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DEC 16/2014

Is radical reform needed to give more prominence to NHS social care?

There is growing recognition within the healthcare sector that a higher quality of care could potentially be achieved by handing social care workers a more central and integrated role within the overall structure of the NHS.

In recent months, the government has been making efforts to make this transition, emphasising the importance of community-focused care and giving patients more choice over whether they receive treatment for their conditions in the hospital or at home.

However, earlier this year a new report from a leading thinktank suggested this process could be taken further still, proposing a bold reorganisation of the way that health and social care are currently organised and funded. This radical shake-up would fundamentally change the way the NHS functions, but could see the social care sector gain more prominence than ever before.

A new structure for health and social care
Published by The King's Fund, the report was compiled based on the recommendations of an independent commission of experts, headed by Dame Kate Barker. It called for current NHS systems to be integrated more closely with social care services, in order to simplify patient experiences and ensure more individual-centred care can be provided.

Key recommendations included moving to a single, ring-fenced budget for the NHS and social care, with a single commissioner for local services, while making a gradual transition to ensure that social care services can be provided for free at the point of use.

Initially, this would be available only to those with critical needs, but as the economy improves this right would be extended to those with substantial requirements, before offering free social care to people with moderate needs on a means-tested basis by 2025.

Other proposed changes include integrating Attendance Allowance - the benefit paid to older people with care and support needs - into the single budget for health and social care, thus ensuring that patients are presented with a simpler, more comprehensive system, with fewer areas of confusion in terms of payment requirements.

Funding the changes
These would be among the most dramatic changes to the overall structure of the NHS in history, and would naturally require a significant outlay to implement and maintain. However, the commission rejected extending charges for NHS services, instead outlining a plan for how the bulk of the reforms could be funded by taxpayers.

Wealthier residents and older people would shoulder the majority of the increased costs via rises in National Insurance costs, while withdrawing free TV licences and winter fuel payments for all but the neediest people would also help generate the funds needed.

Meanwhile, notable changes to the prescription payments system were also mooted, with the thinktank suggesting that charges could fall as low as £2.50, though the number of prescriptions exempt from charges would also drop significantly.

Potential benefits
According to the authors of the report, these reforms - if enacted - would ensure the health and social care system is better integrated and ready to provide simpler services that are easier to understand and more responsive to the needs and means of individual patients.

Dame Kate said: "We propose radical change, greater than any since 1948, that would bring immense benefit to people who fall into the cracks between means-tested social care and a free NHS."

The findings have also been welcomed by the Royal College of Nursing (RCN), which said the proposals could help to bridge the unhelpful gap between the health and social care sectors. It also concurred with the conclusion that this is an issue that needs to be examined sooner rather than later.

RCN chief executive and general secretary Dr Peter Carter said: "As we approach the general election, this report provides a powerful reminder that we can no longer continue to delay difficult decisions." 

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