up the independent Commission on the Future of Health and Social Care in England (AKA the Barker Commission) in 2013 to explore what a new settlement for health and social care might entail. The commission’s interim report set out a compelling case for a new settlement and identified the hard choices that would need to be made to fund it. At the heart of the report was the argument that England should move towards a combined health and social care system, singly commissioned, with a ring-fenced budget, within which entitlements are more closely aligned.

The commission’s final report proposes that the new settlement should be funded through a mix of higher public funding, reallocating funds from other areas of spending, and changes to prescription charges. Tax and National Insurance increases would be needed to pay for the new settlement and the commission also recommends a review of wealth taxes. Given the current state of public finances, the commission proposes that these changes are phased in over a decade to enable entitlements to social care to be fairer, more consistent and more generous.

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. When fully implemented, a new settlement will account for around 11–12 per cent of GDP. This is less than current levels of spending on health care alone in some countries. The key point is that there are choices to be made about public spending and levels of taxation as the economy recovers, with scope to increase spending on other important services as well as on health and social care.

In making the case for a partnership funding model based mainly on additional public funding, the commission is acknowledging the lack of interest shown by private insurers in offering new products that would cover the costs of care up to the Dilnot cap. The consequences of not providing additional public funding for health and social care are that more people will have to pay for care themselves, and more NHS organisations will find themselves unable to provide timely access to acceptable standards of care within budget. Even more importantly, the prize described by the commission – equal support for equal need, with entitlements to health and social care more closely aligned – will remain a distant dream.

Achieving this prize will make a very real difference to the people in our society who most need help and support. Today we have a fragmented health and care system which too often ends up being distressing and confusing for people in times of need. The new settlement outlined by the commission is one that seeks to create a simpler, fairer and more transparent system for these people and their families.

The King’s Fund will use the commission’s analysis and recommendations to engage with a range of stakeholders to explore the practical implications of implementation. This process of engagement will ensure that the debate on the future of health and social care is kept alive during the forthcoming election campaign and is not consigned to the ‘too difficult’ basket. Further details about this will be published in due course.

At the end of this process we will present our own views to the incoming government on how the new settlement outlined by the commission should be implemented. We will challenge political leaders to acknowledge the impending crisis in health and social care and to move beyond sticking plaster solutions to create a system that is sustainable and equitable for the foreseeable future.

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#42542 Caroline Molloy

This blog glosses over one of the most worrying precedents in the Barker Commission recommendations - the recommendation to separate out NHS accomodation costs, and charge for them, with the defence that this streamlines health & social care practices. Ok, this is just for NHS continuing healthcare patients at the moment - but this is real Rubicon-crossing stuff. Perhaps they're hoping we won't notice...

#42551 james Meacham

We all know what the problem is , but our committees will not realise it. We have allowed many thousand of people to come into this Country and whether or not they have worked , they get free health care and schooling, therefore that puts extra burden on hospitals and schools. I know of elderly people waiting nearly a year for operations. Why should we lose our benefits, and have to sell our homes for care, when those who have lived in rented accommodation, and have smoked, boozed, and foreign holidays, using all their money get care free. As we have contributed all our lives be penalised over the few concession we get. We give millions to foreign aid which does not lower the problem. Why now give it to our hospitals and aid our country.

#42554 Caroline Molloy
#42569 suzi

Many people like myself are somewhat alarmed that exemptions from from free prescriptions will include those with chronic illnesses and the elderly (who else is exempt) and this could cause great hardship for many who are already struggling with the many nuances of their condition.

#43628 Professor Chris...
Self-employed university lecturer/pharmacist

I agree with the concept of changing Rx charges. Based on my limited experience of Norway, I think something similar to what is suggested is the way forward: there should be no exemptions - everyone pays something, perhaps £5/item to an annual maximum for patients with long-term conditions. Once that maximum has been reached, all subsequent medicines in that year are without charge. Having so many exemptions = service not appreciated, and patients go to the GP "because I can get my medicine free" than buying an OTC medicine they could afford.

#97887 Christine rowley
P/T Retired, P/T working
self employed

As a slightly better off person of pension age but still working part time I agree with the sensible proposals for funding health and social care. Is it entirely right that we should help to pay our way. The individual contribution that we are being asked to make is small but as there are so many of us it would greatly improve things for the whole population. I feel that it is correct that this generation of pensioners is better off than those who have gone before and those who are to come. We do however seem to have a sense of being hard done by which is wholly unfounded. I am grateful that I have benefited from the NHS throughout my life, that I have been employed at a reasonable wage (mostly!) and that the rise in house prices has left me with a significant asset which I did not earn. Time to give something back in return

#194212 Isabella Davis
Wholesale Dealer

Yes ,using these new creative instruments we can make our society tobacco free.

#211439 Adrienne Banks

I would be happy to forego the £250 winter fuel payment I received so that it could benefit those who are really in need of it. I am a pensioner but still work part-time and am certainly not badly off.

As far as paying for care is concerned. My elderly mother's savings have been almost wiped out by care home fees and I have just submitted an assessment form for local authority funding, which, even if granted will still not meet the full cost which is over £1000 a week. My mother would be horrified if she knew the truth. No one should have to worry about paying for care in their old age.

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