England & Wales Democracy, devolution and governance, Health and social care

Barker Commission: A threat to social care?


Yesterday the Barker Commission on the Future of Health and Social Care was launched at the King’s Fund.  I can only commend the commissioners’ willingness to tackle some really tough issues. We know that care is in a perilous state. We know that many people in desperate situations aren’t getting the care that we’d want for ourselves or our family members. And we know that despite a great deal of focus and attention and new policies (such as the Better Care Fund and the Care Act) health and social care integration isn’t anywhere near where it should be.

It’s good, too that they were willing to tackle some of the issues of funding in ways which are likely to be unpopular (such as the removal of most  prescription charge exemptions) and increased taxation on the over-40s.

Some of the recommendations just seem right – such as free at the point-of-delivery critical social care and emphasis on end-of-life care, including helping people to die at home.

A single commissioner for health and social care also seems to make sense. That would be a big step toward ensuring integration.  Health and well-being boards might be a likely candidate for that single commissioner, but my great fear is that health will dominate and barring really critical care needs (which might be so critical that they’re arguably a  health issue anyway) care will continue to take a back seat.

Those that have ‘moderate’ care needs – which are often fairly serious by any normal estimation, such as help with personal care and mobilisation (hygiene, nutrition and movement are essential to health) will continue to have to pay for the foreseeable future under Barker recommendations.

Speaking personally and only anecdotally, my experience of continuing or follow-up care on the NHS hasn’t been great. It’s not something they tend to do as well as critical care or even self-presenting primary care. I can’t shake the worry that care in terms of helping people live independent lives or recover abilities in their own homes will get short shrift.  Aspirations for social care including social elements (such as helping people re-connect with their friends and neighbours) slip away under central control.

Democratic accountability for care issues also potentially goes.  Remote departmental responsibility fettered by heavy DoH prescriptions could leave little scope for personal or public voice on care which is often best dealt with at a community level.

We also know that some of the most important determinants of health such as mobility and sociability (exercise and friends) are best influenced at a local level and are in the purview of councils (e.g. community groups, parks, recreation, education and inter-generational activities).

So maybe the best answer is a single pot and a single commissioner, but maybe that’s a position that should be held by local government?