A new form of health and wellbeing board – containing greater clinical representation – should be put in charge of commissioning health and care services, the chair of a major commission into service integration has said.
Kate Barker, chair of the independent commission on the future of health and social care set up by the King’s Fund, outlined her approach in an interview with LGC to mark the launch of its final report.
A New Settlement for Health and Social Care called for a major expansion of free social care, and for councils’ care budgets to be pooled with NHS cash and ringfenced.
It stopped short of saying which organisation should commission services from the pooled budget, but it suggested a version of health and wellbeing boards could in future carry out this role.
Ms Barker (pictured), an economist and former member of the Bank of England’s monetary policy committee, told LGC: “My sense is that the health and wellbeing boards are going to have to grow into the sort of body that can do it.
“We don’t think health and wellbeing boards as they’re structured today would be right for doing the commissioning because of the need for greater clinical expertise.”
However, she added, reshaped health and wellbeing boards, with more clinicians serving on them, could be the new commissioners.
The commission said everyone with “critical” or “substantial” care needs should receive social care free at the point of need, in line with NHS healthcare.
Free care for those with “critical” needs should be introduced immediately, and free care for those with “substantial” needs should be rolled out “as the economy improves”, the report said.
It said councils’ care budgets should be pooled with a significant proportion of NHS spending as well as the Department for Work & Pensions’ budget for attendance allowance, a benefit paid to those with disabilities.
Making critical care free, as a first step, would initially cost “substantially less than £3bn a year”, the report said.
Making care free for those with substantial and critical needs would cost about £3bn initially and £14bn by 2025, it said, the latter figure being £5bn more than currently projected expenditure related to such needs.
This would be funded with a series of measures, including increases in national insurance, changes to the prescription charge and the restriction of winter fuel payments and free TV licences to the poorest pensioners.