Health and social care services should have a single commissioner responsible for their local area, with a ring-fenced budget, the final report from the Barker Commission has proposed.
An independent commission established by the King's Fund and chaired by economist Dame Kate Barker has concluded that a new settlement is needed for health and social care to provide a simpler pathway through the system.
Health and social care services should have a single commissioner responsible for their local area, with a ring-fenced budget, the final report from the Barker Commission has proposed.
An independent commission established by the King's Fund and chaired by economist Dame Kate Barker has concluded that a new settlement is needed for health and social care to provide a simpler pathway through the system.
Yet the commission "did not have time" to explore who the single commissioner should be, but said that a debate should be avoided over whether health or local authorities should take responsibility.
The report noted the Health Select Committee has said that over time health and wellbeing boards could evolve into a single commissioner for health and social care locally.
More work should be carried out to explore whether health and wellbeing boards could take on the role of health and social care commissioner, the commission recommends.
Services are currently organised and funded in a way which creates "confusion, perverse incentives and distress" for individuals and families, the report argues.
The new ring-fenced local budget would be made up of the existing Attendance Allowance spend from the Department for Work and Pensions, CCG budgets including primary care, Continuing Healthcare, and the local authority social care budget for home care, residential and nursing care.
The report states: "Single commissioning does offer the opportunity to achieve better integration in ways that are likely to be far more powerful than the current attempts to pool budgets between health and social care.
"Moving to a single budget with a single commissioner is not a sufficient condition to tackle the myriad problems of integration that face health and social care. But we believe it is a necessary one."
However the report's author, Dame Kate Barker, acknowledged that the changes wouldn't necessarily mean instant integration.
The commission calls on the government to plan on the assumption that public spending on health and social care combined will rise to 11-12% of GDP by 2025. These levels will be broadly comparable to current expenditure on health alone in many other countries.
The report has also called for social care to be free at the point of use for those whose needs are currently defined as "critical".
Free social care should be extended to those with "substantial" needs as the economy improves. And by 2025 some support should be given to those with "moderate" needs, on a means-tested basis.
To fund the initial roll-out of the new settlement, the report recommends:
– Radical changes to prescription payments, reducing charges to as low as £2.50 but significantly reducing the number of prescriptions exempt from charges.
– Limiting free TV licences and the winter fuel payment for older people to those on pension credit.
– Requiring people working past state pension age to pay National Insurance at a rate of 6%.
The report also recommends that new recipients of NHS Continuing Healthcare should pay the costs of their accommodation, as those receiving residential social care do now.
As the more generous elements of the new settlement are phased in, the report recommends further measures to raise revenue:
– A 1% increase in National Insurance contributions paid by those over the age of 40.
– An increase of 1% in National Insurance paid by those earning more than £42,000 a year.
The report also recommends that a review of wealth and property taxation should be undertaken to raise additional funds.
Kate Barker, chair of the commission said: "Our challenge was to look at the big and difficult questions about the kind of care system, and indeed what kind of society we wish for ourselves and our families. The prize, if this kind of change can be achieved, is huge – a more integrated service, a simpler path through it, more equal treatment for equal need, a better experience for people who need care and their families.
"We have concluded, as others have before us, that our system is not fit to provide the kind of care we need and want. We propose radical change, greater than any since 1948 that would bring immense benefit to people who fall between the cracks between means-tested social care and a free NHS. This includes people at the end of life and those with dementia or other conditions where too often there is a conflict about who pays at the expense of what people need."
Barker said that if the proposals are taken on, the costs of the system would be shared between private individuals and the state, but with the taxpayer taking on a "heavier load" than at present.
Professor Chris Ham, chief executive of The King's Fund said: "The proposals as set out by the commission may not appeal to politicians, fearful of commitments of greater public expenditure, but these issues cannot simply be ignored. The commission is clear – there is no “do nothing” option.
"The issue is not whether health and social care are affordable in future –they have to be paid for one way or another. The issue is how far they are publicly or privately funded and at what level of quality and decency. This report lays down a challenge to politicians of all parties to acknowledge the unsustainability of current funding for health and social care and to set out, ahead of the election, some of the difficult choices that need to be made."
