Illustrated summary of the Barker Commission's final report
The final report from the independent Commission on the Future of Health and Social Care in England examines the current health and social care systems and proposes a new approach that redesigns care around individual needs. 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.
Hospitals were given to the NHS. What we now call social care was left with local authorities.
This organisational structure persists to this day.
Most health care (major and minor) is free at the point of use. Social care is heavily rationed and means tested.
This leads to situations where people with dementia have to pay for their own care while people with cancer don’t. Both cases involve significant care needs but they get very different levels of assistance from the state. There is not equal treatment of equal needs.
The NHS budget is ring-fenced, comes mostly from national taxation and must be spent on health. Publicly funded social care is paid for by local authorities through a mixture of central government grant, council tax and user charges. Levels of spending vary across the country.
Deciding who pays for what is a constant source of friction which can impact on people who are caught between the two systems.
The organisations that commission health and social care - 211 clinical commissioning groups for hospital care, emergency care, community care and mental health; 152 local authorities for social care; and NHS England for primary and specialist care - are not aligned.
This creates inefficiencies with financial and human costs. For example, 3,000 beds a day are occupied by people who are fit to leave but are stuck in hospital while funding or assessment is resolved.
These changes offer a big prize – a more integrated service, simpler pathways through it and more equal treatment of equal needs. But this has to be paid for somehow, either from the public purse or out of people’s own pockets.
This new settlement will be more efficient and achieve better outcomes for people – but it will cost more overall.
These changes should not be paid for by new NHS charges, nor should they be funded privately or through insurance.
Instead, this increased access to social care should be paid for by public finance, and much of the cost should be borne by those who can most afford it (wealthier people) and those who will benefit from it the most (older people).
Overall, the government should assume that public spending on health and social care will increase from 9.6% to 11–12% by 2025. The commission believes that in the long run this is affordable and sustainable.
That sounds like a lot of extra money but it’s still less than other similar countries spend on health care alone.