Exclusive: King's Fund calls for merger of NHS and social care budgets

The study, which has been shared exclusively with HSJ and its sister title Local Government Chronicle, also recommends that the Department of Health be given control of the national budget for social care.

Options for Integrated Commissioning follows on from last year’s Barker commission report, through which the think tank examined the financial viability of the healthcare system.

The new report concludes:

• There should be a fully pooled health and social care budget in every area by 2020.
• Each area’s NHS and council commissioners should agree who should be in charge of this budget by 2017.
• CCGs and councils should be allowed to take control of the single budget, but health and wellbeing boards are not fit for this role in their current form.
• The government should consider legislating to allow a new form of health and wellbeing board to take over health and social care commissioning.
• The national social care budget should be transferred from the Department for Communities and Local Government to the DH, to create a single fund for the entire service.
• Central government should establish a single “outcomes framework” setting out what an integrated health and social care system should aim to achieve.

Mandating the full integration of health and social care funding while remaining permissive about how the budget should be administered was a key policy of former health minister Norman Lamb. He also publicly called for the national health and social care budgets to be placed under the sole control of the DH.

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The report says the government should consider how a single commissioner should be regulated. Currently, CCGs are regulated by NHS England, but councils do not have equivalent oversight.

Richard Humphries, one of the report’s authors, told HSJ that local authorities and NHS commissioners would have to share financial risk, as councils are by law not permitted to run at a deficit, while CCGs may.

Although the NHS Five Year Forward View contained little about integrating health and social care commissioning, Mr Humphries said merging the two budgets was necessary because “none of the new models of care [in the forward view] will work without the active engagement of adult social care”.

He said that “there is an inexorable logic” to merging the budgets since the introduction of the better care fund. “If it is a good thing for 5 per cent of the budget, it should be good for 100 per cent of the budget. If this is a good thing in principle, why limit it?”

Mr Humphries also argued that the entire NHS, public health and social care budget should be ringfenced from cuts. “I hope this government learns from the mistake of the last one of protecting the NHS but not social care.”

The Local Government Association is broadly supportive of the proposals, and is understood to believe that HWBs are well placed to become the sole commissioner for a single service. Responding to the Barker commission’s final report last autumn, a spokesman said having only one commissioner would “do away with some of the unhelpful distinctions between social care and the NHS”.

However a Department of Health spokesman said there were “no plans for the mandatory pooling of all health and care budgets,” adding that areas were already able to pool more than the minimum amount required under the better care fund.

“The DH already oversees policy for social care” the spokesman said. “There are no plans for DH to administer social care budgets.”