Website of the Department of Health

It is very fitting that four days after residents across the planet united in their ambition to recognise our common obligations to those in need abroad, that we combine here today to learn from each other new ways in which we can satisfy the same sentiment in our own backyard.

At a time when great debates about our future course in Europe are breaking out not just in the corridors of power and up the road but in the street, the right place to start is to remind ourselves of just what it is that is shared, shared in our inheritance, shared in our values and shared in our future.

Because whether we look at Catholic Europe, Protestant Europe, Multicultural Europe or secular Europe, nowhere is our common ethical heritage more apparent than in our approach to social and health care. 

Here, in our shared determination to ensure collective finance for random risks do we see a uniquely European approach and recognition that real freedom is not about some kind of liberation from all constraints - but mutual support to strengthen the capabilities of each of us.

A politician once described his ideal of freedom by citing JM Keynes's description of Britain after the first world war;

"The inhabitant of London could order by telephone, sipping his morning tea in bed, the various products of the whole earth -- he could at the same time and by the same means adventure his wealth in the natural resources and new enterprise of any quarter of the world -- he could secure forthwith, if he wished, cheap and comfortable means of transit to any country or climate without passport or other formality."

This was not the reality for most Britons was very different. There is no better description that the formidable petition called Mrs Braddock in the House of Commons (former MP for Liverpool, Exchange) speaking in the Second Reading debate on the National Assistance Act in 1947 the foundation on which the National Health Service was set up. Describing the lives of families in Liverpool after the first world war she said;

'When we talk about queues at the present time, we do not realise what queues used to be like. Let us remember the queues outside the Poor Law relief offices, the destitute people, badly clothed, badly shod, lining up with their prams - many of the men lining up with the kitbags which they had carried during the 1914-18 war - for their week's rations of black treacle and bread. Bread was issued once a week - and we know what bread is, even in the best of times, when it has been kept for a week.'

Our response in Europe was the magnificent creation of the welfare state.  This week - days before we celebrate the 60th anniversary of the end of the second world war - it is worth reminding ourselves of what it took to win the peace. Because the determination that drove us after the war we need again to transform the welfare state in the face of three - at least three - revolutions in the years to come.

The demographic challenge sets the context because of the cost challenge it poses;

Today in our country we spend 40% of the NHS budget and 50% of social services budgets on the over 65s.    In the next 10 years, the population of over 65s will increase by 15%, and the population of over 85s by 27%.

This is a challenge we all share.  Over the next five decades, across the OECD fertility will remain below the rate required to stabilise the population, life expectancy already up from 66 years in the late 1960s to 77 today is expected to increase. The result will be a dependency ratio which could more than double to reach nearly 50 per cent in 2050.

Second, the new possibilities of medicine will put a different life within the reach of millions more.  Genetic therapy will soon mean that predicting and preventing debilitating illness and life threatening conditions will become common place. Biotechnology will let us grow new arteries, bionics will reverse sight and hearing defects. Telecare and telemedicine - today distinguished only by our first tentative efforts - will be transformed.

And that transformation will be coming just in time, because the third revolution I see is the biggest one of all - the revolution in expectations.

The transformation of information within reach of our fingertips, the decline of traditional deference, the rapid changes in consumer markets are all combining to change what we expect to see in public services. Soon British households will spend more on services than anything else - and those people turning 60 next year will be the first 60 year olds to have lived with the NHS all their lives. All of these changes will drive new perceptions of what is and what is not acceptable. So, even though we are seeing better outcomes, in health people are telling us they are less satisfied.

In this world of the future, all sorts of new freedoms become real. Trade and technology will transform our national wealth and our quality of life.  But our challenge, a challenge in harnessing this revolutionary change is to couple this economic progress at large with social progress at home in a way that rises to those new ambitions, that brings the new possibilities of medicine within reach of rich and poor alike and in a way that does not mortgage the future for generations that follow us.

And beyond that our challenge is more fundamental still; to ensure that in this new world, our oldest values emerge not just undimmed but stronger.

The agenda for me is threefold;

Now none of this is easy.

To give everyone - no matter their home - a flying start in the world we have to solve the challenge of why morbidity and mortality rates are significantly higher for poor parents, parents from ethnic minorities and young parents; 60 per cent higher than for babies of older women. We have to change the shape of our healthcare for children to address new challenges like obesity. We have transform our mental health services for young people - for who suicide is now the most frequent cause of death amongst men and the third most frequent cause of death among young women.

To deliver independent living requires bold action - bold action on behalf of the 10 million disabled adults, 700,000 disabled children and about 1.5 million people with learning disabilities. The vast majority of people tell us that their ambition is to remain living in their own home - yet just 8% of the people living in care homes, live in extra care housing units. 

And to deliver dignity for life, we must once and for all put an end to abuse of older and vulnerable people.

We have had to triple the numbers of staff working to deliver the Protection of Vulnerable Adults Scheme. Why? Because we've received over 1700 referrals already - far far more than we predicted.  We have to tackle abuse in the home because research tells us that 85% of reported abuse is at the hands of paid carers. But we have to act to protect people not just in their homes - and people in hospital.