Health and wellbeing boards could be put in charge of commissioning combined health and social care services if they beefed up their contingent of clinicians.

This is the conclusion of economist Kate Barker, a former member of the Bank of England’s monetary policy committee who chaired the King’s Fund commission on the future of health and social care.

In her report A New Settlement for Health and Social Care Ms Barker called for a major expansion of free social care and for councils’ care budgets to be pooled with a “significant” proportion of the NHS budget.

While stopping short of settling on the organisation that should act as commissioner for pooled services, the report pointed to the HWB model. Ms Barker admitted the choice of HWBs - which are hosted by local authorities - could prove a controversial choice and would hand local authorities “a bigger role” in commissioning.

“There’s this incredible, perpetual kind of tension about whether commissioning should be done by local authorities or clinical commissioning groups,” she told HSJ’s sister title Local Government Chronicle.

“My sense is that health and wellbeing boards are going to have to grow into the sort of body that can do it. We don’t think health and wellbeing boards as they’re structured today would be right for doing the commissioning because of the need for greater clinical expertise.”

The commission also suggested that access to social care should be opened up significantly. The report suggested everyone with “critical” or “substantial” care needs should receive social care free at the point of need, bringing it in line with a central NHS principle.

Free care should be introduced immediately for people with critical needs with the same level of access introduced for those with substantial care needs “as the economy improves”, the report added.

It said councils’ care budgets should be pooled with a significant proportion of NHS spending, as well as the Department for Work and Pensions’ budget for attendance allowance, a benefit paid to those with disabilities.

Making critical care free would initially cost “substantially less” than £3bn a year, while the cost of free care for people with substantial and critical needs would cost £14bn by 2025, according to the report.

The latter figure represents a £5bn increase on current projected expenditure and could be funded by increases in national insurance, changes to prescription charges and the restriction of winter fuel payments and free TV licences to only the poorest pensioners.

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