The
health and social care systems are no longer fit for purpose, anindependent 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:www.kingsfund.org.uk/barkercommission
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.