Analysis

Expanded role for Jeremy Hunt prompts clamour for better social care

The health secretary kept his portfolio in the cabinet reshuffle – news that disappointed many nurses. But the addition of social care to his responsibilities was broadly welcomed by nursing, social care and medical

The health secretary kept his portfolio in the cabinet reshuffle – news that disappointed many nurses. But the addition of social care to his responsibilities was broadly welcomed by nursing, social care and medical

  • RCN says effective integration of health and social care will benefit patients
  • Charities seek action on funding shortfalls for care services
  • Green paper in summer to address cost, improvement of care for older people

Health and social care secretary Jeremy Hunt leaves 10 Downing Street. 
Picture: Getty Images

After a turbulent few days of rumours of promotion, Jeremy Hunt emerged from the cabinet reshuffle still in post as health secretary.

Gossip had swirled that he would be elevated to first secretary of state – effectively deputy to prime minister Theresa May – and it seemed likely that the Department of Health would have a new leader.

But Mr Hunt left 10 Downing Street with an expanded title of health and social care secretary. Reports suggested that he persuaded Ms May not to move him to another post during a long meeting that is thought to have included discussion of the NHS winter crisis.

Nursing issues

Mr Hunt’s role has always included responsibility for policy on adult social care but funding has been largely overseen by the Ministry of Housing, Communities and Local Government and care administered by local authorities. His extended title places greater emphasis on social care, ahead of him leading on the forthcoming social care green paper.

The move was broadly welcomed by nursing, medical and social care leaders.

The need for health and social care to be more integrated has long been recognised, with delays in social care packages leading to high rates of delayed discharge, with patients left languishing in hospital unnecessarily.

The RCN said it would continue to push for progress on nursing issues.


Picture: Charles Milligan

RCN general secretary Janet Davies says: ‘We will continue to work with the department on pressing issues such as nurse staffing for safe and effective care and developing the long-term workforce strategy that the health and social care service so desperately needs. With the secretary of state’s remit expanded to include social care, we look forward to the benefits that more effective integration of health and social care services will bring patients.’

1.2 million

older people are not receiving the social care they need

Source: Age UK

Social care pressures have been acknowledged as a factor in the winter crisis engulfing the NHS. Many patients have had to wait in ambulances outside emergency departments and thousands of planned operations have been cancelled as demand soars.

In its budget last spring, the government announced an extra £1 billion for social care this winter to reduce delayed transfers of care and free up 3,000 NHS beds. But 91% of trusts told NHS Providers there was a lack of social care capacity in their area to cope with the expected demand this winter.

Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said it is essential that social care and health work together.

‘We support the bringing together of health and social care into the portfolio of one minister as we recognise that what happens to patients in the NHS is profoundly impacted by the state of social care,' she said.

New partnerships

While integrating health and social care has long been the aim in England, and has been pushed by successive governments, progress has been slow.


RCN general secretary Janet Davies.
Picture: Barney Newman

One approach to tackle the gap has been sustainability and transformation partnerships (STPs), formed from NHS organisations and local councils in 44 regions covering the whole of England.

These new partnerships are intended to support the implementation of the Five Year Forward View, but critics say the plans are being developed as a cost-cutting exercise. A BBC report said an investigation it carried out showed more than half the plans involve cutting hospital services.

£2 billion

The size of the funding shortfall for adult social care

Source: Association of Directors of Adult Social Services

But think tank the King’s Fund says STPs offer an ‘important opportunity’ for improving health and care services in England.

Another initiative to improve integration is the Better Care Fund, which received £5.3 billion when it was launched in 2015. A National Audit Office report published in February 2017 said it had improved joint working but had not achieved the expected value for money in terms of savings, outcomes for patients or reduced hospital activity.

While the case for improved integration is not disputed, the difference Mr Hunt’s extended title will make remains to be seen.

‘Window dressing’

Liberal Democrat MP Norman Lamb says the Department of Health already had responsibility for adult social care, and that unless funding is shifted to the department following the change, the move will just be ‘window dressing’.

One piece of work that will cross Mr Hunt’s desk now is the social care green paper, due out this summer. It will set out the government’s plans for how to improve care and support for older people and how to meet the growing cost of this care.

91%

of trusts say that social care services in their area lack the capacity to cope with winter demand

Source: NHS Providers

Age UK says social care is in crisis, with 1.2 million people aged 65 and over not receiving the support they need with essential activities. There is declining access to care due to cuts in local authority funding, and a postcode lottery of provision, according to the charity.

Age UK director Caroline Abrahams called for urgent action by Mr Hunt on the ‘huge funding shortfalls crippling local services’.

National Care Forum executive director Vic Rayner is hopeful that Mr Hunt’s expanded title will lead to positive change.

She says: ‘There has been great frustration within social care about the lack of parity between health and social care, despite the DH having social care within its brief. This renewed focus on social care, alongside the work being undertaken around the green paper on adult social care, presents an opportunity for real, concrete change.’

The vision for social care in Scotland

Health and social care has been integrated in Scotland since April 2016, and the joint £8 billion budget is run by new integration authorities.


Theresa Fyffe: ‘The work to better
integrate health and social care in
Scotland is moving in the right
direction.’

The Scottish Government called that move the ‘most significant change to the way we care for and improve the health of our people, in their communities, since the creation of the NHS’.

It aims to improve services, making them seamless and more responsive to an ageing population with increasingly complex care needs.

It is also intended to shift the focus of services onto prevention, move more care away from hospitals and reduce delayed discharge from secondary care.

‘Significant work still required’

RCN Scotland director Theresa Fyffe says: ‘The work to better integrate health and social care in Scotland is moving in the right direction but the pace of change and investment are yet to align with the vision and overall aspiration of having more people in living longer, healthier lives at home or in a homely setting.

‘Scotland’s integration authorities, health boards and local councils are still working through the structures and processes required to make integration work for their communities. As is expected with change on this scale, there are areas of best practice and areas where significant work is still required.

‘What is clear from the developments to date is the significant role nursing teams play in supporting integration and the need to ensure that these teams, in particular community nursing, are adequately resourced.’

‘Tipping point’ or ‘a sensible way forward’?

Nurses mainly responded with disappointment to news that health secretary Jeremy Hunt will remain in his post.

Anne Milton, a former nurse with 25 years’ experience working in the NHS, had been tipped to become health secretary if Mr Hunt was moved.

Many nurses posting on Nursing Standard’s Facebook page had expressed optimism that Ms Milton’s healthcare experience as a district nurse could bring positive change to the NHS and the profession.

But when news broke that Mr Hunt would not be leaving, the majority of nurses commenting said they felt despondent about the decision.

Unenthused

After he has overseen the NHS pay cap and scrapping of the nursing student bursary and with the NHS mired in a difficult winter, nurses were unable to find much enthusiasm for Mr Hunt’s tenure continuing.

One said: ‘He can’t manage his responsibilities with health. How is he going to manage social care?’

Another said: ‘NHS and social care are already in crisis. This is the thing to tip them over the edge.’

Many others said they felt ‘doomed’, while another post said it was a ‘sad day’.

One was more optimistic, stating: ‘At last a sensible way forward, hopefully.’


 

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