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There may be new ways to bridge the health and care divide

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The independent commission on the future of health and social care, chaired by Kate Barker, reported last month to generally positive acclaim.

The final report was name-checked in this year’s party conference fringe meetings where national politicians are beginning to recognise the scale of the funding challenge.

But will Barker be a short-term talking point – just another addition to groaning bookshelves stuffed with past reports? Or will it help to change the policy weather in terms of how we join up our separate and fragmented health and care systems?

There are some important and possibly unexpected headlines, for example that we should ‘level up’ social care provision to NHS entitlements so that people with very high needs receive all care free at the point of use.

The commission rightly concluded that continuing to demarcate between NHS care (free) and social care (means tested) was illogical, unfair and inefficient, with the commission’s experts by experience offering powerful testimony to the human as well as financial costs incurred in policing the boundary between the separate systems.

When a former member of the Bank of England monetary policy committee argues that higher funding on care and health is affordable and sustainable – as long as we face up to hard choices about where the money comes from – politicians should sit up and take notice.

The commission pulled no punches in arguing that those who would benefit most from a more generous settlement should contribute their fair share.

A recommendation that has excited a particular frisson of debate is that there should be a single local commissioner responsible for its share of a national ringfenced budget for health and care.

For some, this has raised the spectre of another big reorganisation. Others have been too quick to conclude it would mean the transfer of health commissioning to local government.

The commission rejects the “sterile debate” about whether councils or the NHS should take on the role but asks if health and wellbeing boards could over time evolve into a single commissioning body.

There may be other options. Over the next few months the King’s Fund will be working with stakeholders to test these out.

A new settlement for social care and health should be a high priority for the next government.

Richard Humphries, assistant director, policy, the King’s Fund

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