All political parties now acknowledge the importance of more integrated - or person-centred - care. The challenge is now how to pursue this during the next parliament.
Podcast of the launch event with Health Minister Norman Lamb MP:
Due to the divides across health and social care, current provision is characterised by huge inefficiency, poorly coordinated support and underinvestment in preventative care. In response, the paper advocates a single local commissioner, a greater role for a diverse market of providers and a future where patients can be given much greater control of spending across both health and social care. It sets out ways to get us there by 2020:
- All-out care – under this outcome-based approach, local Health and Well-Being Boards and Clinical Commissioning Groups would commission an external provider to achieve specified health and well-being outcomes for the local population. The provider would bring together health, social care and community services to meet these outcomes.
- Patient First Budgets – under this choice-based approach, the patient (guided by GPs and other professionals) would determine what units or packages of care or support to buy using public funding from a personalised budget. Any unpaid care provided by family and friends would become eligible for at least partial remuneration.
The second part of the report addresses the inequity, unsustainability and illogicality of current funding: while the NHS remains free-at-the-point-of-use, many individuals have to cover their own costs for social care. In addition, we face a care funding shortfall of £12bilion by 2020.
The paper recommends that eligibility for social care services should be the same as for health, and it advocates redistributing the costs borne privately in social care across the whole of health and social care services. By spreading the costs more widely, it would make the system fairer; by broadening the base of contributors and giving individuals an incentive to prevent care costs, this would boost sustainability. Putting Patients in Charge recommends the creation of Personal Care Accounts, under which:
- The individual would make co-payments set at a small percentage of the actual cost of care.
- Payments would be capped as a per annum charge and as a total lifetime charge, with the state paying for the remaining costs.
- Those on low incomes or with low levels of wealth would be exempt.
- Reforms would be introduced on a cost neutral basis: the level of charges in the future system would not exceed the levels of charges in the current system. To ensure that those with ‘moderate’ social care needs are eligible for support, this would mean redistributing £7 billion of charging that currently falls solely on social care patients to all health and social care patients.