Huge social, demographic and technological changes have taken place since the NHS and social care systems were established in 1948. People are living longer, often with multiple long-term conditions, while the boundaries between health and social care are becoming increasingly blurred.
Despite this, services are still largely based on an outdated model of care founded on single episodes of treatment in hospitals, with social care provided under a separate system. With the NHS and social care facing unprecedented challenges, it is time to ask whether the post-war settlement, which established separate systems for health and social care, remains fit for purpose.
The Barker Commission asked whether the post-war settlement – which established the NHS as a universal service, free at the point of use and social care as a separately funded, means-tested service – remains fit for purpose. It explored whether, and if so how, the settlement should be re-shaped by bringing the NHS and social care system closer together.
It also asked:
- Does the boundary between health and social care need to be redrawn? If so, where and how? What other ways of defining health and social care needs could be more relevant?
- Should the entitlements and criteria used to decide who can access care be aligned? If so, who should be entitled to what and on what grounds?
- Should health and social care funding be brought together? If so, at what level (ie, local or national) and in what ways? What is the balance between the individual and the state in funding services?