Statement from the Barker Commission
This statement from the Barker Commission highlights their concerns about the lack of progress since their report was published, and calls on the Chancellor to take action on health and social care funding in the Spending Review.
Download the final report from the Commission on the Future of Health and Social Care in England. Its 12 recommendations set out a vision for a more integrated health and social care service, simpler pathways through it and more equal treatment for equal needs.
Implementing integrated care
One of the commission's central recommendations was for a single ring-fenced budget and a single local commissioner for health and social care. The King's Fund report, Options for integrated commissioning, explores the options for implementing that recommendation.
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.
- Watch Kate Barker's presentation
- Watch Becky Huxtable's presentation
- Watch Bobby Duffy's presentation
- Watch Steve Richards' presentation
- Video reponses to the final report
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:
Chris Ham blog
One of the great merits of the commission’s report is that it rises above the immediate pressures facing public finances to show that additional public funding is affordable.
In the run-up to the launch of the final report we asked three other organisations to contribute to the debate. Each author focused on one of the possible options for funding future health and social care considered in the commission’s interim report.
- Andrew Harrop (Fabian Society): Taxing retired households to pay for care
- Andrew Haldenby and Cathy Corrie (Reform): Can we ignore NHS charges any longer?
- Nick Pearce (IPPR): An NHS tax is needed to keep the NHS free to all at the point of need
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.
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.
Kate Barker, Chair
Kate Barker is a business economist. She is presently a senior adviser to Credit Suisse and a non-executive director of Electra Private Equity plc, Taylor Wimpey plc and the Yorkshire Building Society. She is also a non-executive member of the Office for Budget Responsibility, and a senior visiting fellow in the Department of Land Economy at the University of Cambridge.
Kate was a member of the Bank of England's Monetary Policy Committee (MPC) from 2001 until May 2010. During this period, she also led two major policy reviews for the government, on housing supply and on land use planning. Before joining the MPC she was Chief Economic Adviser at the CBI.
Geoff chairs the LGA multi-agency task group on health transition. He was previously Chief Executive of Hammersmith & Fulham Council and NHS Hammersmith and Fulham. He chaired the NHS Future Forum Patient Involvement and Public Accountability workstream and was joint co-lead on the integration workstream in the second phase of the Future Forum.
Lord Bichard was founder director of the Institute for Government in 2008 and held the post until 2010. He was previously Chief Executive of Brent and Gloucestershire Local Authorities and in 1990 became Chief Executive of the Government's Benefits Agency. In 1995, he was appointed Permanent Secretary of the Employment Department and, subsequently, the Department for Education and Employment.
Michael received a Knighthood in the Queen's Birthday Honours 1999. In May 2001, he left the Civil Service. He was appointed Rector of The London Institute, the largest Art and Design Institute in Europe in September 2001, which became University of the Arts, London in May 2004. In January 2004, he was appointed by the Home Office to chair the Soham/Bichard Inquiry. He was Chair of the Legal Services Commission 2005–2008 and Chair of the Design Council 2006–2011.
He is currently Vice-Chair of Shakespeare's Globe Trust, a board member of the River and Rowing Museum Foundation and Henley Business School Strategy Board. He is Senior Adviser to Ten Professional Services (2010–) and Deputy Speaker, House of Lords (2012–). He is Chairman of Film Club Limited, Chair and a trustee of the CNAA Art collection Trust. He has been a governor of Henley Management College, Chair of the Board of Companions of the Chartered Management Institute, a member of the Guild of Educators, Chairman of Rathbone Training Limited and a governor of Langley Academy.
Baroness Sally Greengross has been a crossbench (independent) member of the House of Lords since 2000 and chairs five All-Party Parliamentary Groups on dementia, corporate social responsibility, intergenerational futures, continence care and ageing and older people (Co-Chair). She is the Vice Chair of the All-Party Parliamentary Group on choice at the end of life, and is Treasurer of the All-Party Parliamentary Group on equalities. Sally is Chief Executive of the International Longevity Centre, UK; Co-President of the ILC Global Alliance; and was a commissioner for the Equality and Human Rights Commission from 2006–12.
Baroness Greengross was Director General of Age Concern England from 1987 until 2000. Until 2000, she was joint Chair of the Age Concern Institute of Gerontology at King's College London, and Secretary General of Eurolink Age.
Baroness Greengross is Chair of the Advisory Groups for the English Longitudinal Study on Ageing (ELSA) and the New Dynamics of Ageing (NDA). She is President of the Pensions Policy Institute and Honorary Vice President of the Royal Society for the Promotion of Health. Baroness Greengross is Patron of the National Association of Care Caterers (NACC) and Patron of Care & Repair England. She holds honorary doctorates from eight UK universities.
Julian Le Grand
Julian recently completed a two-year secondment to 10 Downing Street as senior policy adviser to the Prime Minister. He is an Honorary Fellow of the Faculty of Public Health Medicine and a Founding Academician of the Academy of Learned Societies for the Social Sciences.
Julian has acted as an adviser to the World Bank, the World Health Organisation, the Treasury and the Department of Health. He has been Vice Chairman of a major teaching hospital, a commissioner on the Commission for Health Improvement, and a non-executive director of several health authorities. He is currently a member of the Group of Societal Policy Analysts advising President Jose Barroso of the European Commission.
He was one of Prospect magazine's 100 top British public intellectuals, and one of the ESRC's 10 Heroes of Dissemination. He writes regularly for the national and international press and appears frequently on television and radio (including as a member of Radio 4's Any Questions? panel and a presenter of Analysis).
Mark Pearson, international adviser
Mark is Head 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, state-of-the-art analysis and appropriate policy recommendations on a wide range of health policies.
Mark gave evidence to the US Senate on health reform during their recent deliberations. Prior to this, he headed up work on social policy at the OECD for many years, giving policy advice to governments on how best to integrate income transfers with social and employment services. Mark has written a number of books for the OECD and initiated the renewal of the OECD social indicators programme.
Before moving to Paris, he was employed by the Institute for Fiscal Studies in London, and he has been a consultant for the World Bank, the IMF and the European Commission.
The commission was independent of The King’s Fund and determined its own recommendations. Here are some resources that relate to its work.
Nicholas Timmins looks at the shifting nature of the funding divide in England's health and social care systems, from pre-NHS to the current day.
It is time to think differently about health and social care. We must transform the funding and delivery of services to meet the challenges of the future. This requires new thinking and radical change. Find out about our work on the future of health and social care.
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?