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I am particularly pleased to be here today so close to the start of my new career. It is an excellent opportunity for me to get to know the LGA and meet the people who carry the torch for older people's care across the country. I am looking forward to working with you on this vital issue.

My predecessor, Jacqui Smith, was deeply committed to improving community care for older people so that more people receive the services they need to live independently for longer. It is also something I firmly believe in and I see improving the hospital discharge experience and reducing delays as being at the heart of the issue.

This is an important part of our ongoing work to increase choice and quality in older people's services. Reducing delayed discharges is not just a question of getting older people out of hospital beds into a care home that is the sort of 'one size fits all' approach we need to move away from. We can no longer risk ignoring the needs and wishes of the individual person, instead, we must be providing support to prevent older people from being admitted to hospital in the first place and a genuine range of care options that will help them live independently after discharge whenever that is what best suits the individual.

Of course, improving older people's care is a priority for councils and social services departments too. I have no doubt that we share the same vision and goals and working together we can do much more than we can alone.

Today I want to talk about the successes we have had so far in achieving better and more diverse care for older people. And I want especially to identify the support that the Department of Health will be offering to ensure this continues in the future.

Achievements - figures and Change Agents report

Reducing delays is and will continue to be a priority for the government, because delays are an indication that patients are not receiving the care they need. At a time when the setting of targets is criticised I am unapologetic in making it clear that the Government remainss committed to this priority.

We can all be proud of the improvements that have been achieved, already, especially since the introduction of the £300m Building Care Capacity Grant in October 2001. This grant provided targeted investment for local authorities to tackle this difficult problem and a great many authorities have put it to excellent use.

And the figures are evidence that the hard work of social workers, discharge co-ordinators and medical staff in health and social care communities across the country has undoubtedly had results. Between September 2001 and March 2003, the quarterly monitoring shows that the number of people of all ages delayed in acute NHS care reduced by over 40%. Even more impressively, delays for the number of people over the age of 75 fell by nearly 50% and this is the age-group which is most at risk of losing independence after a prolonged hospital stay.

In addition, the length of time for which people are delayed has also dropped significantly, with a 61% reduction over the same period in those waiting for 28 days or more.

Behind these percentage reductions are individuals, mainly older people, who are no longer waiting needlessly in an acute hospital bed when they do not need to be there, and are instead receiving the quality of care that they deserve at the time that they need it.

But it is not just the figures that tell us that progress is being made. On July 2nd, the Department's Change Agent Team published its first annual report, Changing Places. Many of you will have come across the Change Agents who, by March this year, had provided intensive practical help on reducing delayed discharges to front line health and social care communities involving a total of 30 councils, 72 primary care trusts and 61 NHS trusts. Since its establishment in January last year, the Change Agent Team has developed a range of programmes and accompanying good practice materials which have enabled local partnerships to measurably improve their performance in delivering services to older people.

Changing Places shows that the Team's approach works and that the Change Agents can help health and social care partners achieve a significant difference. The Team aims to give local services the support and confidence they need to address difficult issues, some of which have been problems for years. The measures employed range from encouraging a whole systems approach to reducing delays - for example, promoting joint working between health and social care and improving service commissioning. Measures range from Southampton's ambitious project to reconfigure all the city's services for older people - to looking at the little things which can improve the patient's experience of hospital discharge, such as dedicated, co-located, discharge teams.

A partnership approach to delays, involving acute NHS care, intermediate care, local authorities and the independent care home sector can have real, sustainable benefits in improving the patient and carer experience. That is what the Change Agents have tried to encourage.

The Change Agents have also encouraged approaches to reduce avoidable hospital admissions for older people, such as the occupational therapist and care manager in A&E at Harrogate hospital who finds alternative care packages for older people so that they do not need hospital admission. They have helped a number of areas expand and improve the care they can provide for older people with dementia, so that this does not become a factor in delaying discharges.

And they have worked with some areas on how they can expand capacity, in a sustainable and timely way, such as South Gloucestershire, which has identified and commissioned extra care housing within eight months.

Delayed Discharges Act and Grant

So the achievements to date are good news. But to some extent they have been achieved by heavy performance management and monitoring of targets. We know that more needs to be done and we also know that a centrally-managed approach is not sustainable. Devolution and earned autonomy are increasingly characteristic of the NHS and local government. Fewer grants are set with conditions and ringfencing, fewer central targets are being set.

We cannot rest on our laurels and allow the number of delays to drift upwards, undoing the hard work of the last couple of years. That's why the system of reimbursement for delayed hospital discharges introduced by the Community Care (Delayed Discharges) Act creates an incentive for health and social care communities to focus on what they can do at a local level to tackle delays in their area.

Now I know that this Act has had its critics in local government. I know that people have been concerned that they will not be ready in time, will not have the extra capacity in community care services, or that it is simply unfair to pick on local authorities for delays. I believe that by postponing full introduction by nine months and providing extra funding specifically to help tackle delays and increase capacity, we have gone some way to meeting those concerns.

And I don't think we should overlook the fact that while the Act sets out timescales and formal notification procedures for discharge, it is only setting out a framework around the existing responsibilities that local authorities have. Local authorities are already responsible for assessing and meeting the needs of individuals who are likely to need community care services after discharge from hospital so the Bill is not making you do anything you were not already duty bound to do.

On the other hand, the Bill does introduce completely new duties for the NHS around communicating with local authorities and with patients and carers. Early communication from the NHS to local authorities is vital if discharge is to run smoothly - and this is something we will be emphasising in the guidance to accompany the Act. This is not a one-sided piece of legislation, as some have claimed - it recognises that health and social care have equally important parts to play in improving discharge for older people and a first time legal responsibility for the NHS to help local government.

I accept that local authorities may well be less than happy at paying the NHS for delays. But at present, if a patient is unable to leave hospital solely because the council has not put in place the services they or their carer need for discharge to be safe, it is the NHS which bears the costs of caring for the patient and is unable to treat other patients as a result. The Bill is not about transferring money between agencies; it is about making the whole system work better for patients, not just those in hospital, but those waiting for a hospital bed.

I want to see minimal charging, because this would be an indication that services have improved.

If local authorities meet their responsibilities and arrange services in time, then there will be no charge and both they and the NHS will benefit. If they don't, and care is not provided for patients in the community when it should be, then it is reasonable that the costs borne by the NHS should be returned through reimbursement. This new duty will come into force on 5th January 2004, after the Act has run in shadow form for three months, and provides a financial incentive for councils to promptly assess and arrange community care services for patients leaving hospital.

Of course, the Community Care (Delayed Discharges) Act will come into force against a backdrop of increases in funding for social services. From this April, local authorities are receiving an average 6% increase above inflation in funding for social services, allowing councils to provide faster access to a range of services and greater choice for service users.

However, we know that for some councils, for example those in areas where there are historically high levels of delays or particular local circumstances, it will be harder to put in place the community services needed to reduce delayed discharges from hospitals and avoid the liability to pay the reimbursement charge. That's why the Secretary of State announced last November that an extra £100 million - on top of the resources already made available - will be transferred from the NHS budget to social services for each full year that the new system is in operation. As the Act is being introduced from October this year, councils will proportionately receive £50m through the Delayed Discharges Grant to cover the second half of the 2003-4 financial year.

This grant will enable all councils to gain, not lose. In May we announced the indicative allocations for each authority and councils will receive their grant allocation before October. Because the reimbursement charge does not start until 5th January next year, councils now have a lead-in period for investing the money in developing and expanding those services which people need when leaving hospital - whether that is extra help in their own home, a period of intermediate care to assist their rehabilitation, or a place in a care home.

This extra time for preparation and investment means it is less likely that councils will need to pay the reimbursement charge when the liability for it starts in January. Both councils and patients will benefit.

A number of councils have already decided with their NHS partners to invest their grant, up front, in services which will reduce delays. They will then take account of this in any charges which become due later in the year, so that the funding can be used to the maximum effect in improving services.

The Delayed Discharges Grant will be allocated using the combined older people's Formula Spending Share for residential and domiciliary services and all councils will receive the full amount to which they are entitled under FSS. We have even built in an additional cushion for those Councils that might have faced special problems so all Councils will receive a sum that should be greater than their reimbursement charges so there is no reason why anyone should lose out.

And because we are making the grants without a ring-fence, if you have already ensured adequate provision and built good systems in your area and as a result you are able to deliver this service to your community for less than the grant you receive, your Council will be free to spend the extra on whatever you decide!

Preparation for implementation

We are now in a period of preparation for implementation of the Act. I know that some people think October is too soon. But in fact there will have been 18 months between reimbursement first being announced in April 2002, and its implementation in October this year, and longer before the charging element comes into force. And implementation is not occurring without practical support from the Department of Health - in January this year the Department established a reimbursement implementation team which is working with health and social care communities to help them get ready for reimbursement. The team will offer intensive support while the Act is in force in shadow form between October and December and will continue do so after full implementation in January. The Change Agents will also continue their programme of intensive work in those areas where the level of delays remains a particular concern.

I know that some people have been concerned that the Act will lead to a breakdown in partnerships between the NHS and local authorities. In fact, I believe that it will lead to increased co-operation and joint working, because for the first time there is a strong incentive for partners to work together to make sure that their discharge procedures do work.

I am very encouraged by the unprecedented work going on to tackle these issues - where social services and their local NHS partners are working on improving joint processes and looking at how best to invest in extending services, finding joint solutions to joint problems and acknowledging the different parts that they have to play in achieving success. Supported by the Change Agents and the Reimbursement Implementation Team, good working relationships have developed in many areas. And it is where partnerships are already in place that local authorities will be best placed to avoid delays. In other words, if you have already got good partnership working I believe you are likely to deliver services for less than the grant you receive.

In addition, the Act clarifies the roles and responsibilities of the agencies responsible for making discharge arrangements so there will be less scope for disagreement over who is responsible for a delay, without damaging working relationships.

The driving principle behind this Act is to ensure that older people are placed at the centre of care and do not wait needlessly in an acute hospital bed when they do not need to be there, and they can instead receive the quality and range of care that they deserve.

Reimbursement will lead to increased quality and choice for older people because if Local Authorities are to avoid delays then in the long term they will need to invest in a wide range of services and capacity so that they can respond flexibly to an individual's needs, providing not just residential care but also intermediate and interim care, extra care housing, equipment and adaptations services and packages of intensive support at home.

Extra care housing, Direction on Choice, Innovations Forum

But this is not all we are doing to help you deliver capacity and choice. Only recently I was delighted to be able to announce a cash injection from DH totalling £87 million over the two financial years from next April to grow the development of extra care housing. This is an important way of adding to the range of options available to older people. Extra care housing will not give us all the answers and it won't be right for everyone, but for some it will offer complete security and an environment where care and support can be delivered effectively. It is a choice we want older people to be able to have.

We will be looking to issue allocations from this fund to locally devised projects to provide up to1,500 new extra care places between 2004 and 2006. I want to hear your innovative ideas and I want to tap into your expertise to deliver this exciting new option.

However, for some older people a care home will provide the level of support that they need. Reimbursement obviously interacts with people's right to live in the care home of their choice, subject to certain conditions under the Direction on Choice. The Department of Health is currently revising the guidance associated with the Direction in the light of the Delayed Discharges Act. We'll be consulting on the guidance later in the summer and our aim is to have the revised guidance in place before the reimbursement arrangements begin in earnest in January.

There is a lot of good work and innovation already going on around the country. I know that the LGA is also very much involved in pioneering new ways of delivering public services. Innovative ideas on improving partnership work and developing community services for older people which would reduce the need for hospital admissions have been emerging from the Innovations Forum, set up by LGA and the ODPM. The work of the Forum is part of creating genuine partnerships and co-operation between health and social care and complements the additional freedoms and flexibilities the government is already committed to providing to excellent councils. I will be looking at the ongoing work of the Forum with great interest.

I feel confident that by the time reimbursement is implemented later this year many local authorities, and their NHS partners, will have been able to find new and creative solutions to the problem of delayed discharge, whether they be co-located teams and improved assessment procedures or investment in capacity such as interim care facilities or extra care housing. In this way they will be able to ensure that minimal reimbursement charges are paid and that patients are receiving a range of high quality services to meet their needs as soon as they are ready to be discharged from hospital.

Closing remarks

Through its incentives to work together to avoid reimbursement and to invest in an increased range and capacity of services, the Delayed Discharges Act is part of this new climate of partnership working between health and social care. It will ensure that preventing delayed discharge becomes the top priority that it should be. No older person deserves to be delayed in hospital, worrying about when they can go home, at risk of losing their independence and confidence or of acquiring further infections. The significant reduction in delays recorded in the delayed discharge figures, and the Change Agents' report, show that we have come a long way in improving the discharge experience. I know that many of you here today are directly involved in providing services for older people and that you care enormously about helping those people in the best way you can.

Your commitment has been vital in the successes to date in improving older peoples' care, of which reducing delayed discharges is an important part. I believe that the new Act will continue to build on our achievements in providing genuinely patient-centred care for older people. I look forward to working with you in the future.