Would targeting affluent OAPs save the NHS?

Higher taxes for the over-40s and those on higher earnings; limit free TV licences and winter fuel payments; increase the amount raised through NHS prescription charges.

These are the headlines of the King’s Fund commissioned report, led by Dame Kate Barker, on the future of the health and social care system.

These measures would, the commission argues, would go towards providing free social care for the elderly and long-term ill.  That, they estimate, would cost an extra £9bn a year – 50 per cent more than current costs.

And it would all come from a single budget – health and social care integrated. Ending what the commission said was the ‘illogical’ historical divide between the two systems.

The report, nicely timed, for the political party conferences and the general election, has been broadly welcomed, if not enthusiastically endorsed.

The refrain seems to be that this is the beginning of an important debate rather than this is the answer to this most complex of issues.

Read more: Kings Fund report: ‘Ready ammunition for service closure’

Age UK, which has been at the forefront of this debate for a long time now, welcomed the integration of health and social care.

But said: “The really tough question is how to pay for the transformational changes that are needed. Here we feel bound to point out that taken together, the Commission’s proposals would constitute quite a big hit on the incomes of many older people. We worry especially about the potential impact on older people with modest means, who sit just above the poverty line.”

The Association of Directors of Adult Social Services said it this is one of the most important discussions to take place in the first part of the century.  BUT… “A free system that is poorly-funded may well serve to create no more than the illusion of progress.”

And Independent Age says it raises essential questions about what kind of old age we want for ourselves and our loved ones and how much we are prepared to pay for it.

This is not the first – and will not be the last – into this increasingly thorny issue. The last Labour Government Royal Commission into long-term care concluded health and social care should be free but a minority report was accepted which left the social care being paid for. Scotland later introduced free social care (to some degree).

This government’s Dilnot Commission recommended a cap of £35,000 before the state starts to pay for care for the elderly. The government said £75,000 although further analysis revealed that with various costs and the disparity between what local authorities are prepared to pay for care homes and what they actually cost, this figure will be much higher.

And so it goes on. The major disparity is always between public expectation, what governments feel they can afford and what the system is actually capable of delivering.

That’s why the calls for an integrated health and social care system are increasingly louder. The current care system is under the most enormous pressure, local authorities and the NHS often fail to work together for the best outcomes and the current funding system is frightening and complex.

The argument is that integrating the two systems would mean a simpler, more unified approach with all parties involved in providing that care being funded out of the same pot.

The problem, as ADASS says, no matter how good the system is if there isn’t enough money it won’t work.

And that goes back to Barker or Dilnot et al. Higher taxes? Means testing winter fuel allowances? Or changing public expectations?

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