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A new settlement for health and social care: interim report


This is the interim report from the independent Commission on the Future of Health and Social Care in England. In it, the commission explains why it believes England needs a single health and social care system, with a ring-fenced, singly commissioned budget, and more closely aligned entitlements. Drawing on accounts from patients and their families, the commission argues that the current system is no longer fit for purpose.

At the root of the problem is a lack of alignment in funding, organisation and entitlement. The report analyses the historical divides between the two systems, the effects of our ageing society, and issues of affordability, before exploring options for change in meeting the costs ahead. It concludes with a call for responses to these options. 

Key findings

  • The problems of the current settlement for health and social care are systemic, in the commission's view. They stem from a lack of alignment in entitlements to care, between funding streams, and in organisation/commissioning of care.

  • There is a problem of adequacy, with too little public money spent on social care and too much demanded of at a time of rising needs. 

  • The public has a poor understanding of the present system of social care. The current system is heavily dependent on unpaid carers and is inequitable, with shifting boundaries on entitlements. 

  • Greater life expectancy, an altered disease burden, and medical advances have all resulted in more people requiring health and social care. 

  • Economic growth means that better health and social care are not unaffordable. But intense short-term pressures and long-term changes mean hard choices will need to be made on funding.

Policy implications

  • The problems of alignment and adequacy raise the issue of affordability – how to fund the type of health and social care system fit for the 21st century.

  • The broad options for raising extra resources are: using existing health and social care resources more efficiently; raising more public funding; and raising more private funding.

  • Improved productivity, improvements in end-of-life care, better integration, ensuring NHS money is spent on what is cost-effective are explored (option 1), but considered insufficient to meet all the costs.

  • Proposals are considered for the ‘harder’ long-term choices, including extending NHS charges, developing a health insurance market, and introducing a hypothecated tax for health and social care. Responses to these are requested.