A future Labour government should create a single health and social care service to deliver better, more efficient and integrated support to older and disabled people, mainly in their own homes, shadow health secretary Andy Burnham said today.
Burnham suggested such a service should be commissioned by council-led health and well-being boards and largely delivered by integrated care organisations developed from existing NHS hospital trusts. He also opened the possibility that all care could be delivered free at the point of need, with the social care element funded from compulsory social care insurance – an idea he mooted before the last general election.
Burnham’s vision, outlined in a speech to the King’s Fund think-tank today, is not yet party policy. He has launched a policy review, led by shadow social care minister Liz Kendall, to examine, over the next six months, the case for full integration of health and social care and how this would be best delivered, including how far it would cover children’s as well as adult services.
Lack of integration and prevention
He attacked the current division of services into physical health, mental health and social care as unfit for a world in which an ageing population and the growing numbers of people with long-term conditions required a “complex blur of the physical, mental and social”.
He said the current system, at great expense, drove people into hospital and from there into residential care, because of the underfunding of preventive health services and social care and a lack of holistic support in hospital.
“We are paying for failure on a grand scale, allowing people to fail at home and drift into expensive hospital beds and from there into expensive care homes,” he said.
Burnham said this arose from perverse incentives in the system: cash-strapped councils cut back on social care in the knowledge that the NHS would pick up the pieces, while NHS hospitals were paid for the number of patients they treated.
‘Turning the system on its head’
“We could get much better results for people, and much more for the £104bn we spend on the NHS and the £15bn on social care, but only if we turn this system on its head. We need incentives in the right place – keeping people at home and out of hospitals.”
He said NHS trusts should be commissioned to provide “whole-person care in all settings – physical, mental, social from home to hospital” to shift resources into prevention. Councils should take the lead on commissioning, he said, because of their wider responsibilities for social care, housing, leisure, planning and, from April 2013, public health.
This would be through the new council-led health and well-being boards, with the GP-led clinical commissioning groups set up by the coalition government to commission healthcare playing an advisory role.
Reforming social care funding
Burnham also said the policy review would examine two options for reforming adult social care funding: a voluntary approach, under which people would receive care free at the point of need if they paid into an insurance fund, with those who did not pay in directly paying for care on a means-tested basis; or a compulsory insurance system which everyone would be obliged to pay into but where care was free at the point of need for all.
He said a voluntary approach would be complex because it involved two payment systems but the compulsory option would result in people paying for social care that they did not need. Burnham rejected the coalition’s likely support for a £75,000 cap on individuals’ care liability as unfair and unable to tackle existing shortfalls in councils’ social care budgets. However, he said that if it was not possible to build a consensus on the voluntary or compulsory option, the integration of health and social care should go ahead.
In April 2010, as health secretary, he announced plans to deliver a adult social care service that was free at the point of need, but did not specify how it should be funded; Labour then lost the May 2010 general election. But Burnham had already voiced support for funding such a service through compulsory contributions and made the idea a central plank of his failed bid for the Labour leadership in 2010.