England’s health and social care systems are no longer fit for purpose, and the time has come for a “new settlement” to meet the needs of 21st century patients and service users, an independent commission has reported.
The nation needs to move towards a single, ring-fenced budget for health and social care, with services singly commissioned and entitlements more closely aligned, says the Commission on the Future of Health and Social Care in England, which was set up last June by policy think tank The King’s Fund to re-examine the post-war settlement which established separate systems for health and social care.
In its interim report, published today, the Commission concludes that the current system is failing to respond to the needs of the increasing numbers of people with long-term conditions, young as well as old.
And a lack of alignment in entitlements, funding and organisation between the two systems results in unfairness, poorly co-ordinated services and confusion for patients, service users and their families, it says.
With health care largely free at the point of use and social care needs-based and heavily means-tested, entitlements vary, so people with different conditions – cancer and dementia, for example – end up making very different contributions to the cost of their care. And there is lack of alignment in funding, with the NHS paid for out of general taxation and a budget that has been ring-fenced for a number of years, while social care is reliant on grant funding that has been subject to significant cuts.
Also, with health care delivered through the NHS and social care overseen by local authorities, there is a lack of alignment in organisation between the two systems, creating confusion for patients, service users and their families and presenting a significant barrier to improving the coordination of services.
On top of this, the Commission concludes that funding is inadequate, with insufficient public money currently spent on social care, and more resources needed to meet future health and care needs as the population ages.
The report considers the following three options for finding extra resources:
1: more efficient use of existing resources: including restricting the existing NHS package;
2: raising more private funding: for example with new or extended prescription charges, development of an insurance market, the provision of tax relief on private medical insurance and the removal of tax disincentives on health and wellbeing programmes; and
3: raising more public finance: including the introduction of a hypothecated tax for health and social care, a wholesale switch to classic social insurance, changes to the tax regime for pensions and increasing inheritance tax.
In its final report in the autumn, the Commission will address questions of affordability and the need to make difficult choices about how to meet these costs, including the balance between public and private funding. It says it is keen to seek views on the options for change which it sets out in its interim report, and has issued a further call for evidence.
