Marie Curie welcomes the findings of the Barker Report

By Imelda Redmond, CBE
Director of Policy & Public Affairs


Imelda Redmond CBE, Director of Policy and Public Affairs



The Future of Health and Social Care in England, by Professor Kate Barker, is a groundbreaking contribution to the debate around the future of health and social care in England. 


It is often said that a fresh pair of eyes can help crack seemingly intractable problems. In Kate Barker we not only get a fresh pair of eyes, we also get a fresh perspective. For some it may seem an anathema to ask an economist to map out the future of health and social care in England, but given that the central blockage is how we pay for care and support for our ageing population, the choice is perhaps less surprising.

It is Barker’s worldview as an economist which runs through the Commission’s report and which is crucial to chances of its key recommendations being implemented. Speaking frankly, politicians and officials are united in their desire to tackle the social care conundrum, but equally reluctant to do so simply because of the perceived cost of any solution.

A methodical approach


That’s why the methodical way in which the Barker Commission has worked through the key issues, problems and blockages is so important.

Barker’s call for a new single legal entity which would be responsible for a single, ring fenced budget is key, but so is the principle that it should not be cash limited. For too long we have put up with a system in which rationing is perceived to be endemic.

Equally vital is the way in which all the Commission’s proposals are costed. We therefore know that to provide free access to care for those who have a critical level of need would cost £3 billion per year. Extending this care to those with substantial care would cost an additional £3 billion. This means that we can provide the care required by those with critical and substantial needs. This would ensure that those who need care most would be able to access it when they needed it.

Barker then focuses on how to pay for this increase. The Commission, rightly in my opinion, dismisses the notion that there should be charging on the NHS. Similarly, it also makes clear that individuals using residential social care would still be liable for so called ‘accommodation costs’, with means-testing arrangements remaining in place. The Commission has come up with some nifty little solutions – including reviews of capital gains and inheritance taxes and introducing National Insurance (NI) contributions for those who are over 60 (it suggests 6%) and increasing NI contributions for those between 40 and 60 years of age by 1%. The total annual revenue from the proposed collection of measures is estimated at £5-6 billion. Interestingly, the polling which the King’s Fund has commissioned in support of the Commission’s report appears to dispel the other great myth which is that the public will not swallow increases to tax and National Insurance to pay for increased funding for health and social care.

Next steps


The focus now shifts to our politicians and those charged with planning health and social care in England. The Barker Commission has produced a set of recommendations which set out a roadmap for the future funding of health and social care. What we need next is for the politicians to use this timely report as a catalyst to remove one of the single biggest barriers which prevent people, including those in the last weeks and months of life, from accessing timely and appropriate care when they need it most.

Download the full report from the King's Fund website.