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A year on, Barker Commission says social care ‘crumbling around us’

The members of the ground-breaking Barker Commission are dismayed that recommendations from last year’s report were not taken on board, with the care system instead “crumbling around us” just a year later.

The commission – chaired by Dame Kate Barker – came forward in September 2014 with proposals for a radical overhaul of how health and social care is funded and delivered in England.

It advocated a single budget for the NHS and social care, new funding streams and changes to prescription charges, as well as more free care for those who need it – ultimately putting an end to the historic divide between the two sectors.

And in June, a ‘Beyond Barker’ report argued that the fragmentation of commissioning is a major obstacle to integrating the two sectors.

It recommended that the Department of Health be given control of the national budget for social care, currently under the DCLG, and that a single local commissioner and budget be established by 2020.

But today, just over a year after these recommendations were published, the Barker Commission’s five members have released a statement written out of “deep concern” at the many signs that social care funding is not being simplified or improved – instead just piling more pressure on the already-struggling NHS.

“The government appears now to have no strategy whatever to tackle the rising and pressing needs for social care,” the statement said.

This is in spite of the series of suggestions as to how the government could raise finances or shift expenditures to deal with economic difficulties without ruining the health and social care sector.

It also criticised the government’s temporary solution to the growing funding hole in the social care sector: a ‘robbing Peter to pay Paul’ approach by diverting cash from the NHS.

“[The NHS] is now struggling to meet many of waiting time and other targets – even in the months of the year when these are more easily achieved – and its finances are under acute pressure.

“Matters are even worse in the local authority sector. More social care           services are failing to meet the CQC’s standards.

“We are reaching the stage where staff shortages mean that good people cannot provide good care,” it continued. “What all this points to is a health and social care system living in the midst of a crisis that will only get worse.”

The statement argued that Whitehall lacks any strategy or action plan to deal with mounting pressures on the sector, despite the 2010-15 coalition recognising the urgency of addressing social care funding.

“All of this makes the need for a new settlement for health and social care even greater and more urgent than we reported a year ago.

“Social care funding needs to be increased and ring-fenced into a single health and social care budget that will end the debilitating transfers and disputes across the NHS and social care divide.

“A single commissioner needs to be developed for such budgets, allowing the simplified pathway through the system that we recommended, along with more generous social care entitlements at the higher levels of need,” it added, echoing what it said in September 2014.

But while the authors reiterated solutions set out last year, they adapted some recommendations to allow for the postponement of the Dilnot reforms.

They advocated that the government use the £6bn earmarked for these reforms over the Spending Review period as a contribution to meeting the increase in NHS funding while stabilising social care spending.

Yet the authors stressed that these costs will not go away, meaning the focus should not fall on whether the money will be spent – it should be, instead, about where costs fall: “on collective provision through public expenditure, or on those individuals and families who are unlucky enough to have high, or very high, care needs”.

The statement concluded: “As we underlined in our report last year, we appreciate that the new settlement will need to be phased in. But the country cannot continue to wait for a start to be made. Better support for the less affluent needing care is required now, as is a return to the principle of some limit on private contributions.

“Our simplest recommendation to the chancellor and health secretary is that they should read our report. And then act on it.”