By Richard Johnstone| 3 April 2014
Health and social care spending should be a merged into a single ring-fenced budget as the current split between the NHS and local government is no longer fit for purpose, a commission has concluded.
The Commission on the Future of Health and Social Care in England, established by the King’s Fund last June, said a merged budget would allow for a single commissioner and ensure entitlements to services were better aligned. With the NHS and social care under significant financial strain, the commission’s interim report also concluded ‘hard choices’ would be needed to increase available funding to care for the ageing population.
The current separate systems – with health care free at the point of use in the NHS and social care support means-tested in local government – were failing to respond to the needs of the increasing number of people with long-term conditions.
A lack of coordination in both individual entitlement and funding was causing unfairness and confusion for patients, service users and their families and had led to social care becoming an increasingly residual service, the five-strong commission warned.
Commission chair Kate Barker, a former member of the Bank of England's Monetary Policy Committee, 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, King's Fund chief executive Chris Ham said the commission had set out a compelling case for change, although hard choices would 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,’ he added.
Other commission members are Geoff Alltimes, the chair of the Local Government Association multi-agency task group, peers Lord Bichard and Baroness Greengross, and London School of Economics professor of social policy Julian Le Grand.
The commission will now consider how best to increase the level of funding available for health and social care, which it described as ‘inadequate’ ahead of its final report in the autumn.
Today’s interim report set out possible reforms, including increased charges for both health and social care, cuts to other areas of public spending to allow a shift in resources, and a tax increase.
This examination of extra charges comes after former Labour health minister Lord Warner recommended to pay for a single National Health and Care service earlier this week.
