The elderly and middle-aged should pay more to fund a merger of the NHS with social care that would stop vulnerable people falling through the cracks of a broken system, a think-tank has said.
Attacking an “unjust” system in which cancer care is free but people with dementia must pay, a commission for the King’s Fund says that today’s much wealthier pensioners must contribute more. An end to free prescriptions and TV licences, and a requirement for those who work past retirement age to make national insurance contributions, are suggested as ways of raising the £5 billion cost of a single health and care budget.Everyone over 40 and higher-rate taxpayers would pay more national insurance.
Chris Ham, chief executive of the fund, said that there was a “conspiracy of silence among political leaders”, who must not be allowed to ignore the need to fix a failing system and pay for an ageing population.
A fracture between the NHS and council-run social care leaves people confused and distressed as they try to find their way through a system designed around institutions not peo- ple, a commission led by the economist Dame Kate Barker reported.
“Our system is not fit to provide the care we need and want. We propose radical change, greater than any since 1948, that would bring immense benefit to people who fall between the cracks between means-tested social care and a free NHS,” she said.
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Julian Le Grand, a member of her commission, said that it had found “a series of injustices, unfairness, and sheer distress and incomprehension caused by different systems for the NHS and social care. Why if someone has cancer do they receive the full panoply of treatment from the NHS, and if they have Alzheimer’s or Parkinson’s or motor neurone disease, they have to pay very considerable amounts?”
Dame Kate said that spending on health and care would rise with an ageing population and should be shared more fairly. She said: “We have to afford this.” She was “startled” by how much richer today’s pensioners were than in previous generations, meaning that it was only fair they met most of the cost when younger people were struggling with houses prices and student debt.
“More older people pay more but fewer older people pay a lot,” she said, calling for free prescriptions and other old-age benefits to be means-tested to save about £2.4 billion a year. A penny on national insurance for everyone over 40 would raise £2 billion; another penny on those earning more than £42,000 would raise £800 million; and national insurance payments by people working past retirement age would raise £475 million. Fees to see a GP and a hypothecated “NHS tax” were ruled out.
Professor Ham said that the government and opposition had offered “sticking-plaster solutions”, adding that they must not be allowed to avoid the issue at the election.
Andy Burnham, the shadow health secretary, has backed a full integration of health and social care, saying that the report was “bold and timely”.
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A government spokesman said: “We agree that health and social care services should be more joined up — our £3.8 billion Better Care Fund is making this a reality.”