Liz Truss appoints cabinet ministers for social care

Incoming prime minister Liz Truss has appointed new cabinet ministers to take overall responsibility for social care, as the sector battles the cost of living crisis and widespread staffing shortages, while facing substantial policy change.

Kit Malthouse has become the fourth education secretary to hold office this year – following Nadhim Zahawi, Michelle Donelan and James Cleverley – giving him responsibility for children’s social care.

And Thérèse Coffey becomes the third health and social care secretary of 2022, in the wake of Sajid Javid and Steve Barclay, a role she will combine with being deputy prime minister.

There will also be new ministers with direct responsibility for children’s and adults’ services, with Brendan Clarke-Smith moved from the children’s services brief he only took up in July and Gillian Keegan leaving the care minister role she assumed last year. Their replacements have not been formally announced, but the moves mean that there will be a fifth children’s minister, and a fourth care minister, in four years.

Coffey, the work and pensions secretary since 2019, will take responsibility for one of the three priorities Truss articulated for her premiership in her opening speech yesterday: putting the NHS on a “firm footing”.

Social care one of four priorities for Coffey

In an interview with BBC’s Today programme this morning (from two hours 10 minutes), Coffey said social care was one of her top four priorities, alongside tackling mounting ambulance response times, the rising NHS backlog – 6.78m people were waiting to start treatment following referral at the end of June  – and access to doctors’ and dentists’ appointments.

NHS leaders have repeatedly warned that tackling healthcare pressures requires investment in social care – particularly by raising wages for the workforce. This is because the mounting vacancy rate in adult social care is a key driver of delayed discharges from hospital, reducing capacity to admit new patients.

During the Conservative leadership campaign, Truss said she wanted to divert the additional funding allocated to the NHS this year (source: The Guardian) – raised through the 1.25 percentage point increase in national insurance contributions – to adult social care, in order to tackle delayed discharges. At the same time, Truss pledged to reverse the rise in national insurance, implying that the government would borrow the money to fund the increase.

When asked about the proposal on the Today programme, Coffey sidestepped the question but stressed the importance of adult social care for stemming NHS pressures. However, in a letter to Truss published yesterday, NHS Providers, which represents trusts, said that the NHS needed more funding to tackle its own workforce shortages and fully fund pay awards.

Adult social care funding reforms

At the same time, the Department of Health and Social Care is planning significant reforms to adult social care funding. Next October, it will introduce an £86,000 cap on care costs, a more generous means-test for accessing care and the ability for self-funders to ask their council to arrange their care home placement.

This would enable them to take advantage of the traditionally cheaper rates councils pay, however, at the same time, the DHSC is aiming to ensure authorities pay providers a fair cost of care, closing the gap in fees with private payers.

Councils and providers have repeatedly warned that the £3.6bn allocated for the reforms from 2022-25 is inadequate, particularly given the workforce requirements arising from the substantial increase in assessments, reviews and care planning that authorities would have to carry out as a result.

This is in the context of councils experiencing increased vacancies and turnover of adults’ social workers, with fewer employed.

This has prompted the Local Government Association to call for the reforms to be delayed until April 2024 to give the sector more time to prepare – but the DHSC has so far remained resolute on its proposed timetable.

Prospects for children’s social care

The children’s social care workforce is also under pressure, with official figures showing rising vacancies and turnover of social workers, and directors expressing serious concerns about the rising costs and challenges of using agency staff.

Under Malthouse, as for previous education secretaries, children’s social care is likely to struggle for political focus compared to the Department for Education’s other responsibilities, particularly schools.

During the leadership contest, Truss unveiled a six-point strategy for education that covered most of the DfE’s remit – schools, universities, further education and childcare – but did not appear to articulate any policies on children’s social care.

In Malthouse’s in-tray – and that of his new children’s minister, when appointed – is the DfE’s response to the Independent Review of Children’s Social Care, the Child Safeguarding Practice Review Panel’s report into the murders of Arthur Labinjo-Hughes and Star Hobson and the Competition and Markets Authority’s study of the children’s social care market.

The care review has proposed significant reforms including the introduction of national pay scales for social workers, tied to a five-year early career framework, the reservation of certain roles, for example, leading child protection cases, for practitioners who successfully pass the framework, a significant increase in early help funding to prevent families’ needs from escalating and regional commissioning of care placements.

The DfE is due to publish its response before the end of the year, alongside an implementation plan for reforming children’s social care, on which it is being advised by Josh MacAlister, who led the care review, and an implementation board comprising sector leaders and those with lived experience of social work. As children’s minister, Clarke-Smith had chaired the board so this role will likely pass to his successor.

Cost of living impact

At the same time, both adults’ and children’s services are struggling under the pressure of the cost of living crisis.

More than half (58%) of social workers said it was having a ‘severe’ impact on the lives of people accessing services, with a further 33% saying the effect was ‘significant’, found a recent Community Care survey.

Practitioners cited rising food bank use, families and people needing care facing the choice between eating and heating, rising debt, mental ill-health and domestic abuse, and some adults refusing services to avoid care charges.

Meanwhile, a survey by fostering information and advice service FosterWiki found that half of carers were considering quitting their roles because of the impact of rising bills, with a separate poll conducted by support service Foster Talk raising similar concerns.

Separately, care home providers have warned about the impact of rising energy bills on their ability to stay in business. Umbrella body Care England reported last month that providers were being charged £5,166 per bed to buy gas and electricity in October 2022, while had they forward purchased the same energy in August 2021 it would have cost £660, a rise of 683%. This was based on research it carried out with consultancy Box Power.

With Truss preparing to unveil an energy package to deal with spiralling prices for households and businesses tomorrow, Care England published a letter to her today urged her to reimburse providers for their increased fuel costs while also substantially increasing funding for adult social care.