End unfair split between NHS and council care, review says


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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.

Prescription charges in Northern Ireland were abolished in April 2010.

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.

Start Quote

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

End Quote Caroline Abrahams Age UK

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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  • rate this

    Comment number 418.

    Why should those who have looked after their money and provided for themselves in old age be targeted, when the people who have wasted their lives and lived on benefits get everything free.
    I don't have a problem with giving up such things as free tv licence etc, if and when I am due to get it. It just gets me that if you live on benefits and do nothing most of your life, you get things free.

  • rate this

    Comment number 341.

    Yet again they want to pick on the elderly many of whom have paid taxes and national insurance for over 40 years to enable the UK to have an NHS and Social Service. Why not stop paying for people who are here just to abuse the NHS and benefits system.Also helping with foreign aid when we can't even help our own elderly people.Leave the elderly alone for the few remaining years they have.

  • rate this

    Comment number 339.

    What is the point in working hard and saving for your old age, every single penny is taken in tax. All we hear is tax this, tax that. I can see in the future all people being taxed heavily taxed to pay for their old age. NI was supposed to fund this, we have been lied to.We do have an ageing population which needs paying for but we also have a huge population explosion they need paying for too.

  • rate this

    Comment number 292.

    Before anything else is done, we need proper regulation of the Care Companies.
    We cannot allow the exploitation of the elderly and vulnerable to carry on in name of profit.
    We need to be sure we get value for money spent, be it public or self funded.
    I cannot understand why the Government says it is incapable of running public services efficiently.
    How do they manage to run the country?

  • rate this

    Comment number 286.

    274 Carol G

    Yes, indeed you are right. Loneliness experienced by the elderly is heartbreaking. Confined to their homes due to infirmity and/or illness.

    It's possible they would be better in a care home, but only if that's what they want.

    We have a problem with the attitude to elderly in this country. We just don't seem to have compassion any more for the vulnerable, just seen as a burden


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