People might have to pay for some NHS services once the health and social care systems are integrated, the deputy director of the Reform think-tank told CIPFA conference delegates.
Nick Seddon called for a national debate about the introduction of ‘co-payment’ into the health service. He said this would smooth integration and provide greater funds for the squeezed NHS.He was speaking as the Institute for Fiscal Studies reported that the real freeze in NHS spending planned from 2010/11 to 2014/15 would be the tightest four-year squeeze in the past 50 years.
However, Seddon said that currently ‘no politician is willing to pick up and run with’ the recommendations of the Dilnot Review on funding adult social care, which included a suggested cap on personal contributions of £35,000.
Seddon said the ‘certainty’ that a cap provides would encourage people to examine ways to shoulder the remaining costs of care, such as insurance mechanisms and equity release from property.
A ‘national conversation’ on extending social insurance models into the NHS, was needed, he said. This would require politicians to have ‘difficult conversations... because nobody wants to tell people the difficult realities’, he added.
‘People are talking about integrating the social care budget and the health care budget. The difficult corollary of that is that they are two very different funding models – one is a national, universal, free-at-the-point-of-delivery model, and one is means-tested [with a] high level of individual contribution. There’s a conflict there, and social insurance models from other countries are something we should be looking at.
‘Co-pay is one of the possible solutions to the funding crisis in health care. I certainly think that you can logically extend the ideas of Dilnot into health care. But we have a big debate to have nationally, which again, no-one seems to want to have.’
He also said that around £40bn of pensioner benefits, including the Winter Fuel Payment and free bus passes, might need to be means-tested to ensure money is not taken from ‘people who really need it’ as welfare budgets shrinks.
The session also heard from Darra Singh, who chaired the Riots Communities and Victims Panel following last summer’s disturbances in England.
He told delegates that some reforms to government spending, such as the roll-out of Community Budgets and more targeted interventions for troubled families, offered ‘a good opportunity’ to help influence the lives of people in deprived areas.
‘Too many people are being left to bump along the bottom,' Singh said.
‘We know that it doesn't make sense for multiple organisations to be interacting with families multiple times and if we can target that, we can get a better result.’
