Tony Blair’s solemn promise to “deliver” following Labour’s
election victory is likely to have a powerful impact on health and
social care, where Alan Milburn has retained his role as secretary
of state with a brief to finish the work he began in the last
The Health and Social Care Act was passed by parliament just
before the election, opening the way for Milburn to pursue his goal
of joined-up, often integrated, services still more vigorously.
Whether intentionally or not, the ministerial reshuffle appears
to signal the radical reconfiguration of services which lies ahead.
Jacqui Smith moves from the schools brief at what was the
Department for Education and Employment to become the health
minister with responsibility for social care. Will her experience
as schools minister help to smooth the path for further integration
of children and family social services with local education
departments? John Hutton, who held the social care brief until the
election, takes charge of mainstream health issues. Will he be
better placed to close the gap between health and adult social care
having had ministerial responsibility for both?
The temperature is likely to rise elsewhere in government too.
The arrival of David Blunkett at the Home Office, for example, will
give no comfort to those in the youth justice field who disliked
Jack Straw’s more punitive policies. Straw may have been tough on
crime, but Blunkett wants to be tougher.
Meanwhile, chancellor Gordon Brown’s grip on employment and
social security is assured, with his trusted lieutenant Alistair
Darling becoming secretary of state in the new Department for Work
All in all, the government has emerged from the election more
focused and more determined. The policies will stay the same
alright, but there will be a marked shift away from the formulation
of aspirations to the expectation of action.
As Jacqui Smith begins to settle into her new job, she faces
dire warnings about the ability of social services to deliver the
government’s modernisation agenda.
A major 10-month inquiry by the King’s Fund confirms that care
workers are poorly paid, poorly trained, and inadequately supported
by managers. Services face collapse without an injection of
The warning comes in the same week as research reveals that
pressure to reduce NHS waiting lists is further burdening the army
of unpaid, voluntary relatives and friends to support the thousands
of older and disabled people who rely on them.
It is yet further evidence that the government can no longer
rely on the carers who often provide the support that the dwindling
number of care staff cannot.
Ms Smith must now fulfil her predecessor’s promise to tackle the
poor image of social care. She must also embark on a wide-ranging
recruitment campaign for all social care staff – not just those
with qualifications. Only then can the government hope to deliver
on its pledge to improve the quality of care services.