What is the role of the UK Secretary of State for Health...and Social Care?

The UK Sunday morning news magazine programme, Broadcasting House (or “BH”), has recently committed to using the ministerial title “Secretary of State for Health and Social Care” in full when discussing related matters – in contrast to the often-abbreviated “Health Secretary”.[1]

This commitment was prompted by the justified concern about the frequent “airbrushing” of “social care” across the UK media when referring to, or introducing, Wes Streeting MP. The concern (on this occasion) was raised by Susan King, a BH listener, who runs the Derbyshire Dales and Amber Valley Branch of Bluebird Care, a homecare company.

BH presenter Paddy O’Connell noted that “millions” are looked after in their homes or in care homes this Christmas, and acknowledged that those working in the extensive social care sector were “simply airbrushed from the conversation every time “Health Secretary” is used”. To BH’s credit, they proceeded to interview “Melissa” and Susan King, as well as some of their clients, giving a platform to reinforce some of the essential work done by the social care sector.

Why does this matter?

Put simply, it matters because social care in the UK is seen as a “Cinderella” service: significantly underfunded and underappreciated. As such it deserves more attention at all levels, including in the media, and especially at UK government level.

It also matters from at least one legal perspective – regarding the Secretary of State’s overarching duty being to “promote a comprehensive health service”, which prima facie refers exclusively to the reach of the National Health Service (NHS). The distinction between health and social care can become increasingly blurred as individuals may experience complex needs which involve both - so the distinction becomes increasingly relevant when funding for support and nursing care is sought. In other words, health and social care can properly be seen as “two sides of the same coin” in a wide range of situations.

The addition of “and social care” to the Secretary of State’s title (and implicitly to their mandate) is a relatively recent development in 2018 by the then Prime Minister, Theresa May. However, no explicit substantive changes were made to the underlying statutory duty of the Secretary of State. 

So what is the role of the

Secretary of State for Health and Social Care?

The statutory duty requires the Secretary of State “to continue the promotion in England of a comprehensive health service” which is designed to secure improvement in (a) the physical and mental health of the people of England, and (b) the prevention, diagnosis and treatment of physical and mental illness. The duty further specifies that the Secretary of State remains accountable to Parliament “for the provision of the health service in England”, and that services provided by the health service must, for the most part, be free of charge.

This evident disconnect between the title “Health and Social Care” and lack of clear accompanying mandate in the statutory duty at UK level is in stark contrast to Northern Ireland, where the comprehensive health system has long incorporated both health and social care.

The equivalent statutory duty specifies that

“The Department shall promote in Northern Ireland an integrated system of—

• health care designed to secure improvement— (i) in the physical and mental health of people in Northern Ireland, and (ii) in the prevention, diagnosis and treatment of illness; and
• social care designed to secure improvement in the social well-being of people in Northern Ireland.”

I have argued here that this disconnect should be addressed, and that social care should be incorporated into the duty of the Secretary of State, and not simply the job title. This would be an important symbolic first step in recognising the vital nature of the UK’s social care sector in this way.