It’s quite possible to regard the carving of the phrase ‘social care’ into the Department of Health’s brass-plate as utterly banal.
It does nothing more than openly acknowledge the ‘interesting’ arrangement whereby the responsibility for social care policy exists in a different government department to the one that funds and delivers social care through councils.
It’s also possible to regard it as a step forward, giving social care equal billing to health and emphasising the need for much closer integration between the two.
There is, however, a less phlegmatic view that seems sadly to be closer to the truth.
The most important thing that will happen in social care this year is the green paper consultation on the future of the service. Until yesterday responsibility for the green paper resided with the first secretary. That made sense. It ensured that DoH, the Department for Communities & Local Government (as was) and local councils could input into the paper in an even-handed fashion. It also meant that the only member of the government apart from the Prime Minister who outranked the chancellor could pressure the Treasury to do the inevitably difficult things it will have to do to make social care sustainable.
Now the green paper is wholly owned by the DoH. There is a major risk here that the views of the Ministry of Housing, Communities & Local Government and councils will now not receive the same consideration. This need not necessarily be because the DoH is deliberately biased (although that could well be the case) but because it is a department whose frame of reference is entirely shaped by the NHS: an organisation that sees that system very much through the prism of its own priorities and interests.
This fear is well-founded. Evidence, for example, the way the £2bn committed to social care in the March 2017 Budget ended up focusing on resolving delayed transfers of care. Important as they are, Dtocs are merely one aspect of the overall social care challenge but which just so happen to be the area of primary interest to the NHS.
There must also be a worry that the health secretary will lack the same leverage over the chancellor as the first secretary. As the leader of one of the big spending departments, Jeremy Hunt’s political future is intimately tied up with the decisions taken by Philip Hammond. The risk that the decisions about the parameters of the green paper consultation and its findings get skewed by wheeling and dealing between health and the Treasury over NHS funding are that much higher now than they were the day before yesterday.
Ideally, responsibility for the green paper would have passed to No.10. It is now clearly too late for that to happen without another reshuffle.
Short of that, it is vital that local government presents a clear and united position on the future of social care so that any attempt to marginalise councils’ views becomes that much more difficult. Now is also the time to pressure Jeremy Hunt to give public assurances that MHCLG, councils and their partners will be treated as equal partners throughout the consultation and to openly acknowledge that their views hold just as much, and almost certainly more, weight than the NHS.
Adam Lent, director, New Local Government Network