‘Unfit’ health and social care systems must be fully integrated and better funded, finds inquiry

Single ring-fenced budget must be created to resolve systemic failings in services for disabled and older people, says interim report from King's Fund commission

A single ring-fenced budget for health and social care must be created and funding boosted to make services for older and disabled people fit for purpose, an inquiry has found.

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, found the interim report of the King’s Fund’s Barker Commission into the future of health and social care.

This meant that many more older and disabled people needed both health and social care; however, their needs were not being met by “the lack of alignment” between health and social care.

The commission – headed by economist Kate Barker – identified three fundamental issues: while health remained a universal service, social care was heavily rationed by needs and means; while health was funded out of general taxation through a ring-fenced budget, social care was not ring-fenced and funded through local authorities; and the two services were commissioned separately.

This created a range of problems including funding disputes over whether people qualified for NHS continuing healthcare, unnecessary hospital admissions and delayed transfers from hospital.

“This lack of entitlements – in entitlements, funding and organisation – needs to be overcome if England is to get a health and social care system fit for the present day,” concluded the commission. “The solution, we believe, is to have a single ring-fenced budget for health and social care which is singly commissioned, and within which entitlements are much more closely aligned. This is our stake in the ground.”

However, the commission also concluded that “too little public money is spent on social care”, exacerbated by “draconian cuts by the coalition government, putting too much pressure on individuals and their families to meet their own care needs.

This meant that publicly funded social care was becoming “a residual service available to those with only the very greatest needs”. Meanwhile, the NHS was heading for a financial crisis borne out of rising demand pressures and government funding that had not risen in real terms since 2010 because of mandatory transfers of funding to local authorities to spend on social care.

The commission concluded that this funding gap needed to be tackled by a combination of increased productivity, a shift of resources from health to social care, and increased taxes and charges for the NHS.

The report was welcomed by the Local Government Association and the Association of Directors of Adult Social Services (Adass).

“It has become an established reality over the past year – evidenced by our budget survey, and the surveys of others from the voluntary sector – that adult social care is increasingly becoming unable to meet the needs of many of our citizens,” said Adass president Sandie Keene.
“Satisfaction levels are high, but there are far too many, and growing, examples of where services are being restricted to those with higher needs for the reality to be ignored any longer. By beginning to look bravely at alternative funding streams, Barker, has done a significant service in raising the debate and actively seeking the solutions we need ”

The commission is now seeking views on its interim conclusions before delivering its final report in September.

The call for evidence will be open until Friday 16 May and all responses should be emailed to the commission.

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