Independent commission calls for a new settlement for health and social care

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The health and social care systems are no longer fit for purpose, an independent commission established by The King's Fund has concluded. The time has come, it says, for 'a new settlement' to meet the needs of 21st century patients and service users.

The interim report from the five-strong commission, chaired by Kate Barker, says that England should move towards a single, ring-fenced budget for health and social care, with services singly commissioned and entitlements more closely aligned. With the NHS and social care now under significant financial strain, the report presents hard choices about how to pay for fairer entitlements and ensure adequate funding to meet future needs.

The independent commission was set up by The King's Fund to re-examine the post-war settlement, which established separate systems for health and social care. In its interim report, the commission concludes that the current settlement is failing to respond to the needs of the increasing number of people with long-term conditions, young as well as old. It argues that a lack of alignment in entitlements, funding and organisation between the two systems results in unfairness, poorly co-ordinated services and confusion for patients, service users and their families.

  • With health care largely free at the point of use and social care needs-based and heavily means-tested, entitlements vary, so that people with different conditions - cancer and dementia, for example - end up making very different contributions to the cost of their care.
  • The lack of alignment in funding, with the NHS paid for out of general taxation and a budget that has been ring-fenced for a number of years, and social care reliant on grant funding that has been subject to significant cuts, has led to social care becoming an increasingly residual service. 
  • With health care delivered through the NHS and social care overseen by local authorities, the lack of alignment in organisation between the two systems creates confusion for patients, service users and their families, and acts as a significant barrier to improving the co-ordination services.

On top of this, the commission concludes that funding is inadequate, with insufficient public money currently spent on social care, and more resources needed to meet future health and care needs as the population ages. This raises questions of affordability and the need to make difficult choices about how to meet these costs, including the balance between public and private funding, which the commission will address in its final report in the autumn.

The commission's chair, Kate Barker, said: ‘The current systems rub up against each other like bones in an open fracture. The lack of alignment between them leads to serious problems of co-ordination, with the NHS and local authorities battling over who should pay for what, and patients, service users and their families left confused and bewildered. This is not sustainable – we need a new settlement fit for the 21st century.

'This report is our stake in the ground. The prize we seek – a single, seamless health and social care system that offers equal support for equal need – is a significant one. This necessitates making choices about how to pay for a better system – hard choices that we must look squarely in the eye.'

Responding to the report, Chris Ham, Chief Executive of The King's Fund said: 'We welcome the commission's report – it sets out a compelling case for change and hard choices that need to be faced. These choices present a significant challenge to politicians but with NHS and social care budgets now under huge strain, this is a debate we need to start before, not after, the next general election.'

The interim report outlines a number of options for funding increased health and social care spending and the criteria against which the commission will judge them. The commission will now seek views on these options and undertake further work on costings, before it publishes its final report in the autumn.

Notes to editors

For further information or to request an interview with Kate Barker, please contact The King's Fund press office on 020 7307 2585 (or 07584 146035 if calling out of hours).

The Commission on the Future of Health and Social Care in England was established by The King’s Fund in June 2013. The commissioners are:

  • Kate Barker, business economist and former member of the Bank of England's Monetary Policy Committee
  • Geoff Alltimes, chair of the Local Government Association multi-agency task group on health transition and previously Chief Executive of Hammersmith and Fulham Council and NHS Hammersmith and Fulham
  • Lord Bichard, cross-bench peer and Chair of the Social Care Institute for Excellence
  • Baroness Greengross, cross-bench peer and Chief Executive of the International Longevity Centre UK
  • Julian Le Grand, Richard Titmuss Professor of Social Policy at the London School of Economics

The commission's terms of reference ask it to explore 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 and whether, and if so how, the settlement should be re-shaped by bringing the NHS and social care system closer together.

The commission is keen to seek views on the options for change it has set out and has issued a further call for evidence to inform its final report.

More information about the commission’s work is at:
The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.