The must-read stories and debate in health policy and leadership.

It has emerged that, after a four-year gap, the department in charge of social care policy has deigned to re-establish a directorate dedicated to social care, with a lead director general.

Since 2016 – when Jon Rouse departed for Greater Manchester – the portfolio has been rolled into a single DG which also had responsibility for public health (much happening on that front lately?) and primary and community services.

There are a few unpleasant ironies in this history, one of which is that, with the 2012 Health Act passing the NHS lead to NHS England, the department was in fact supposed to be focusing more on its other responsibilities like public health and social care.

Instead its DGs seemingly became rather NHS-facing. It was also in 2018 that Jeremy Hunt insisted the Department of Health must have “and Social Care” tacked on to its name plate. That was despite it already actually having policy responsibility for social care at the time; while Mr Hunt’s statement of intent apparently did not extend to creating a director general with dedicated focus.

Here we are in 2020 post coronavirus wave one, with neither the government’s record on social care nor public health in recent years exactly covered in glory.

The covid pandemic has seen huge mortality in care homes, prompting heightened calls for reform of funding and delivery. Could this covid-inspired reshuffle be the first step towards addressing the inequality within the same department?

Best wishes to Ros Roughton, who has been social care director since last year, and is now promoted to director general, and to David Pearson, chair of the government’s new coronavirus social care taskforce, for setting things on a better course.

Look North

One politician who has been holding a flame for social care for quite some time now – though with limited success – has been Andy Burnham. As health secretary before the 2010 general election, Mr Burnham proposed a “national care service” and he has intermittently returned to proposals involving a greater role for the NHS, with the introduction of a much more universal, and joined up, service.

As Greater Manchester mayor since 2017, he called in 2018 for central government to experiment in that city with a bold integration reform bringing together health and care, along with a call for greater powers in general.

He revealed to HSJ he had now renewed that request in light of the coronavirus disaster in social care, putting it to the current communities secretary Robert Jenrick. Perhaps the covid-19 fallout will mean government needs such a pilot to signal it is serious about major care reform.

Matt Hancock has said in recent weeks that the spectacle of widespread deaths in care homes, and signs that some of the NHS’ actions hindered rather than helped, have highlighted the need for integration of the two.

HSJ readers will no doubt note that Greater Manchester was already meant to be radically experimenting with health and social care integration since 2015, before Mr Burnham arrived on the scene, and has struggled to show results. The changes did not involve unifying health and care funding, but extra money and support did go in.

It’s too early to judge regional response to covid, but certainly Greater Manchester’s care sector has not gone unscathed. Mr Burnham says there have been benefits during the outbreak from things like its joined up health and care record; and that boroughs like Tameside, where there has been much greater day-to-day and institutional join-up, have seen dividends during the outbreak.

It is rumoured that the virus has also started to open the minds of unreconstructed hospital chiefs, including Manchester University Foundation Trust’s Sir Mike Deegan, to the point of integration.