The King's Fund statement in response to Liberal Democrats' vision for the NHS and social care

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Commenting in response to the Liberal Democrats' vision for the future of health and social care published today, King's Fund chief executive Niall Dickson said:

On social care

'We are at a critical point in planning for how we fund the care and support needs for tens of thousands of older and disabled people and their carers in this country. All the main political parties now accept that the current, means-tested care system is unsustainable and needs to be reformed. We welcome the strong emphasis the Liberal Democrats have today placed on reforming a deeply unpopular system - one that has for so long not only damaged thousands of lives, but also wasted resources by failing to help people live independently without the need for more expensive support.

'The Liberal Democrats have long advocated free personal care, but to make that a reality would be extremely expensive and may not be cost effective - in any case it has been a political non-runner in England since the Royal Commission on Long Term Care almost 10 years ago.

'The party's move today to advocate a new funding system in England - one that combines a clear-cut entitlement to care and support with a sharing of costs between individuals and the state - does appear a sensible way to provide an affordable and sustainable way of providing good social care for all. A system along these lines was set out in the King’s Fund's review on the funding of social care for older people in 2006*. This moves us another step closer to the political consensus that is needed to help us finally achieve the fair, effective and affordable system that is so necessary.'

On proposals for a constitution for the NHS

'A constitution for the NHS has become one of the must-haves for the main political parties - and it is not necessarily a bad idea. But to judge the merit of a constitution we need to know what's in it and what's not. On the positive side something that sets out lines of accountability, as well as the roles and relationships in today's more devolved health care system, could help clarify what the NHS is designed to do and how it is governed. It could also place appropriate legal checks on ministerial and departmental decisions.

'But there are dangers if it is not thought through with care. A detailed list of patients' rights, for example, could become caught up in endless legal wrangling. On the other hand, a constitution that simply reiterates core principles or restates existing targets, such as 18-week waiting times, without any enforceable rights for patients would lack credibility.'

On moves to increase local democratic accountability

Niall Dickson, who is chairing the Local Government Association's independent cross-party commission on health accountability, added: 'Strengthening local accountability in the NHS and enabling people to have a greater say in how their local health services are run is a key challenge for the health service. The Liberal Democrats are right to want to devolve more power to local NHS bodies - their proposal to directly elect PCT boards is one of many ideas on how to improve accountability and deserves further discussion.

'But this would not necessarily address the fundamental problem of weak local commissioning. Making services more responsive to local people requires robust local commissioning with a clear vision and co-operation between GPs and primary care trusts.'

On direct payments and individual budgets

'Everyone agrees that the principle of handing over control to individuals and their families is right - this could signal a massive cultural change, driven locally, in the way care is delivered,' said Niall Dickson. 'But we are still at an early stage of knowing what works well and why. The Department of Health is in the middle of a major study to assess the value of individual budgets that brings together a number of different funding streams and it will important to learn the lessons of that work.

'We also need to look carefully at the implications of extending personalised budgets into the health service. Although direct payments have been successful in social care, their effective use in health care is more of a challenge. Challenges include getting the initial payment level right and determining who would pay for care should the budget be exhausted. There is also the danger that converting NHS services into cash could allow the better off to enhance their allowance thereby creating a two-tier service, which undermines the founding principles of the NHS.'

Notes to editors

  1. For further information or interviews, please contact the King’s Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. *Securing Good Care for Older People: Taking a long-term view, the King’s Fund commissioned report into the future of social care funding by Sir Derek Wanless, was published in March 2006.
  3. The Fund was part of Caring Choices, a coalition of 15 organisations from across the long-term care system that sought to gather the views of older people, carers and others with direct experience of the system on how care should best be funded in the future. Throughout 2007, the coalition engaged with more than 700 individuals at a series of consultation events across England and Scotland and through an interactive website. The final report was published on 7 January 2008 and is available as a free download at 
  4. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.