Will the new ministers understand the link between social care and health?

There is hope that at least Norman Lamb, who replaces Paul Burstow as care minister, will appreciate that cuts in social care will have a significant impact on health, by David Brindle

The social care world has not always been convinced that the health world “gets it” when it comes to the interdependency of the two systems. With more than nine in 10 respondents in the Guardian’s healthcare network survey recognising that cuts in social care will have a significant impact on health, it appears the message is now heard loud and clear in the NHS. But will it also be heard in government?

Last week’s reshuffle included the departure from the Department of Health of ministers who, whatever their weaknesses, did show signs that they got it. An unprecedented £4bn of NHS money is being transferred to social care or earmarked to support integration of the systems, recognising that local authorities are being clobbered by cuts, and that investment upstream in care and support in the community saves much more downstream in costly hospital admissions.

Will the new health ministers get it too? Health secretary Jeremy Hunt is on a steep learning curve and there will be concern that his presumed brief – to make the NHS reforms of his predecessor, Andrew Lansley, better appreciated – will tempt him towards populist policies. These would not include being seen to take money from hospitals to spend on social care.

On the other hand, Hunt’s deputy Norman Lamb, who replaces his Lib Dem colleague Paul Burstow, comes with a keen grasp of the broader agenda, having been his party’s health spokesman before the general election. And Dr Dan Poulter, a new junior minister (impressed as a backbencher and continuing part-time hospital doctor), with his understanding of the health and social care system as a whole.

Lamb was a key player in the ill-fated cross-party negotiations on long-term care funding in the runup to the election. His top priority will be for the coalition to commit to implementation of the reform proposals tabled subsequently by the commission led by economist Andrew Dilnot. Although some journalists were briefed in August that David Cameron had resolved belatedly to do so, having indicated in July that the issue was parked in the long grass, no detail has been forthcoming.

The reshuffle, and the Treasury’s deepening problems, throw fresh doubt in this direction. A report on NHS spending by the Institute for Fiscal Studies and the Nuffield Trust put the options starkly: an unreformed social care system would cost an extra 3.3% a year between 2014 and 2022; implementing Dilnot’s £35,000 cap on individual lifetime liability for care costs would cost an extra 5.4% a year – about £3bn more annually by 2022.

Yet the wisest heads know that maintaining the status quo would be a false economy. In a report published last week, the King’s Fund health thinktank says there needs to be “a major shift” in how and where health and social care is delivered. “Nowhere is the need for fundamental change more apparent than in social care, where arrangements rooted in the 1940s have not kept pace with social and demographic changes.”

Sarah Pickup, president of the Association of Directors of Adult Social Services, welcomes the conclusive verdict of health professionals in our survey, but she would like to see the underlying logic applied to positive investment in care and support.

“We need to be taking [what people in health have learned] about the effect of reduced spending in social care and saying that if you actually increase spending, you will have a positive impact on health,” Pickup says. “I’m not sure that message is fully understood yet.”

• David Brindle is the Guardian’s public services editor