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A New Settlement for Health and Social Care

Published On: 23 September 2014

A bold vision for the future of health and social care has been published by the Commission for the Future of Health and Social Care in England, chaired by Kate Barker.

The report calls for a new settlement for health and social care, proposing a single joined up system where a person suffering from dementia can expect the same free level of care as a cancer sufferer. It challenges our idea of what is fair and equitable, and builds on the existing principle that services should be built around individual need with a graduated path for health and care support which is clear and simple.

The recent reforms of health and social care are seen as inadequate to achieve the radical reform needed to safeguard the needs of a growing elderly population, who will become increasingly dependant on health and social care services. Injustices in resource allocation are highlighted with eligibility for NHS Continuing Healthcare, being seen as akin to winning the Lottery for those who find themselves entitled to free care and decreasing numbers reaching the threshold for social care services.

The Government's immediate response is that some of the ideas in the report are being promoted already, examples being the Better Care Fund delivering £3.9m of integrated health and social care provision out of hospital and the promotion of more integrated services at a local level.

As to affordability, a single ring fenced budget is called for with one commissioner in charge, possibly the local Health and Wellbeing Boards (although there would need to be legislative changes to their current powers to enable this to happen). The report rejects any insurance based scheme or charging of the individual, and argues its proposals are affordable if wage-earners are willing to pay more in taxation and national insurance and other costs are re-allocated to meet the £9 billion cost, which is estimated to rise to £14.5 billion by 2024/5.

The cost of doing nothing is stark, with fewer individuals eligible for public funding of social care and healthcare services facing extreme pressure as the gap between demand and provision widens.

The immediate challenge for health and social care is how best to navigate a way through current rules to deliver integrated services.

It is likely that the future of the NHS will remain an area of considerable public debate as we move towards the 2015 general election and beyond.