The Commission on the Future of Health and Social Care in England (also known as the Barker Commission) was asked whether the post-war settlement, which established separate systems for health and social care, remains fit for purpose.
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 ...
The third in a series of guest blogs that we are publishing in the run-up to the launch of the final report from the Commission on the Future of Health and Social Care in England. Each f...
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Despite this, services are still largely based on an outdated model of care founded on single episodes of treatment in hospitals, with social care provided under a separate system.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?
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.
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:
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.
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.
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?
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.
- Chair, Commission on the Future of Health and Social Care in England
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.
Lord BichardCross-bench peer and Chair of the Social Care Institute for Excellence.
Baroness GreengrossCross-bench peer and Chief Executive of the International Longevity Centre UK.
Julian Le GrandRichard Titmuss Professor of Social Policy at The London School of Economics.
Mark PearsonHead 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, analysis and policy recommendations.