Make social care free at point of need, ex-ministers say

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The NHS could benefit from a “radical simplification” of streamlining and making social care free at the point of need, former Labour and Tory health ministers have suggested.

Lord Ara Darzi and Lord David Prior, now Labour and Conservative peers respectively, have proposed a number of radical reforms that would roll back drastic changes made by former health secretary Andrew Lansley in 2012.

Their plan, compiled with think tank the Institute for Public Policy Research (IPPR), suggests streamlining the NHS by replacing 244 commissioning bodies and other organisations with up to 10 new Health and Care Authorities.

They argue there should be free social care for those with “critical” or “substantial” care needs, which they say would bring current mean-tested provision into line with the NHS principle of “free at the point of need”.

And they put forward the case for a long-term funding settlement which guarantees NHS funding will grow at its historic annual rate of 1.5% above overall economic growth, for a total of around 3.5% a year.

The report sets out how the NHS and social care system could deliver productivity savings which they claim, combined with the extra funding, would release resources to meet the rising needs of an ageing population and enable it to embrace medical and technical advances.

On social care, they propose to eradicate means testing, which puts many at risk of facing personal bills of £100,000 or more, for those with the greatest care needs.

Elderly people in residential accommodation would still be expected to pay their own housing costs if they can afford to as at present.

The report points out that cuts in social care funding over the last decade have led to an average fall of 5% annually in the number of people receiving state-funded care.

Meanwhile the NHS spends £3 billion a year on looking after hospital patients who could be discharged. They suggest providing free social care would help reduce this.

The reform would require annual spending on social care to double, from its current level of around £17 billion to £36 billion, by 2030.

The report recommends funding this during the current parliament by putting a penny on National Insurance Contributions (NICs) for employers, employees and the self-employed, as part of a wider settlement for the NHS.

They suggest the creation of up to 10 new Health and Care Authorities (HCAs), to replace the current 195 Clinical Commissioning Groups (CCGs) and five NHS England regions.

This would mean undoing some of the Lansley reforms, which separated acute and community care commissioning – undertaken by CCGs – and primary care and specialised commissioning – undertaken by NHS England.

The number of national NHS leadership bodies would also be cut from six to three, by merging NHS Improvement, Health Education England and Public Health England with NHS England.

They also suggest the obligation to competitively tender for services – internally or externally – should be scrapped, arguing that the constant churn generated by this process is costly and disruptive to care, with limited evidence that it has improved quality or efficiency.

Lord Darzi said: “The NHS and social care have done well to improve or maintain quality over the last decade. But the cracks are now showing.

“We need bold action to ensure that the NHS is fit for the 21st century. This will mean caring as much about social care and public health as the NHS and embracing reform as much as additional funding.

“The gift the NHS needs on its 70th birthday is a pragmatic plan to secure it for future generations.”

Lord Prior said: “Simply putting more money into the NHS and hoping for the best will not work. With funding must come radical reform. We need a shift from ‘diagnose and treat’ to ‘predict and prevent’.

“Care must be joined up around – and tailored to – the patient. A universal service should be there for everyone, not the same for everyone.

“At the heart of our plan for reform is a radical simplification of the NHS and a properly funded social care system to make this happen.”

The Prime Minister is expected to announce a funding boost for health and social care services to mark the 70th anniversary of the NHS and to help address the rising costs associated with the ageing population.

Health and Social Care Secretary Jeremy Hunt said on Thursday the discussions over a long-term funding plan for the NHS are “difficult” and “ongoing”.

Speculation about the funding boost includes the potential for money saved by leaving the European Union being diverted to the NHS – a key promise made by Boris Johnson and his fellow Leave campaigners during the referendum.

The Daily Telegraph reported that Theresa May is set to give the NHS a £4 billion-a-year boost funded by borrowing, income tax and a Brexit dividend.

Ministers are also considering freezing the thresholds for the personal allowance, the rate at which people start paying income tax, and the threshold for the 40p rate from April 2020.

Meanwhile The Sun reported that the package would be £5 billion extra a year for four years, funded by tax and borrowing.

Downing Street would not be drawn on the speculation.

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