An independent Commission on the Future of Health and Social Care in England, set up by The King’s Fund to re-examine the post-war settlement that established separate systems for health and social care, has concluded that the time has come for a ‘new settlement’ to meet the demands of 21st century patients.
The commission’s interim report, entitled “A new settlement for health and social care”, argues that England’s health and social care systems are no longer fit for purpose and fail to respond to the needs of the increasing number of patients with long-term conditions. With the NHS and social care systems under significant financial strain, the commission calls for a single, ring-fenced budget with services singly commissioned and entitlements more closely aligned.
Age UK highlights that the commission, chaired by Kate Barker, finds that a lack of alignment in entitlements, funding and organisation between the systems results in unfairness, poorly co-ordinated services and confusion for patients, service users and their families.
Although the NHS is largely free at the point of use, social care is needs-based and means-tested, meaning that a person with cancer and a person with dementia can end up making very differed contributions to the cost of their care because of how entitlements vary between the health and social care systems.
Social care is reliant on grant funding and has been subject to significant cuts which has led to social care becoming an increasingly residual service to the NHS. The commission reports that the current funding is inadequate and more public money needs to be spent to meet future health and care needs as the population ages.
The commission’s report suggests a number of options for funding increased health and social care spending and will now seek views on the options and associated costs, before publishing its final report in autumn 2014. The final report will aim to address how these costs will be met and the balance between public and private funding of the ‘new settlement’.
Caroline Abrahams, Charity Director at Age UK, said: “Integration of health and care is the right approach but it can’t happen until the social care funding gap is filled, and politicians in every party need to recognise this and commit to action as an urgent priority.”
Commenting on the report, Lucie Prothero, associate in the clinical negligence team at Penningtons Manches, said: “This is an important report that proposes a more cohesive approach to the way health and social care is administered and funded in England. I agree with Ms Abrahams’ comments that a more ‘joined up’ approach between the NHS, social care and the barriers to achieving that is vital. Underfunding of social care is clearly one of the greatest barriers to achieving the more cohesive approach and ensuring that people receive appropriate levels of care and support in the community.
“As the population ages, the greater the burden becomes on our health and social care systems. We are seeing a rise in the number of enquiries regarding poor standards of medical, nursing and community social care, particularly amongst the elderly. In many instances, a lack of resources and time appears to be a significant factor which can result in devastating outcomes, such as the worsening of the person’s health and the loss of community living. The current squeeze in social care funding risks increasing the expense of acute medical care, thereby adding to the financial crisis in the NHS. From our experience of dealing with complaints regarding elderly care, we consider that health and social care services are in urgent need of reform and, importantly, additional funding to protect the elderly and vulnerable. It will be very interesting to see what proposals are suggested when the commission’s final report is published in the autumn.”