With Parliament now resumed after the summer recess, my hope is that new ministers aren't planning on getting too obsessed with Brexit to the detriment of addressing the pressing domestic agenda. Regular readers won't be surprised to learn that top of my list for our government is health and social care.
In the government reshuffle that swiftly followed Theresa May's appointment as Prime Minister, many social care commentators were dismayed to see the Department of Health's ministerial structure changed. Jeremy Hunt remained as Health Secretary, with a new role of Minister of State for Health going to Philip Dunne (overseeing hospital care, NHS performance and operations, the workforce, patient safety and maternity care), Nicola Blackwood becoming Parliamentary Under Secretary of State for Public Health and Innovation, and David Mowat appointed as Parliamentary Under Secretary of State for Community Health and Care.
David Mowat's brief encompasses adult social care, carers, community services, cancer, dementia, learning disabilities and all elements of primary care, including dentistry and pharmacy. A pretty sizeable portfolio you might think - social care alone is a huge remit - and one perhaps more fitting of a dedicated ministerial post.
On the face of it, healthcare and the NHS are the primary focus of Theresa May, but she must not lose sight of the need to adequately provide and fund social care as so many of her predecessors in 10 Downing Street have. David Mowat needs heavyweight backing for his portfolio, since failure to strengthen the areas he is responsible for means the 'bigger' picture of healthcare and the NHS is doomed.
Most people are far better off being cared for in their homes and via relatively low-level community support than they are in A&E and acute hospital beds for days, weeks or months on end. People rarely thrive in those conditions, it costs the country more money once a person needs hospital care, it affects NHS performance when too many people are accessing hospital care, it increases the chances of poor patient safety, and puts additional stress on the already overstretched workforce.
The Health Select Committee's report, 'Impact of the Spending Review on Health and Social Care' that was published last July made the case for funding social care very clear:
"Historical cuts to social care funding have now exhausted the opportunities for significant further efficiencies in this area. Increasing numbers of people with genuine social care needs are no longer receiving the care they need because of a lack of funding. This not only causes considerable distress to these individuals and their families but results in additional costs to the NHS. We are concerned about the effect of additional funding streams for social care not arriving until later in the Parliament."
Meanwhile, research also published last July by the Association of Directors of Adult Social Services (ADASS) showed that local authorities are left with a gap to fill of around £940 million just to keep social care services operating at last year's levels.
Against this backdrop, the complete false economy of compartmentalising health and social care infuriates me. Reform of NHS services, alongside meeting the demand for social care, is how the NHS will remain sustainable. Indeed, even the CEO of NHS England, Simon Stevens, echoed that latter point in his speech to the NHS Confederation less than three months ago when he said:
"I do not believe that it would be prudent for us to assume any additional NHS funding over the next several years, not least because I think there is a strong argument that were extra funding to be available, frankly we should be arguing that it should be going to social care. That is one of the arguments that I have been making publicly, and I think social care has a very strong case for that."
Social care's case, however, isn't high on the agenda of the electorate who politicians ultimately answer to (in the way the NHS is as was proven again in those Brexit NHS funding claims). It's also an incredibly tough nut to crack, being largely privatised and with the country in a state of austerity, so it's convenient to side-step it.
Yet for all the reasons (or excuses), and for all the challenges and impossibilities, I come back to one simple fact:
Right now there are people who are unnecessarily in hospital beds, losing independence and desperate to be discharged. Meanwhile, there are people in their own homes having to choose between getting out of bed, having a shower, eating a meal or going to the toilet (because they don't have the support to do it all). And there are many, many people who genuinely fear getting older, becoming ill and needing care and support.
That is why health and social care remain top of my list, and I desperately hope the same is true of our new Prime Minister.
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