Will a rebranded Department of Health change anything?
In another week of extreme pressure across the NHS, with senior hospital doctors telling the prime minister that the situation is “intolerable”, the Department of Health has been rebranded. But will it make any difference?
On the face of it, changing the DH to DHSC will change very little in Whitehall, let alone on the front line of the health service in England. The Department of Health has formally become the Department of Health and Social Care, but in recent times it always has been technically responsible for social care.
There will be no change to the funding stream which takes Treasury cash through the Department for Housing, Communities and Local Government (itself renamed from the DCLG) and out to local authorities to provide social care in England. Town halls will continue to raise some of the money for social care from council tax. There will be no legislative or organisational changes.
So is this window dressing and a PR exercise designed to show that the government is committed to social care? The answer is that there is one important change which could have a major bearing on the future of social care in England.
Green paper test
Jeremy Hunt, now secretary of state for health and social care, will take over the preparation of the government’s policy paper (known as a green paper) on social care which is due in the summer of this year.
Previously, the work was being done in the Cabinet Office and overseen by Damian Green (now no longer in government). As one source put it, rather than having three Whitehall departments trying to run the process, at least now it will be led by one.
Arguably the social care green paper will be one of the most important pieces of work done by this government. The Conservatives’ general election campaign was seriously dented by the manifesto plan to remove a proposed cap on personal social care costs. This was swiftly dropped but the U-turn swung some voters against the Tories.
Jeremy Hunt was not consulted at the time about the controversial manifesto pledge. It’s understood he was against the idea and, like other senior Conservatives, was dismayed that such a radical policy was being introduced in the heat of a campaign.
Now Mr Hunt is in charge of drawing up a policy which has to provide some solutions to the immense challenge of funding the long-term care of elderly people as the population ages. The questions it has to address include where to set a cap on individual care costs and how to reflect the value of housing in working out personal liability for those costs. Votes in England at the next general election could be won or lost on those decisions.
Whitehall sources say nothing is being ruled in or out during the consultation and policy discussions leading up to the publication of the green paper. Mr Hunt, it is said, has an open mind. There is now a dedicated social care minister in his team – Caroline Dinenage has taken that role having moved over from the Department for Work and Pensions.
The health world is withholding judgement until more detail emerges. But there has been a welcome for the idea of having a department with both health and social care in the title.
The symbolism is seen as important at a time when social care problems have been seen as responsible for some of the troubles of the NHS. The heads of emergency departments who wrote to the prime minister identified social care as the main issue which needed fixing.
At the back of Mr Hunt’s mind will be the thought that he can help restore the Conservatives’ credibility on social care. Drawing up a plan which binds the NHS and social care providers closer together will go down well in the health world as calls for full integration gather momentum.
He was so keen on the job that he rejected Theresa May’s idea of moving him to the Department for Business and persuaded her to let him run a rebranded health and social care portfolio.
But there are high risks and it could go badly wrong. A fudged plan will not win the approval of politicians and policymakers.
With no Conservative majority, legislation may fail to get through the Commons. If there is inadequate funding for social care, the already fragile system will be undermined.
In those scenarios, Mr Hunt will find he is blamed both for the struggles of the NHS and the shortcomings of social care.
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