The Barker Report is close in its general argument to the policy position of the SHA especially in key areas:-
- as a matter of policy social care should be free as with health care and this should be achieved in stages with each stage widening entitlement
- there should be clarity over entitlement with no scope for local variation
- the level of funding for our care system has to rise significantly from its current level as a %GDP
- higher funding level need to be supplemented by investment in the short term as the care system evolves from the current mess
- there should not be user charges and that the principle of the funding through general taxation
- commissioning or planning of services should be through a single budget – controlled through some part of local authorities
- “integration” of health and social care is desirable but that any savings that will be made will be insufficient to pay for the changes to bring about a free care system.
Our policy position around progressive removal of market features within the NHS (and also social care) will bring some savings as will structural efficiencies from integration but this does not raise anything like enough to close the gap.
One difficult issue that is tackled is around principle that “accommodation” costs should be subject to means testing; removing the anomaly between NHS and Social Care accommodation. This does mean some who currently get free accommodation (under Continuing Healthcare) would lose out. One obvious safeguard would be that anyone in receipt of Continuing Care should continue to receive it. The principle that “accommodation” costs are outside the scope of free care has been accepted (at least for now) in Scotland and the logic is obvious. It could be argued that this is a housing issue not a care issue.
The suggestions for funding also contain some losers in that some benefits would be means tested for all including pensioners. The SHA position is that increased funding should come through increases in redistributive taxes with taxes levied on wealth as a prime candidate. The Barker suggestion is that changes should be made in national insurance especially for those above a certain age and this is probably worth looking at.
Another departure is the suggestion that Personable Budgets take a central role in cost containment. The SHA opposes anything which seeks to make Personal Budgets compulsory or which might be seen as directing people into having one.
The SHA has other policy positions which would increase the overall costs above those being estimated by Barker. These will come from changes in the care workforce to make it better trained, better paid (in social care), and better supported.
We would also argue that the desirable outcomes advocated by Barker cannot be implemented without structural changes especially the removal of market competition, the morphing of commissioning into planning and greatly enhanced accountability (for a start). Our view is that this can be achieved without a major top down reorganisation but that it will take time – probably ten years – although it will reduce rather than add to costs.
So much we would agree with and some we wouldn’t. The wicked issue remains – how to make the changes without massive disruption and prohibitive transition costs.
And of course the impact of these changes on their own will not deal with a host of other issues facing the care system especially growing inequality, unacceptable variations in outcomes and a workforce best suited to a system from 30 years ago!