Hard choices lie ahead over how to pay for care, says commission

BMJ 2014; 348 doi: (Published 03 April 2014) Cite this as: BMJ 2014;348:g2534
  1. Nigel Hawkes
  1. 1London

England needs a single ringfenced budget for health and social care to repair the growing rift between the two systems, says a commission established by the health think tank the King’s Fund and chaired by the economist Kate Barker.1

Without such change, the systems are no longer fit for purpose, the commission has concluded in an interim report. A reformed system would cost more, but how exactly those costs should be divided between the public and the private purse must wait for its final report in the autumn.

At present, the commission says, people face a lottery, with the type of ailment they have largely determining whether their care will be funded by the NHS free at the point of use or by a social care system that is free only to those with the greatest needs. That means that developing dementia rather than cancer, say, results in very different costs to the patient. This situation is inequitable, says the commission.

Efficiency …

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