The move by the First Minister just before Christmas to appoint a Minister for Drugs Policy led some to question, given the government’s repeated commitments to improving adult social care, why social care doesn’t warrant a dedicated minister of its own.

When Caroline Lamb takes over in January as the Scottish government’s most senior civil servant for health, she will have the title Director General of Health and Social Care.

However, at the cabinet table there is no secretary with ‘social care’ in their title.

Jeane Freeman is Cabinet Secretary for Health and Sport, as was her predecessor Shona Robison. Before them, Alex Neil and Nicola Sturgeon had the title of Cabinet Secretary for Health and Wellbeing.

One rung below, and answering to Jeane Freeman, we have ministers for public health, recently taken over by Mairi Gougeon, and for mental health.

The argument for a minister for adult social care is not that there is nobody in government responsible for it, rather that responsibilities are spread across lots of different ministers.

As Minister for Public Health, Sport and Wellbeing, Mairi Gougeon has specific responsibility for carers, the Care Inspectorate, person-centred care and self-directed support.

However, Shirley-Anne Somerville, Cabinet Secretary for Social Security and Older People, is responsible for the Carers Allowance, Personal Independence Payments and Disability Living Allowance; while the Minister for Older People and Equalities, Christina McKelvie, is tasked with looking after the equality and human rights of older people and people with disabilities, whilst also leading policy to address social isolation and loneliness.

Given that Scotland’s local authorities have a central role in adult social care, you might also need to engage Aileen Campbell, Cabinet Secretary for Communities and Local Government, or her deputy, Kevin Stewart, Minister for Local Government, Housing and Planning.

Around the rest of the UK, the approach is mixed.

The Westminster government – which renamed its department of health as the Department of Health and Social Care in 2018 – has had a care minister since 2006, the post currently held by MP Helen Whately.

In Wales, oversight of Social Care Wales, the Welsh Care Inspectorate and accountability for social services delivered by local authorities, are all the responsibility of the Minister for Health and Social Services, Vaughan Gething and his health minister deputy, Julie Morgan.

In Northern Ireland adult care services all fall under Health Minister, Robin Swann.

The argument for a single Scottish minister for adult social care centres on accountability. Although Jeane Freeman has led consistently during the pandemic on issues such as care homes, without absolute clarity on who is responsible for what, citizens may not know who to approach, and issues might disappear through the cracks.

And Ms Freeman doesn’t have control of all the levers for the delivery of effective adult social care when Self-Directed Support and payments to carers, sit with colleagues in other departments.

A single minister could have oversight and responsibility for making things happen without having to go to anybody else.

Another argument is about perception.

When the First Minister appointed a Minister for Drugs Policy – answering directly to her – she was making it clear that she is taking the problem very seriously indeed.

So, the question arises of why Scotland’s intractable drugs problem warrants the attention of a dedicated minister, but adult social care does not.

A dedicated drugs minister but no social care equivalent is not justified on the basis of numbers.

Even if you take into account the toll on families and those around them of the 1,264 people who died from illegal drugs in Scotland in 2019, this issue directly affects far fewer people than the number of Scots receiving or providing care – where estimates for which never fall below one million.

Is the reason because Scotland is performing worse on drugs deaths than other countries but about the same in terms of any measure of the delivery of social care?

Perhaps it is because we measure drug related deaths but have no single measure of success or failure for people receiving or giving care?

Is it because previous promises on care have been relatively vague compared with the pledge to address the single metric of drug deaths?

There are, of course, arguments against appointing a minister for adult social care.

The first of these is that you can simply have too many ministers, that valuable resources would be diverted from frontline delivery to supporting the civil service machine that would form around a new minister.

Another is that social care is too broad, affecting so many different aspects of the lives of those who care and are cared for, that it cannot naturally fit into a single departmental box.

Indeed, some of the concerns raised about a single national care service are precisely that you cannot have a one-size-fits-all approach to social care delivery, that a medical model of how the NHS looks after those who are sick will not work when applied to the continuing support that people receive for the rest of their lives in their homes, whether a care home or their own home.

The SNP will go into the Scottish parliament elections in just a few months’ time with a manifesto commitment to deliver a national care service, informed by the recommendations, due in the coming weeks, of the Independent Review of Adult Social Care.

These might, of course, include advice to create a new dedicated ministerial role.

Should the SNP form the next government, and few question that it will, then the creation of a national care service will be a central plank of the Scottish government’s policy agenda.

That could be a massive task.

And, if she doesn't appoint a Minister for Adult Social Care before the election, the First Minister should give serious thought to doing so at the start of the next parliament.

 

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