Website of the Department of Health

In Care

For many in this country living independently at home will not be an option. Many will decide that residential or nursing care is the right option for them. And we have always sought to ensure that for those in care, who need healthcare, the National Health Service will always stand ready.

But we didn't get everything right first time. And now is the time to correct this. This morning, therefore, I laid before the House of Commons, our response to the Health Select Committee's report of NHS Continuing Care.

In that response I explain that I have asked Department of Health  officials to accelerate development of a new National Framework for eligibility criteria to end the risk of post-code lottery for Continuing Care - and to give new weight to those who suffer from so-called stable conditions or whose care needs change in the latter stages of their disease. Henceforth our policy therefore will be three-fold:

Further, we will bring forward proposals to look specifically at just how continuing care fits with the registered nursing care contribution.

Now a vital part of this review will be to understand how to accommodate the many stages and the many systems of assessment, as an individual's needs change. We have already started to streamline this process through the Single Assessment Process (SAP).

But SAP could be much more valuable still, and a keystone of providing the personalised care that actually sits at the heart of the Green Paper vision, but it will only do that if it is much more robust, if it is much more consistent, and if it applies to a wider population of people with complex needs rather than just simply older people.   And so, to this end we have agreed to pilot ways of sharing information between the benefit system and social services so that people do not have to undergo similar assessments by more than one agency.

In Healthcare

Now as a health minister, you would expect me to talk about health. And as we are amongst friends, I think we should speak frankly as friends do and say that the picture painted on television last night does not reflect the high quality of care provided in, and  out, across the NHS by the vast majority of nurses and other healthcare workers. Our National Health Service treats 1 million people every 36 hours - it treats nearly half a million older people every day - and the vast majority of patients have a positive experience. Two thirds of NHS users are over 65 - and actually 73% say they are satisfied or very satisfied.

But 'the vast majority' is still not enough. Our job has to be to ensure that correct respect is paid to all.

We have already seen great change where Essence of Care has been systematically introduced. But with or without the help of the BBC it was clear to me that we have to go much much further - to accelerate the momentum that Essence of Care started.

In the autumn therefore, the Older Peoples' Tsar Ian Philp will present his Next Steps for the Older People's National Service Framework. But between now and then, I can announce that I, together with the Chief Nursing Officer will bring forward a programme of measures under the banner of Caring in Confidence to accelerate the spread of best practice within acute services.

Now this agenda of delivering dignity in a world that is different requires us not just to re-imagine what social care can look like over the decades to come, it actually requires us to recast the foundations on which we work. I do not believe we can succeed without renewing that foundation. A new base must I believe be re-built on three things:

Let me talk about each in turn.

A workforce that is professional and proud

Every modern organisation today says that the workforce is its greatest asset. But in social care it is a truth that is absolutely beyond question. Over 80% of social care costs are the costs of wages. We cannot change unless our workforce changes too. 

We consulted on a number of workforce issues in the Green Paper. Now I'd like to propose some next steps. So to build on our progress - progress like the new social work degree, the first ever register of social workers; learning resource centre networks; national recruitment campaigns; pilots to develop new social care roles, a national strategy to develop leadership & management; two new employer-led organisations as well as the excellent practice already being delivered on the ground in the independent sector. 

To build on this, we have to now evaluate what has been achieved, and work out costed priorities for the future in a way that is inclusive and user-focused. I have therefore agreed with my colleague Beverley Hughes, the Minister for Children, Young People and Families, that our two departments should initiate a joint review to identify further workforce options - Options for Excellence - involving all key stakeholders in a review which will make recommendations on the key issues that we confront;

On this last issue we need, I believe, to move quickly. So, having made a good start in registering social workers, I will ask the General Social Care Council to begin to register the rest of the workforce, including early plans to extend registration to include domiciliary care staff and care home staff.

One Team with the VCS

Second though, if we are serious about the Green Paper vision of deploying the resources of an entire community then I believe we have to do more to sweep away the frustrations that stop the voluntary sector and the public sector joining to work effectively.

The National Strategic Partnership Forum created by Dr Reid will be a critical resource for us as we try to solve these questions. I am delighted therefore today to be able to publish the Forum's statement of purpose. And to ensure that the Forum begins work immediately on this substantive agenda, I have today asked Melinda Letts as chair of the Forum and my officials in the Department to work closely together to develop detailed proposals for the establishment of a Task Force that will drive forward a programme aimed at identifying, and recommending decisive action to address, the specific barriers to a strong commercial relationship between the voluntary and public sector. 

I have asked, in particular, for special attention to be paid to how we can reduce the administration costs for the voluntary sector. And I believe this work will act as a bridge between the National Strategic Partnership Forum and our broader work to ensure that the Forum's aims for plurality of provision and increased choice that benefit patients, service users and carers, are delivered in a way that both:

Renewed alliance

Finally, let me turn to the need for a new alliance between health and local government. The 1948 alliance, an alliance that I believe has stood the test of time. An alliance, which in our manifesto we promised to renew; to create a national care system and a national health service which are integrated.

Many of you have said to us, that if our intent is serious then it makes no sense to have a White Paper to follow this Green Paper and a second White Paper on out of hospital care. In fact you said that it 'beggars belief'.

I agree. I think that if we are serious about achieving the prize of working together around the needs of the people that we serve then we should rise to the challenge of writing one White Paper that takes forward this agenda. I have therefore asked the Secretary of State if we can take forward the work of the social and health care work that we started in the Green Paper and put it together with the forthcoming White Paper on out of hospital care and I am glad to say that she has agreed.

I know that there will be concerns in some quarters about this approach - but it is a test for me to get the final product. And we should also be clear that for us in social care we may need to supplement the White Paper vision with additional work; and we also have to be clear that this White Paper  is  but one  piece of the intellectual architecture that will span the report of the Pensions Commission published in  autumn, the Wanless review that will be published in spring next year, first reports of our pilot programme next year culminating in our submission to the Spending Review in 2007.

But beneath this strategic agenda, this alliance cannot be simply on paper - it is a marriage not a treaty. It must be about reform and improvement on the ground. It must be an alliance for change - it must be a partnership that finds new ways to make sure that where social care services are not being delivered to the standard of our aspirations that we take combined and concerted action to change that course. We are already seeing the potential of this alliance in the new approaches to working that we have seen born from the National Service Framework on Long Term Conditions.   But I want to go further still.

I have therefore asked the Department of Health's Care Services Improvement Partnership (CSIP) to work together with the Local Government Improvement and Development Agency (IDeA) to develop the first joined-up national improvement strategy for adult social care.

A strategy that I believe will offer practical support through a range of methods and approaches. That can be tailored at regional level to local needs and circumstances. So CSIP and IDeA will develop this new improvement strategy in collaboration with SCIE, LGA and the ADSS to make sure that their future work programmes are based on a good assessment of what actually needs to be done locally. This will I believe make one more vital contribution to councils as they set about advancing their well-being agenda, an agenda that has already made such a difference on the ground.

Effective leadership from the centre

These are the foundations on which I believe that we will build the future of social care. But for the Department of Health to play its part, it must act as a wise partner that knows where to act, because it knows where things need to be done.

We already know that there is a wealth of information about social care activity, collected and managed by organisations such as the Information Centre, CSCI, as well as partners like ODPM.

But I want to ensure that the Department always makes best use of what is available so that it can understand performance and target its service improvement resources accordingly. 

I am therefore launching the 'virtual' social care information initiative to look at what information lies where and how we use our technological capacity to ensure that it can be brought together and be readily available to support policy development, on the ground. This will be, amongst many things, a critical asset as we redouble our commitment to contributing to decisions about Local Area Agreements.

This then is our agenda - dignity for life, independence, well-being and choice. Built by a new workforce that is proud and professional; that works in a team with the voluntary sector; within a stronger alliance between health and local government. It is certainly, it is certainly, an ambitious agenda. And when it gets tough, we will need to draw energy by remembering just what it is that is the prize.

One day I received a letter from a man in his late eighties. He has been married to his wife for over 60 years and they had not been separated other than during the 2nd World War. She even had their children at home. Now, they live 30 miles apart because, in his words 'the council has said I can't cope anymore and that she needs proper care and the nearest home is in the next town - it breaks my heart. They say that I can't go with her because I don't have the same needs. So, it's come to this, after all these years the council have managed to split us up where the war, illness and rows never did. But I could have coped if they had helped me just a little more - that's her and my choice isn't it? Aren't we supposed to live in a free country where we can choose how to live, we're not hurting anyone. I fought for us to live in a free country. I want to care for my wife, it's what I promised I would do all those years ago, and she would me if it were the other way round, she has cared for me all these years. Isn't there a better way?'

And what I have to say is yes, there must be a better way, this can't be the right final chapter to a life story of support, and of love and of companionship - and are the right solutions really so difficult to find? Together we can find them to ensure that dignity and choice are elements of all our lives and to the end of our lives.

Today there is a new spirit animating social care. I have seen it wherever I have gone. What struck my fresh eyes when I arrived in this post just over 50 days ago is just how vital social care has become to so many of the important changes we are trying to achieve as a country.

Our ability to deliver reform in social care will have an incalculable impact not just on the people we serve but on our success as a Government in the reform of education, of work, of crime and regeneration. To achieving equality in the quality of life.

But what struck me too is how your values epitomise what is best about our country. You should be very proud of what you do.  But I need you to use that pride to redouble your determination to change social care and change it for good.

Thank you.