Now is the time to create a combined health and social care system
4th September 2014
Merging two leaky buckets does not provide a watertight solution.
NHS England’s chief executive, Simon Stevens, recently told the Health Select Committee that merging two leaky buckets does not provide a watertight solution. It is for this reason that the growing problems in the NHS and social care cannot be solved by the Better Care Fund or any of the other short-term solutions on offer. Nothing less than a fundamental reform of the funding of health and social care services and citizens’ entitlements to publicly funded support is required to address these problems.
The impending crisis in the NHS and social care led The King’s Fund to set up the independent Commission on the Future of Health and Social Care in England (AKA the Barker Commission) in 2013 to explore what a new settlement for health and social care might entail. The commission’s interim report set out a compelling case for a new settlement and identified the hard choices that would need to be made to fund it. At the heart of the report was the argument that England should move towards a combined health and social care system, singly commissioned, with a ring-fenced budget, within which entitlements are more closely aligned.
The commission’s final report proposes that the new settlement should be funded through a mix of higher public funding, reallocating funds from other areas of spending, and changes to prescription charges. Tax and National Insurance increases would be needed to pay for the new settlement and the commission also recommends a review of wealth taxes. Given the current state of public finances, the commission proposes that these changes are phased in over a decade to enable entitlements to social care to be fairer, more consistent and more generous.
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. When fully implemented, a new settlement will account for around 11–12 per cent of GDP. This is less than current levels of spending on health care alone in some countries. The key point is that there are choices to be made about public spending and levels of taxation as the economy recovers, with scope to increase spending on other important services as well as on health and social care.
In making the case for a partnership funding model based mainly on additional public funding, the commission is acknowledging the lack of interest shown by private insurers in offering new products that would cover the costs of care up to the Dilnot cap. The consequences of not providing additional public funding for health and social care are that more people will have to pay for care themselves, and more NHS organisations will find themselves unable to provide timely access to acceptable standards of care within budget. Even more importantly, the prize described by the commission – equal support for equal need, with entitlements to health and social care more closely aligned – will remain a distant dream.
Achieving this prize will make a very real difference to the people in our society who most need help and support. Today we have a fragmented health and care system which too often ends up being distressing and confusing for people in times of need. The new settlement outlined by the commission is one that seeks to create a simpler, fairer and more transparent system for these people and their families.
The King’s Fund will use the commission’s analysis and recommendations to engage with a range of stakeholders to explore the practical implications of implementation. This process of engagement will ensure that the debate on the future of health and social care is kept alive during the forthcoming election campaign and is not consigned to the ‘too difficult’ basket. Further details about this will be published in due course.
At the end of this process we will present our own views to the incoming government on how the new settlement outlined by the commission should be implemented. We will challenge political leaders to acknowledge the impending crisis in health and social care and to move beyond sticking plaster solutions to create a system that is sustainable and equitable for the foreseeable future.