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Commission calls new health and care settlement

Published on 02 April 2014 11:01 PM

The time has come for ‘a new settlement' to meet the needs of 21st-century patients, an independent commission established by The King's Fund has concluded.

With the NHS and social care systems now under significant financial strain, the commission calls for England to move towards a single, ring-fenced budget, with services singly commissioned and entitlements more closely aligned.


The commission was set up by The King's Fund to re-examine the post-war settlement, which established separate systems for health and social care.

Current system fails to respond to patient needs

In its interim report, it finds the health and social care systems are no longer fit for purpose and failing to respond to the needs of the increasing number of people with long-term conditions.

It argues that a lack of alignment in entitlements, funding and organisation between the systems results in unfairness, poorly co-ordinated services and confusion for patients, service users and their families. The report outlines key areas where the current systems are failing.

People with different conditions, such as dementia or cancer, can end up making very different contributions to the cost of their care because of how entitlements vary between each system. While the NHS is largely free at the point of use, social care is needs-based and heavily means-tested.

While the NHS is paid for out of general taxation and has a budget that has been ring-fenced for a number of years, social care is reliant on grant funding and has been subject to significant cuts. This has led to social care becoming an increasingly residual service.

With health care delivered through the NHS and social care overseen by local authorities, the lack of alignment in organization between the 2 systems is creating confusion for patients, service users and their families, and acts as a significant barrier to improving the services.

Furthermore, the commission concludes that current funding is inadequate, with insufficient public money currently spent on social care and more resources needed to meet future health and care needs as the population ages.

This raises questions of affordability and the need to make difficult choices about how to meet these costs, including the balance between public and private funding, which the commission will address in its final report later this year.

‘We need a new settlement'

Kate Barker, chair of the 5-strong commission, said: ‘The current systems rub up against each other like bones in an open fracture.

‘The lack of alignment between them leads to serious problems of co-ordination, with the NHS and local authorities battling over who should pay for what, and patients, service users and their families left confused and bewildered.

‘This is not sustainable - we need a new settlement fit for the 21st century.

‘This report is our stake in the ground. The prize we seek - a single, seamless health and social care system that offers equal support for equal need - is a significant one.

‘This necessitates making choices about how to pay for a better system - hard choices that we must look squarely in the eye.'

Responding to the report, Chris Ham, Chief Executive of The King's Fund, said: 'We welcome the commission's report - it sets out a compelling case for change and hard choices that need to be faced.

‘These choices present a significant challenge to politicians but with NHS and social care budgets now under huge strain, this is a debate we need to start before, not after, the next General Election.'

Caroline Abrahams, Charity Director at Age UK, said: 'This important new report rightly highlights the importance of a more joined up approach between the NHS and social care and the barriers in the way, of which the chronic underfunding of social care is one of the greatest.

'Because funding is failing to keep pace with growing demand, social care is increasingly restricted to those with the greatest needs, making life a misery for many older people and their families and intensifying pressure on the NHS. This makes no moral or practical sense.

'Integration of health and care is the right approach but it can't happen until the social care funding gap is filled, and politicians in every party need to recognise this and commit to action as an urgent priority.'

The interim report outlines a number of options for funding increased health and social care spending and the criteria against which the commission will judge them.

The commission will now seek views on these options and undertake further work on costings, before it publishes its final report in autumn.

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Last updated: Dec 05 2018

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