This is the final report from the independent Commission on the Future of Health and Social Care in England. In it, the commission discusses the need for a new settlement for health and social care to provide a simpler pathway through the current maze of entitlements. The commission, chaired by Kate Barker, proposes a new approach that redesigns care around individual needs regardless of diagnosis, with a graduated increase in support as needs rise, particularly towards the end of life. The commission has concluded that this vision for a health and care system fit for the 21st century is affordable and sustainable if a phased approach is taken and hard choices are taken about taxation.
The commission recommends moving to a single, ring-fenced budget for the NHS and social care, with a single commissioner for local services.
A new care and support allowance, suggested by the commission, would offer choice and control to people with low to moderate needs while at the highest levels of need the battlelines between who pays for care – the NHS or the local authority – will be removed.
Individuals and their carers would benefit from a much simpler path through the whole system of health and social care that is designed to reflect changing levels of need.
The commission also recommends a focus on more equal support for equal need, which in the long term means making much more social care free at the point of use.
The commission largely rejects new NHS charges and private insurance options in favour of public funding.
Proposals for a single, ring-fenced budget and single local commissioner will have major implications for central and local government and the NHS.
Public spending on health and social care is likely to reach between 11 per cent and 12 per cent of GDP by 2025, the next government needs to consider how to respond to these spending pressures.
The commission proposes funding changes, including changes to National Insurance contributions, to meet the additional £5 billion that would be required to improve social care entitlements.
A comprehensive review of various forms of wealth taxation needs to be undertaken with a view to generating additional resources that will be needed for health and social care in future years.