The National Health Service should be fully merged with social care to create a clearer system that is better able to cope with surging demand, an independent review has found.

Proposing the most radical overhaul of health and social care since 1948, the Commission on the Future of Health and Social Care, established by think-tank The King’s Fund, said budgets for the two factions should be ring-fenced, with the installation of a single commissioner for local services.

In its current state, the system creates “confusion, perverse incentives and much distress for individuals and families”, and is not fit for purpose, it says. 

The commission, chaired by Kate Barker, has set out a new approach to refocus care around individual needs with a graduated increase in support as these needs grow, particularly towards the end of life.

Free social care for those in need

It recommends that social care for people whose needs are currently deemed ‘critical’ should become free at the point of use, which, it argues, “would end the confusing distinction between social care provided in residential care homes and NHS Continuing Healthcare, which is provided free of charge in nursing homes”.

As the economy picks up, free social care should be extended to those with ‘substantial’ needs and, by 2025, some support should also be provided to those whose needs are ‘moderate’, but on a means-tested basis, it said.

So how will this be paid for? Crucially, the commission said that, after careful consideration, it has rejected the idea of extending charges for NHS services, with the exception of prescription charges. Instead, to generate the additional £5 billion needed to improve the social care side of things, it argues that the bulk of additional funding should come from the public purse, with wealthier people and older generations, as the principle beneficiaries of the reforms, contributing more. 

It proposes cutting prescription charges to as low as £2.50 but “significantly reducing” the number of those exempt from charges, as well as limiting free TV licences and the winter fuel payment to older people on pension credit, and taking a National Insurance tax of 6% from people working past state pension age (who are currently exempt). Looking further forward, the commission suggests 1% rises in NI contributions paid by those over the age of 40 and those earning more than £42,000 a year to help fund the more generous elements of the new system.

Sharing costs

“Our proposals would continue a system where costs are shared between the private individual and the state but with the taxpayer carrying a heavier load of that cost than at present,” said Dame Kate. “The cost of a more generous settlement, though large, can be afforded if phased in over time,” she stressed.

“The proposals as set out by the commission may not appeal to politicians fearful of commitments to greater public expenditure, but these issues cannot simply be ignored,” added King’s Fund chief executive Chris Ham, adding: “the commission is clear – there is no “do nothing” option”.