Commission moots payment for NHS care

The think tank’s commission on the future of health and care, led by former Bank of England monetary policy committee member Kate Barker, is mooting the introduction of payment for NHS care.

Ms Barker told HSJ’s sister title Local Government Chronicle it was “straightforwardly odd” that people diagnosed with cancer received free treatment on the NHS but people with dementia faced potentially large bills for social care.

• Kate Barker: Why we need a single budget for health and social care

Ms Barker said: “All proposals about paying more for health are controversial… [But] in some ways it’s just straightforwardly odd, the difference between dementia and cancer.

“It comes across as novel and shocking [to suggest patients should pay for NHS care], but it’s a provocation to challenge people to say why they think it’s right to do that in one case but not another.”

The commission’s interim report, A New Settlement for Health and Social Care, said one way of aligning health and social care would be applying the Dilnot principles to the NHS.

“In other words, individuals would be covered for the extremes of expenditure – the cap on expenditure – but they would pay an appreciable amount in contributions for health as well as for social care,” it said.

Ms Barker stressed the commission was not advocating payment for NHS treatment but was “just starting a debate” on the issue.

She also said it was “unlikely” that the commission’s final report, due to be published ahead of this autumn’s party conferences, would recommend “the whole of social care to be completely free”.

The interim report’s main finding was that England should have “a single ringfenced budget for health and social care, which is singly commissioned and within which entitlements are much more closely aligned.”

Ms Barker told LGC it would be “naïve” to say this could be achieved without some reorganisation, although she stressed it should be done without top-down change “as far as possible”.

She said the commission had deliberately avoided getting “bogged down” in a debate about which organisations would be responsible for the single ringfenced budget. Health and wellbeing boards “might well play a role”, she said, but the commission was “reluctant to put the whole weight on them” because the organisations were still fairly new.

“Pulling the budgets together would change the pressures about who pays for what,” she said. “You could achieve that without reorganising everybody.

“I think it’s true that no-one wants to see a big reorganisation. But it’s difficult because people say the system doesn’t work well but they also say, don’t reorganise it.”