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Now is the time to create a combined health and social care system

by Chris Ham, Chief Executive, The King's Fund

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.

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.

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