There has been a general welcome for a report, set up by the King’s Fund, that calls for the NHS and social care to be merged.
The King’s Fund commission, chaired by Dame Kate Barker, proposed a new approach that redesigns care around individual needs regardless of diagnosis, with a graduated increase in support as needs rise, particularly towards the end of life. The commission concluded that this vision for a health and care system fit for the 21st century is affordable and sustainable if a phased approach is taken and hard choices are taken about taxation.
The commission wants to see a single, ring-fenced budget for the NHS and social care, with a single commissioner for local services.
A new care and support allowance would offer choice and control to people with low to moderate needs while at the highest levels of need the battlelines between who pays for care – the NHS or the local authority – would be removed.
But while individuals and their carers would benefit from a much simpler path through the system of health and social care, it would have to be paid for with people over the age of 40 footing much of the bill.
The Commission suggested 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 and increasing contributions for those earning more than £42,000 a year or over the age of 40 by one per cent.
Winter fuel payments, free TV licences and prescription exemptions given to older people could also be curbed to meet the costs.
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,” she said.
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."
NHS Confederation chief executive, Rob Webster, said: “This Commission has outlined in absolute clarity how we might move to solve some of these challenges and is a hook for the debate on how much we invest, where we put that investment and how we join health and social care together.
“While we might not agree with all the recommendations it puts forwards, we welcome its contribution to that debate. We know the impact funding and demographic pressures have on health and social care, and this report highlights the funding gap that is likely to exist in both budgets in the future.
“There does, however, appear to be a political vacuum on many of these issues. The task for politicians now is to address the real financial challenges facing the health and care system and establish a vision for how they want services to be funded.”
Tony Hunter, the Social Care Institute for Excellence’s chief executive said: “We welcome this timely and necessary report on the future of health and social care in England. Given health and social care systems that have grown up incrementally over many years, it is good to see this attempt to simplify the hugely complex web of entitlements so they make better sense to people needing services.
"It is good to see the range of income-generating options to fund future health and social care. There are, of course, policy and logistical considerations for the options but the overriding point is that there really are ways forward if we are serious about building sustainable ways to meet growing need and demand.”