Make social care free at point of use for critical needs, says commission

Social care should be free at the point of use for people assessed as having critical needs, an inquiry has recommended, in proposals for what would be the most radical overhaul of the health and care system since the 1948 post-war settlement.

In its final report, the King’s Fund’s Barker Commission said that the move would cost ‘substantially less’ than £3 billion a year. It recommended that ministers should implement the critical needs policy as an ‘early initiative’ and, as the economy recovers, consider extending the entitlement to free social care to lower need groups.

The commission – headed by economist Kate Barker – said that the making all care free for critical needs would end the current split in funding arrangements for people assessed as eligible for NHS Continuing Healthcare, who get their health, care and accommodation costs covered, and those who receive local authority-funded social care, which is means-tested.

Both the NHS and social care should be paid for from a single ring-fenced budget with a single local commissioner, the panel said. Health and wellbeing boards are proposed as a potential option to take on the commissioning role. An interim report published by the commission in April concluded that the separation of health and social care rooted in the post-war settlement was no longer appropriate given increases in life expectancy and the number of people with chronic conditions.

To fund the initial roll-out of the proposed ‘new settlement’ the commission said that the government could:

• Raise around £1.4bn by introducing means testing for free TV licenses and winter fuel payments currently provided universally to over 75s.
• Raise around £1bn a year by removing the current exemptions on NHS prescription charges but reducing the charge from £8.05 to £2.50 and maintaining a cap on charges to ensure a maximum medicines bill of £104 a year per person.
• Raise around £475m by requiring people working past state pension age to pay National Insurance at a rate of 6 per cent. This group is currently exempt from National Insurance contributions.
• Raise around £200m by introducing means-testing for NHS Continuing Healthcare accommodation costs.

In the longer term the government should review wealth and property taxation to raise the additional funds needed for the ‘more generous’ parts of the settlement, the commission said.

Kate Barker, chair of the commission said, the recommendations could deliver a simpler, more integrated service with ‘more equal treatment for equal need’.

“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,” she said.

“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. The cost of a more generous settlement, though large, can be afforded if phased in over time.”

David Pearson, chair of the Association of Directors of Adult Social Services (Adass), said: “Barker has explored ways of bringing in additional money and the connections between care and the welfare system. They are trying to design a simplified system graduated according to need, and we will all want to consider their proposals and test them over the coming weeks.”

Pearson said Adass did not endorse the commission’s proposal for a single ring-fenced budget for the NHS and social care. He said that “services should be delivered locally by health and social care professionals and should be accountable to local people through local democracy”.