The news earlier this week that Jeremy Hunt was not only going to be staying as Secretary of State for Health, but was also extending his ministerial remit to cover social care as well, came as something of a shock. The reshuffle appeared somewhat shambolic, with sources reporting that whilst former NHS nurse Anne Milton was apparently lined up to take on the health brief, Hunt had refused to take the role that was offered to him (Secretary of State for Business, Energy and Industrial Strategy). Anne Milton was not an uncontroversial appointment, her husband’s well-documented links to Virgin Care were subject to some minor editing/re-editing on her Wikipedia page during the day. As it turned out, none of this came to pass and we are left with the same Secretary of State for Health, with a now extended brief for social care. All of this re-shuffle occurs at the point in time of one of the biggest NHS crisis in recent history. Indeed, yesterday, while allegedly Hunt was refusing to be reassigned, his deputy Philip Dunne was telling the house that “there are seats available in hospital for those who can’t get a bed” – Mr Dunne has since departed the front bench.
This shuffling shambles raises a number of questions. The most immediate one being who was his brief extended from? I have to confess I was somewhat ignorant of who had held ministerial responsibility for social care prior to this. From talking to colleagues, and looking through government webpages, it appeared that since July 2016, David Mowat had ministerial responsibility for social care, under a title of ‘Parliamentary Under Secretary of State for Community Health and Care’. This role marked a downgrading in the adult social care brief, which prior to 2016 had been a position which afforded a minister of state, the most notable recent incumbent being Norman Lamb, who occupied the role from 2012-2015, as the ‘Minister of State for Community and Social Care’. All of these roles were contained within the Department of Health, for which Jeremy Hunt, as Secretary of State for Health, was ultimately responsible. So, in effect, Jeremy Hunt has extended his remit over a junior ministerial role. But it’s not that straightforward. David Mowat failed to get re-elected in the 2017 general election (he was beaten by 4% swing to Labour’s Faisal Rashid). It seems fair comment to say that Mowat’s failure to get re-elected may have been somewhat connected to his plans for a so-called ‘dementia tax’ which caused the government a ‘manifesto meltdown’ in the 2017 general election. Interestingly, the tax plans in the manifesto were most likely to impact the well-off (e.g. people with relatively expensive homes – some even said in this regard that the tax plans were progressive). Certainly the debacle appears to have marked the turning point where the polls began to shift (Conservatives were projected by YouGov to have 80-100 seat majority before they published their manifesto – the final nail in coffin appears to have been May’s ‘magic money tree’ comment).
It would appear that the position of Parliamentary Under Secretary of State for Community Health and Care has been empty since the 8th June 2017. I then came across a source which stated that Mowat had been replaced by Jackie Doyle-Price, and she is indeed listed as Parliamentary Under Secretary of State for Health, with responsibility for adult social care. So, at last, some progress it seems. But none of the news reports I could source made any mention of Jackie Doyle-Price losing her role to Jeremy Hunt. On Tuesday the government reported Caroline Dinenage and Stephen Barclay had been appointed as new Ministers of State for the Department of Health and Social Care, with ministerial responsibilities ‘to be confirmed in due course’.
So whilst, procedurally this appears to be the person whose role that Hunt has taken on, there seems to be a lack of recognition of the previous incumbents efforts. I then came across a tweet from Laura Kuenssberg , political editor at the BBC, who stated that Hunt had taken Social Care from under the purview of Damian Green (the same Damian Green who had resigned the previous month after being found to have twice breached the ministerial code).
Understand Hunt 'argued passionately' to stay at Health and take on reponsibility for sorting out social care (which had been under Damian Green) His arguments persuaded the PM to leave him in place
— Laura Kuenssberg (@bbclaurak) January 8, 2018
In terms of a social care profile, certainly it was Damian Green who launched the details of the plans for consultation on social care which were announced in November 2017. At that time, Green was First Secretary of State, but this is a role that, in terms of the parliamentary bureaucracy, has no specific powers or authority attached to it, it certainly does not have a social care remit – maybe the truth in Kuenssberg’s tweet is that social care was perceived to be in a mess after the dementia tax manifesto meltdown and that Green had been tasked with sorting this out, but this appears to have been without the assignment of any explicit social care ministerial responsibility. Norman Lamb, previous Minister of State for Community and Social Care, rightly points out that social care has always been under the remit of the Department of Health, stating that Hunt’s new role is simply window dressing.
So what does new title of Sec of State for Health and Social Care actually mean? I was Minister responsible for social care IN Health Department in 2015 so unless they are proposing change to funding of social care, this looks like window dressing
— Norman Lamb (@normanlamb) January 8, 2018
How we treat the elderly is the litmus test of a civilised society. The health & social care systems are umbilically linked, so putting leadership in one govt department makes sense as a first step ahead of a vital green paper.
— Jeremy Hunt (@Jeremy_Hunt) January 9, 2018
By extending Hunt’s brief to social care, it means that responsibility for the social care review is taken away from the Cabinet Office, with its cross-government focus, and placed under the purview of Hunt who it is feared will focus on “individual cost liability and how social care can help the NHS by moving people more quickly out of hospital”. This may be the real drive underpinning this move.
In writing about democratic accountability, Bovens says we can judge the degree of democratic accountability by asking
Given the difficulty in ascertaining who is actually responsible (pre and post reshuffle) for social care, and what, with Damian Green’s non-specified social care brief looked like the assignation of ministerial responsibility without attendant ministerial accountability, the ability of any particular body to hold the executive to account seems limited at best.
But then, maybe this lack of transparency and accountability is part of the work of modern government. Perhaps we will see the rise of an NHS England-like behemoth in social care, positioned between ministers and the great British public to take the flak for failing (read underfunded) services. Maybe the failure of the dementia tax as an attempt to fundamentally transform social care, compared to the remarkable ‘success’ of Hunt in fundamentally transforming health care (without any apparent political fallout) has convinced his party of his worth in the social care arena. If he enjoys similar ‘success’ in social care, then we face a wholly transformed welfare state in the UK, and it is not a transformation that augers well for the those already enduring the inequities and inequalities of this government. And it’s coming soon to a local authority near you…