Website of the Department of Health

Context: health and social care

The demands upon the NHS and the social care system now are very different to those of sixty years ago. 

We have an ageing population. In 1948 when the NHS was established, over 65s made up less than ten per cent of the population. They now make up around sixteen per cent. For the first time in our history, there are currently more pensioners than children, and centenarians are the fastest growing age group.

In addition, we have the emergence of lifestyle epidemics such as obesity:  two thirds of adults and a third of children are either overweight or obese. If we do nothing, this will rise to nine in ten adults and two thirds of all children by 2050, leading to lower life-expectancy, increased risks of cancer and heart disease and of complications such as diabetes. Left unchecked it would also lead to a seven fold increase in the costs to the NHS.

And increasingly, we need to do more to tackle inequalities in healthcare.

People in Yorkshire and the Humber are likely to die younger than anywhere else in the UK. But within this bleak statistic, there are significant variations. You will hear this afternoon in Helen Smith’s presentation about how a baby born in Bradford is three times more likely to die before their first birthday than a baby born in Hambledon, and how life expectancy in different parts of Sheffield can vary by as much as ten years.

Poverty, poor housing, poor access to primary care services, unemployment – these things all impact on people’s health.  Increasingly, we need health and social care professionals to work together and with a whole range of professionals and organisations to support the health and wellbeing of the people they are responsible for.

We know that when this happens, they achieve more. In the local authorities with the most success in reducing teenage pregnancy, PCTs are actively working in partnership with schools. Nurse-led family partnerships, where vulnerable first time parents receive ongoing support from a named health professional, who can pull in additional support from social workers, job centre plus and education services as required are achieving better outcomes for both babies and parents.  

Another modern and entirely healthy development is that people expect more from health and social care services. By any objective measures, there have been huge improvements in the NHS: waiting lists down; one million extra operations every year, 280,000 more staff. This week we met our target for a 40% reduction in CVD amongst the under 75’s – five years early.  But we can’t expect people simply to be grateful for the fact that things are better than they were ten or twenty years ago when we could go even further – from a health system that’s world class in some aspects to one that’s world class in all.

Action

The NHS can never hope to get the best possible results for all patients by simply treading water. This is the reason behind the NHS Next Stage Review. Lord Darzi’s interim report presented a vision for the NHS that doesn’t just diagnose and treat but prevents ill-health and promotes good health too – an NHS that’s fairer, more personalised, effective and safe. An institution that is truly patient focused.

We will also be consulting this year on the principles that will underpin how we fund social care over the coming decades – money spent on social care has increased by 39 per cent in real terms over the last ten years. But even with this increase – in some parts of the country only the most severe cases of hardship are receiving any care at all.

In December we agreed a concordat between 6 government departments and 14 organisations and charities including the LGA which allows us to begin the process of reform over the next 3 years with £520m available in Adult Social Care Grants for those local authorities who really engage with the need for radical improvements. Our ambitions for health and social care need to be matched by our ambitions on skills.

In health, as the Next Stage Review Interim report pointed out, our approach to workforce planning and commissioning of education needs an overhaul.

In particular, we need to avoid any repetition of problems last year where newly graduated NHS-trained physiotherapists were unable to find work in the NHS.

On a local level, we need to link workforce planning and training more coherently with financial and service planning – so every penny spent on training leads to better outcomes for patients.

At the heart of this process, is the understanding that clinical skills alone aren’t enough – if we want a patient-centred NHS, then clinicians can’t survive on updating their clinical skills alone; communication, teamwork, leadership – are all important too and they can really change the patients experience of the NHS.

Social care, of course, is a profession that is all about building relationships with people. It is often misleadingly described as an unskilled profession – particularly in relation to those involved with care of older people, disabled people or those who are terminally ill. Anyone who has seen the commitment and dedication of care workers first hand, and the trust they build with those they care for will know that to describe them as unskilled is an insult to their professionalism.

That said, there is a pressing need to improve formal skills in social care. 

Only 30 per cent of 1.6 million people working in social care have a relevant qualification.

It is important to tackle this if we want staff to be able to progress and build a long term fulfilling career in social care. In many parts of the country, there are acute staff shortages and retention is poor – staff turnover ranges between 14 and 19 per cent. Improving training opportunities and expanding career pathways will help to retain these staff.

Improving skills

There are several things we need to do together to recruit people with the right skills and to improve the skills of those already in the workforce.

First of all, we need universities, colleges and employers working in partnership to develop qualifications and training courses that meet their skill needs.

And if you want to see what that means in practice, you need look no further than the work that Viv and her colleagues at the University of Hull have been driving forward, in partnership with the Learning and Skills Council, Leeds SHA and other local employers, to widen access to careers in health and social care. I understand that the Dean of the health and social care faculty actually sits on the Strategic Health Authority Board.

The Yorkshire and Humber Partnership with the Learning and Skills Council is now the national model for the NHS. It has attracted £3m of inward investment and over 1,000 support staff have begun ‘Train to Gain’ funded qualifications.

Secondly, we need to make sure investment in training and development in health is properly targeted – so that the money spent actually plugs the skills gaps and is directly linked to improving quality of care, rather than being used just for the best and brightest clinicians to improve their clinical skills.

At a national level, the Strategic Health Authorities and the Learning and Skills Council are together investing £100 million per year in education and training of staff, working with employers to identify skills gaps.

And my Department is working with our Sector Skills Council for Health to develop more comprehensive and clear skills frameworks for SHAs that will cover the skills that all clinicians need – in particular, those so-called “soft skills,” which can be overlooked but are hugely important.

There are specific issues in social care that require a different approach.  This is why in the first instance, we are producing a national strategy, that will drive local workforce strategies in social care and enable us to meet the ambitions of the forthcoming green paper and the Health and Social Care Bill.

And following on from Denise Platt’s report on social care in 2006, we are working to build the expertise and profile of workforce and to give it a clear national voice.

In particular, we will establish a social care skills academy to build expertise within the workforce – on leadership and management, commissioning, improving quality and integrated working.

We also want to establish a national social care board to give a clear voice for the sector, to advise – and no doubt sometimes challenge – government on social care issues.

One of the difficulties in recruiting more people into the care system is the lack of public understanding about what people working in social care actually do – there may be 1.6 million of them, but their work isn’t marshalled around obvious public institutions such as schools and hospitals. Often, their incredibly important work goes unnoticed. In general, people simply don’t comprehend what a career in social care entails.

To raise the profile of careers in social care, we’re running a £2 million recruitment campaign from March this year to run on national television.

At the Health and Social Care Awards in April this year, there will be an additional award – the ITN Calendar Health and Social Care Hero award, which will be voted for by members of the public and will rightly recognise and celebrate the profession.

Conclusion

When people discuss with their friends or family their thoughts about the NHS or social care, it’s doubtful if the statistics that politicians use – greatly increased investment, more doctors and nurses, more social workers will feature much in their conversation. 

What they are more likely to mention is their personal experience: the team of care workers that provided round-the-clock support to a dying partner; the midwife who delivered their baby; the speech and language therapist who enabled the stroke sufferer to speak again; the occupational therapist who got them walking again.

It’s people’s local experience of national change that really matters.

It’s what people who work for the NHS, for councils, for care homes actually do that makes the difference. Our job nationally is to support them to do the best possible job they can. Improving skills and training plays a crucial part in this which is why it's such an important topic for your deliberations today.