When Care Management Matters (CMM) made its debut in March 2003, the Secretary of State at the then Department of Health was Alan Milburn of the Labour Party. Ten others, four Labour and six Conservative, have since held the role. Strictly from a social care perspective, have any of them stood out?
The long silence I anticipate such a question prompting tells a story of the care sector’s dismay at our political leaders’ consistent failure over the past two decades to get to grips with social care reform in England – a failure which goes back even longer, at least to 1996 when John Major’s outgoing Tory Government published a consultation paper entitled: A New Partnership for Care in Old Age. It was to become just the first of a stream of proposals left to gather dust on Whitehall shelves.
It would be wrong to pin the blame for this policy dereliction entirely on the shoulders of health (latterly health and social care) secretaries. The fingerprints of HM Treasury are all over the many crime scenes involved and Prime Ministers, too, must take their share of the rap. We shall come to that.
Under review
But let us take a stroll down memory lane and remind ourselves of those 11 individuals who have presided over the Department responsible for social care policy – and we’ll have no nonsense about that being the case only after its change of name in 2018. We’ll give each a mark out of 10 for their performance on social care and Jeremy Hunt will start with a one-point penalty for pretending it was not in his brief before that name change.
Alan Milburn (1999-2003) – The consummate Blairite was to resign in June 2003 after a clash with the then chancellor, Gordon Brown, over Milburn’s wish to give hospital trusts more freedoms. His focus was on market reforms in the NHS, doing little about social care. In what has become a pattern of ex-ministers recognising the sector’s importance only after leaving office, he recently told Times Radio that social care was critical to society and that care workers should be paid a social care wage ‘well above current levels’. Rating: 3/10
John Reid (2003-05) – Something of a ‘Mr Fixit’ for Tony Blair, this was the tough-talking Glaswegian’s fourth Government job in 12 months. In 2003, he announced the creation of the role of Director General for social care, but it was not in fact to happen until David Behan’s appointment in 2006. Rating: 5/10
Patricia Hewitt (2005-07) – The last of Blair’s appointees, she published the White Paper Our Heath Our Care Our Say, which proposed closer working of health and social care in the community through local area agreements and which set new standards of person-centred care. Hewitt resurfaced last year as leader of an early Government review of the new Integrated Care Systems, in which she concluded that social care must become a national priority for investment and workforce development. Rating: 5/10
Footnote to the Blair years: Lord Crisp, who as Nigel Crisp was NHS Chief Executive and permanent secretary at the health department from 2000 to 2006, wrote recently in the British Medical Journal that there had been ‘a failure to pivot away from health services towards health and care’ in that period. ‘Various policy papers were published, but no political will drove this forward …’
Alan Johnson (2007-09) – Prime Minister Brown’s first appointee, he published a consultation paper: Why England Needs a New Care and Support System, which developed the principles of choice and control for care users and was to lead in 2009 to another green paper, Shaping the Future of Care Together, which introduced the concept of a national care service. That idea is still the core of Labour’s policy, though 14 years on it remains only sketchily defined. Johnson has since spoken of a behind-the-scenes debate within the Brown Government about creating a wholly new funding stream for social care – an unrealised vision – and has lamented the fact that the calibre of the national debate has ‘rarely risen above the glib and the facile’. Rating: 6/10
Andy Burnham (2009-2010) – Labour’s last Health Secretary, he presided over the Big Care Debate, a series of events and roadshows involving 68,000 people, leading to a White Paper called Building the National Care Service. Seemingly out of the blue, it introduced a new policy of free personal care at home. Just a week later, however, Brown called a General Election and was to be defeated. It emerged during the election campaign that Burnham had been involved in secret cross-party talks to broker a deal on care funding. The Tories claimed he wanted a 10% levy on people’s estates after death and they campaigned effectively against ‘Labour’s death tax’. The mistrust caused by this bedevils any cross-party initiative to this day. Rating: 7/10
Footnote to the Brown years: Ed Balls, who was close to Brown and served as Children and Families’ Secretary, made a two-part BBC2 documentary on social care in 2021 and spoke of his ‘guilt’ that he had not done more to help deliver reform. ‘It was the realisation that I thought I knew what care was, and I didn’t.’
Andrew Lansley (2010-12) – In the coalition Government created after the election, and led by David Cameron, Lansley became Tory Secretary of State with the Liberal Democrats holding the care minister portfolio. It was not a marriage made in heaven. Lansley was preoccupied by a determination to introduce enormous, and ultimately unworkable, NHS structural change. His time is notable, however, for the Commission of Funding of Care and Support, under economist Andrew Dilnot, which proposed a cap on people’s liability for care costs. Although subsequently legislated for, it has still not been introduced and the chances of it ever being so look fast diminishing. Rating: 5/10
Jeremy Hunt (2012-18) – The longest serving Health Secretary in history, Hunt straddled the coalition and the Tory majority Government after 2015. Given his unparalleled opportunity, Hunt’s record on reform must be judged as disappointing and, moreover, social care suffered greatly from funding cuts under the Tories’ austerity programme. Between 2009-10 and 2014-15, spending by councils on care fell 10% in real terms. At the 2017 General Election, the Tory manifesto appeared to drop the Dilnot cap and proposed inclusion of the value of any property in the means test for care at home. Prime Minister Theresa May famously insisted that ‘nothing has changed’ but Labour, turning the tables on the Tories for 2010, campaigned against their ‘dementia tax’. The resulting row probably cost the Tories their overall majority, forcing them to do a deal with the Democratic Unionist Party.
Despite continuing to claim that he was not responsible for social care policy until 2018, when his department was formally renamed the Department of Health and Social Care, Hunt has since regretted not achieving more. He told LBC last year: ‘I wish I had secured a 10-year plan to transform the social care system in the way that I did for the NHS.’ Rating: 4/10
Matt Hancock (2018-21) – A colourful character who will be remembered for many things but probably for only two when it comes to social care: his claim to have thrown a ‘protective ring’ around care homes during COVID-19, which was linked to the deaths of more than 40,000 of their residents and the green care badge initiative which he took over from its promoters and sought to encourage care workers to wear to create an NHS-style consciousness. History and the COVID-19 inquiry will judge. Rating: 2/10
Sajid Javid (2021-22) – The first of a recent succession of short-lived secretaries of state, he has more than most to show for his 13 months in the post. The Dilnot cap was resurrected, to start in 2023 (now 2025) and to be paid for by a rise in National Insurance (NI), and a White Paper, People at the Heart of Care, outlined a 10-year programme for care reform. While the White Paper survived last year’s mayhem in Government, the NI levy did not. Rating: 6/10
Steve Barclay (2022) – His first go, lasting three months. Too little to rate.
Thérèse Coffey (2022) – Held office during the brief and chaotic prime ministerial tenure of Liz Truss. Even less to rate.
Steve Barclay (2022-) – Back for a second time, a steady hand on the Department tiller but little evidence so far of much interest in social care. A claimed ‘record’ funding increase of £7.5bn for the period 2023-25 has been pledged by Hunt, now Chancellor, but some of a separate £1.7bn pot for reform, announced by Javid, has been held back. Rating: 3/10
So, there we have it: 20 years of disappointment for social care and a roll call of 11 health (and care) secretaries who, often by their own admission, have not left much of a mark. But what of the seven Prime Ministers they have reported to? Blair, Brown, Cameron and May have all expressed some regret at not having done more on social care. Their successors? Well, not so much yet.
We await in particular an explanation from Boris Johnson of his hubristic claim as he entered Downing Street in 2019 that ‘we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve’. It may be quite a wait.