Ministers should be held to account for the integration of health and social care

Editorial: Leaked plans reveal that Matt Hancock, the health secretary, wants to take more power over local health and care services

Matt Hancock, the health secretary, wants more power to shape local health and care services (Getty Images)

The Conservatives have been in power for so long that they have started to dismantle “reforms” that they introduced themselves. A leaked copy of plans for a health and care bill suggests that Matt Hancock, the health and social care secretary, wants to tear up some of the changes made by Andrew Lansley, his predecessor, nine years ago. 

One of the most controversial changes made by Mr, now Lord, Lansley was to make the NHS, and specifically NHS England, more independent of himself as secretary of state. The change was never clear cut in practice – especially after David Cameron took fright and tried to modify the legislation as it was being passed – but Mr Hancock clearly wants the pendulum to swing back in the other direction. He does not seek to take the power to direct individual hospital trusts, but to intervene in the restructuring of local services. 

This is broadly sensible, in that greater integration of health services with social care is needed, and ministers should be held to account for the way in which such services are organised. The document says: “We want to strengthen the secretary of state’s powers of intervention, oversight and direction. This will serve, in turn, to reinforce the accountability to parliament of the secretary of state and government for the NHS.” 

Jeremy Hunt, who succeeded Lord Lansley and preceded Mr Hancock, yesterday welcomed the change and said that it was made necessary by the growth in the numbers of older people, who have more complicated health and care needs. This is an ingenious way of explaining why he didn’t undo Lord Lansley’s changes himself, but the important point is that they are being undone now. 

It seems odd to be proposing organisational changes in the middle of a pandemic, but the need to integrate social care with the health service was pressing before the coronavirus struck, and the virus only made this more obvious. 

Of course, it is more important that the combined health and care services have the greater resources that they need, and the pre-pandemic plans to increase spending on them were long overdue and must be followed through. But one of the insights of New Labour was that simply pouring more public money into unreformed public services is not the whole answer. Structures do matter, and it is right that politicians should be answerable for them to parliament. 

Lord Lansley’s changes were a terrible distraction at a time when overall funding for the NHS was failing to keep up with rising demand. If the proposals in the leaked document are aimed at reversing some of their worst features while avoiding yet another major bureaucratic reorganisation, they should be welcomed.