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Social care at a turning point

But, what really struck me as I listened to the broad range of debate was the speed with which social care is moving centre-stage. Across the breadth of the domestic policy agenda - in health, education, criminal justice and welfare to work - and at the heart of our broader ambitions for a third term, we see that social care is mission critical.

Take criminal justice.  We know that prisoners are 13 times as likely as the general population to have been a child in care, 14 times as likely to have been unemployed, 10 times as likely to have been a regular truant and 2.5 times more likely to have had a family member convicted of a criminal offence. Many prisoners have more severe problems that need treatment. About 7 out of 10 prisoners were using drugs before imprisonment and around 43% of sentenced prisoners have 3 or more types of mental illness. A significant number have tried to commit suicide prior to their imprisonment. And it is social care that provides root cause solutions. From better care for vulnerable young people to innovations in delivery like in-reach teams bringing together a multiplicity of disciplines to provide help.

Or take education. Every day over 50,000 pupils miss a day of school without permission and an estimated 7.5 million school days are missed each year through truancy. These children out of school are often the most vulnerable; easily drawn into crime and anti-social behaviour and more likely to be unemployed after leaving school. With tougher sanctions, it will be social care that helps provide root cause solutions.

Or take health. Better social care is already helping transform the health system's ability to serve the country; making sure residents are out of hospital faster. In September 2001, delays in acute hospitals on any one day were 7,065; by March this year this figure had been slashed to 2,359. And already better social care is preventing more and more needing acute care in the first place.

Or take welfare to work. We have set a goal of achieving better and better employment rates. Yet if we are to reform incapacity benefit, health and social care will have to play a big role.

All of these issues are not just important in themselves - they are politically required. At the last election, 70% of the electorate thought we did a good job with the economy. But far fewer thought we had made the same progress reforming public services. And to deliver this agenda requires strong social care.

Beyond this is our government's ambition to change this country for good. By creating a society in which each of us achieves the full measure of our potential, and where through our interdependence with each other our society is richer. The economist Amartya Sen called this the enlargement of our capability, but pointed out that to deliver this we must remember that poverty is as oppressive as tyranny; poor economic opportunity as stultifying as systematic social deprivation; inexcusable neglect as brutal as intolerance.

In the final debates about the National Assistance Act, legislators expressed the hope that 'eventually a rising level of prosperity for all will in the long run leave it (the National Assistance Board) with little to do'.  In fact, advances in technology and medical science have over-turned this thesis. At the start of the cold war, Albert Einstein said; 'It has become appalling obvious that our technology has exceeded our humanity'. Now we stand a chance of over-turning that aphorism. We live in an age when technology - especially medical technology - creates new chances not threats for humanity.

Today, we stand on the brink of a revolution in medical science and Britain is at its forefront.  In the next few years we will finish mapping the human genome. By 2010 genetic screening may be widespread. By 2015 30% of life threatening diseases may have a cure. By 2020 a new born baby girl will live to see in the 22nd century. And, in our country, half of our 46 Nobel prizes are in medical science. We are the world's 2nd best environment for biotech. The NHS could lead the world ensuring revolution changes lives of everyone rich and poor alike.

But, we will only live out the promise of this new era to the full, if we not only save and lengthen lives, but enrich them.

The second phase of reform

During our first two terms, the Labour government laid the foundations for today's social care system designed to do just that - a system of assistance that would help ensure that the most vulnerable members of society had the chance to thrive, to develop, to contribute and in turn enrich the community around them. This blueprint consisted of three key elements;

First, we clarified and enlarged the entitlement which individuals could expect. Set out in a series of National Service Frameworks - for Mental Health, for Children, for Older People and for Long Term Conditions, supplemented with new legislation to support the right of carers with the Carers Equal Opportunity Act, and the most vulnerable with the Mental Capacity Act, we defined better than ever before the basic standards to which residents had a right.

Second, beginning with the Care Standards Act of 2000 and strengthened by later legislation, we established a new framework for regulation and protection.

Third, we transformed the level of resources available for adult social services, raising resources from just over £6 billion in 1996/7 to over £11 billion last year. In the last year alone, resources have been increased by £850 million.

And a hallmark of our reforms has been the concern with abuse of the most vulnerable. That is why we issued No Secrets to local authorities in 2000. It is why our programme of research with partners like Comic Relief and Action on Elder Abuse continues today.

In our third term, we will move into a second phase of reform in which we go further by building on these foundations already in place, and going further to address the building blocks of effective delivery - our social care workforce, unlocking the true capacity of the voluntary sector, and recasting the relationship between health and local government.

Much of the groundwork for these changes is under way. I am delighted that we are able to announce today the membership of our taskforce focused on analysing the barriers that stand in the way of better partnerships between the voluntary sector, health and social care.

Work on our workforce review Options for Excellence is on track to report at the end of November, and of course, reform of PCTs - their boundaries and their focus - is already clearing the path for a stronger, closer union between local councils and the local NHS. Where there are good arguments for co -terminosity, you will find this minister arguing your case. And the new focus for PCTs on commissioning rather than delivery, clearly creates a rare new opportunity for local councils to venture forward with their agenda for wellbeing.

The White Paper will develop many of these ideas.  It will be work that will be immeasurably stronger for the 1500 submissions drawing on 21,500 individual comments from 100,000 individuals who engaged with the Green Paper before it. In particular, the response from people using services has been particularly strong.

Soon we will publish the summary of what you said. But I can tell you today that emerging results suggest that there is strong support for the vision we set out in the Green Paper; strong support for empowering people to take control of their lives through the introduction of individual budgets and the extension of direct payments; and strong support for a shift to earlier intervention.

But on two questions - on regulation and finance - I can report progress today.

Strong rules are a key defence for service users, promoting as they do both dignity and independence.  Last year, my predecessor began the review of these national minimum standards for adult social care.

We have now drawn conclusions from our first endeavours and I would like to set them before you this morning.

In April next year, we will suggest that Commission for Social Care Inspection is given the power to set about its work with maximum effect.

I believe that it is essential that the Commission should be able to target its activity where risks are greatest.

But, today's system requires the Commission to inspect all providers regardless of their quality once, and in the case of care homes twice a year.

I think this should change. I think that CSCI should decide how often they inspect particular providers, using a robust system of risk assessment.

CSCI should be able to focus its inspection activity on providers about which it has the greatest level of concern, rather than treating both high quality and poorer quality providers in the same way.

So we plan to remove the requirement for inspections every year, but retain a requirement that all providers are inspected at least once every three years.  CSCI must still be able to carry out random inspections and will, as now, respond vigorously to complaints and whistleblowing.

But to go further still, I will consult on the introduction of a legal requirement for regulated providers to carry out an annual quality assurance assessment.  This will give legal force to something that many providers already do.  CSCI will be able to dispense with pre-inspection questionnaires, making lighter the burden of regulation for good providers.

I will begin consultation on these changes later in October. I look forward to hearing your thoughts.

Second, I have a little good news to report about money. Today, it is a great privilege to able to announce that five local authorities have successfully made the case for the award of £125 million of PFI credits.

Already local authorities are getting more for the delivery of adult social services than ever before.  But some local authorities, trying to develop new services to meet the needs of their communities are working in innovative ways to directly improve the care that they deliver. Government should and will step in to help them.

Five authorities have been successful in bidding for financial support. Birmingham and East Sussex will both be awarded nearly £35 million. Wolverhampton will be awarded nearly £23 million. Medway will be awarded over £17 million and Tower Hamlets will be awarded £16 million.

The hallmark of bids from these successful authorities was the integration and coordination they proposed between social care, health and other providers. These new services - such as better connected intermediate care and outreach services, or new types of support for people with learning disabilities - will not just make a difference to people's live in communities up and down the country, but they will serve as new examples of pioneering practice from which others can learn.