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A new settlement for health and social care

Interim report

The NHS faces a short-term funding crisis. At the same time, social care, arguably underfunded for many years, is set to come under increasing strain – publicly funded social care is available only for those with relatively high needs. The border between the two is widely recognised to be very imperfect, leading to confusion and frustration for patients and their carers, and wasting resources on administration. Life expectancy, family structures, medical treatments and technologies are all quite different from when Beveridge and Bevan devised the 1948 settlement for health and social care. It is time to think afresh – and establish a new settlement fit for today’s circumstances.
In this interim report, we set out (on p 43) the key criteria that we propose to use to assess the options which would move England towards this new settlement. Broadly, they consider transparency, equity, efficiency, the split between collective and individual responsibility and affordability. The evidence discussed here suggests that the present settlement fails on all of these criteria