End unfair split between NHS and council care, review says

Patient Image copyright Amelie-Benoist / BSIP/SCIENCE PHOTO LIBRARY

The NHS and social-care systems in England should be merged in the most radical overhaul since the 1940s, an independent review says.

Currently the NHS is free at the point of need, while payment for care homes and home support is means-tested.

But the Barker Commission said the distinction was unfair and must end.

It said the cost of providing free social care could come from a mix of new taxes and cuts to benefits and prescription exemptions.

This could include ending the National Insurance exemption for those working past the state retirement age, the expert panel led by economist Dame Kate Barker suggested.

Increasing National Insurance contributions for those earning more than £42,000 a year by 1% and for those above the age of 40 by the same amount was also suggested.

Winter fuel payments, free TV licences and prescription exemptions given to older people could be curbed, the review also said.

A tale of two systems
NHS Social care
Services: Hospitals, GPs, mental health care and ambulance crews Services: Care homes, domiciliary care at home and day centres
Budget: £111bn (2013-14) Budget: £17bn (2013-14)
Structure: Run by NHS England and 211 GP-led clinical commissioning groups Structure: Overseen by 152 councils, but many services are provided by private care firms
Cost: Free at the point of need, but charges made for dentistry and prescriptions Cost: Only those with assets under £23,250 get help from the state. The rest have to pay all their costs
Numbers helped: One million every 36 hours Numbers helped: 1.3 million a year get some contribution to care

It said the merger of the two systems - created in 1948 as part of a post-war welfare settlement - was needed because the ageing population and rise in long-term illnesses had blurred the lines between the two and was now causing "distress and unfairness".

The commission, which was set up by the King's Fund think tank, compared the care given to cancer patients, who get their treatment free, with the support needed to help people with dementia, which often falls into the means-tested social-care system.

Dame Kate said the country was facing "difficult questions" but added the current system was simply "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," she said.


She said the proposals were affordable if phased in over time, suggesting only those with the most critical needs should get social care free initially, which would cost an extra £2.7bn a year..

But as the economy improved the entitlement could be extended to those with substantial needs, she said. This would push the costs up to £5bn a year.

However, the review did not make clear which bodies - NHS or council - should hold the budget or run services.

The call for radical change comes after the government has already under taken a major reorganisation of the NHS this Parliament and is in the process of introducing a cap on social-care costs of £72,000 from 2016.

Dame Kate said there was clearly a reluctance to embark on more changes, but claimed politicians could not ignore the reality any longer.

Mixed reaction

There has been mixed reactions to the proposals. A Department of Health spokeswoman suggested there were no plans for the radical measures being suggested.

She said steps were already being made to create a more joined-up system by the creation of the £3.8bn Better Care Fund, a joint NHS and local government pot largely funded by NHS money, which will be launched next year, and a fairer social-care system via the cap.

Meanwhile, Labour said it was committed to integrating health and social care, but had yet to decide how it would be organised.

Shadow health secretary Andy Burnham said: "The stark truth is this - if social care is allowed to continue to collapse, it will drag down the rest of the NHS. This is precisely what is happening under this government."

Caroline Abrahams, of Age UK, said she "fully supported" the call for an integrated health and care system.

"For too long policymakers have failed to grasp this nettle and the result is the fragmented, underfunded health and care services we see today."

But she questioned whether it was fair to target older people's benefits and entitlements so much to pay for it, saying it would "constitute quite a big hit on the incomes of many older people".

How extra money could be raised
Limiting free TV licences and winter fuel payment for older people to those on pension credit. Saving: £1.4bn
Prescriptions exemptions scrapped for over-60s, pregnant women and even some children, although fees could be reduced from £8.05 to about £2.50 to mitigate the impact. Saving: £1bn
Those working past state retirement age to pay national insurance contributions at 6% - they are currently exempt. Raises: £475m
A 1% increase in National Insurance contributions paid by those over the age 40. Raises: £2bn
A 1% increase in national insurance contributions paid by those earning more than £42,000. Raises: £800m

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