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Yet we face these changes in a position of enormous strength. A nation strong enough to win the Olympics. We are a country with one of the world's few trillion pound economies - three times the size of Indian economy. Nearly 30% bigger than China which has a population 16 times our own.

But the politics that shapes the way we approach these changes is changing.  In 2009, the baby boomers born after the war will be over 60 - grey voters for the first time.  This will change the way we think about politics and the challenges for public services and there will be also be challenges for the private and independent sectors. But there will also be terrific new opportunities - rapidly changing technology but also risks of new inequalities.

At the start of the cold war, Albert Einstein said; 'It has become appallingly 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, 30pc of life threatening diseases may have a have cure. And we may well have a cure for cancer in my lifetime.

If as I hope, I am blessed with grandchildren, not I hope before 2020, they are likely 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 second best environment for biotech. We have, uniquely, the NHS which could lead the world ensuring revolution changes lives of everyone rich and poor alike for every community in this country.

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'. Well, wishful thinking.

In fact, our health and social care system is at an inflexion point. As our health spending finally begins its long convergence with the level common across Europe, extraordinary advances are being made against the great killer diseases. In the last ten years, standardised mortality rates for cardiovascular disease have fallen by nearly a third.  Mortality rates for cancer have dropped by almost 10%.

These changes coupled with the lower birth rate are quite literally changing the balance of society. By the time I hope to retire, well over the half the country's adults will be over 50.

But as we make advances in the battle against the killer diseases, we have to remember that the lives we save need the salve of care if they are to fully heal. This recognition will be demanded by older voters not simply as an end in itself but because the alchemy of care is required by an aging society is to achieve its full potential. The over 50s today already control 80% of the country's wealth. But in truth their contribution to society is immeasurable.

So, needs have not evaporated, they have changed. More and more people are asking questions about their future and in the unprecedented public consultation on the White Paper, there were clear messages which endorsed the direction of travel we set out in the Green Paper, and which we heard back from you in the 100,000 responses.

People are very clear about the care they want; faster access; more information; seamless services. Care in other words, that is round the clock, and round the corner. Care that complements the people they are, the ambitions they have and the way they lead their lives. Care that is as unique as they are. That builds up confidence and builds up capability. That not only lengthens life, but enhances its quality.

I believe that Governments must respond to this. I think the Department of Health and the world of social care need to respond to these developments, and in so doing, I believe that in the White Paper, we will need to address three distinct challenges;

Let me take each in turn briefly.

Evidence from researchers such as Michael Marmot demonstrates that people who have more control and more choice and over their lives tend to be healthier and to live longer.  But today we have a two tier system where an articulate, well-informed middle class seems to find their way around and others do not. Reforms to promote choice simply put the chance to opt for the best around, within reach of everybody. Choice and diversity are not goals.  They are the means by which we deliver a fairer society and give the people we serve more power, not less, over their own lives.  They are the means, just like increased public investment and extra staff are the means to help improve the quality of our public services.

Key to our strategy to drive personalised services in social care will be individual budgets. Since their introduction, direct payments have been highly successful for some groups but take-up amongst older people has been poor. We want to change that, and so I am glad to be able to announce that in the pilots that I, together with DWP and ODPM, will announce in November there will be a strong emphasis on personalised care for older people, and that ministers have agreed that the first pilots will included six income streams:

Upto 27 other income streams could be included in the future; but the key to their success will be to place the person who is supported, or given services, at the centre of the process and to give them the power to decide the nature of their own support - flexibility to meet the individual's need that the current system of commissioning services rarely allows or delivers.  And I know you have strong views about commissioning!

And to strengthen our base of innovation still further, the Secretary of State will later this month announce £60 million in pilots to challenge local authorities, primary care teams, and their partners in the voluntary and private sector to develop new ways to support the most vulnerable older people.

Second, I think we have work to do to give a sharper focus to the health needs of older people.  Yes, we have made great advances in our war on the big killer diseases, but in the future, we have to make the same progress on diseases like stroke and Chronic Obstructive Pulmonary Disease.

Let's take stroke as an example. It is a condition that many of you must be very familiar with.  It is said that in about 20 per cent - perhaps more - of admissions to a care home, stroke will have been a contributory factor.  That makes stroke a serious issue.  The cost of proving nursing home care for people with stroke approaches three quarters of a billion pounds per annum.

Over the past few years we have seen real improvements in the services provided to people who have had a stroke but also challenged the way stroke is seen. For years, stroke was viewed, not just here but internationally, as something that happened to the very old and the dying. For stroke patients, there seemed little to be done, except making them more comfortable.

The Older People's NSF began to change that. It set out a programme of action for the NHS to reduce the incidence of stroke on the one hand and to ensure prompt access to integrated care services on the other.  The result is that almost all general hospitals now have a specialised stroke service.  Where specialist stroke services were a rarity ten years ago, they are now the norm. More patients are being seen by stroke specialists and stroke mortality is declining. Modern scanning technology, new drugs and organisational improvements are leading to improved outcomes for patients.

But progress has to accelerate.  It will take more than an edict from the Department of Health to turn around a pervasive culture of low awareness and low expectations.  It takes leadership.  When I met with the Stroke Association earlier last month I was encouraged by their work to increase public awareness - in how to prevent strokes, in how to recognise them when they happen, in what to do.  But we have to harness the commitment among both professionals and voluntary organisations to drive forward.

We are already tackling the lifestyle factors that can lead to stroke - smoking, poor diet and high blood pressure; through concerted public health campaigns; through rewarding GPs; through supporting the groups of patients most at risk.  We are already working on best practice guidance to raise their standards and reducing their emergency bed days.  Together with the recent £20 million funding we have put into stroke research, we will recast the foundation for the way stroke is treated, it is an example of how we have to respond to changing needs of older people.

Third, I believe we, as a Government, made a very big promise in May. As waiting times continue to fall in the health service, down in due course to our target of 18 weeks slashed from the scandal of a year and half which we inherited in 1997, so as we've put in the capacity to deal with this the debate about health and social care will move and a sharper focus on quality on standards will emerge.

That is a challenge to which all of us must respond - the challenge to create a new culture of care distinguished by the values that are a hallmark of this country at its best. Each of us is unique.  Each of us has value not because of what we can do, but because we exist.

Some weeks ago, I reviewed the results of the first year's work of our joint project with Action on Elder Abuse into how authorities are recording abuse. It had some blunt headlines. We have had to triple the numbers of staff working to deliver the Protection of Vulnerable Adults Scheme. Why? Because just under 3,000 people have been referred for consideration to be put on the POVA List since July 2004.  Every month about 200 people are referred for inclusion.  There are currently about 230 people on the list and it is growing.

None of us can be proud of that but it is a challenge to which we together must address.

A fortnight ago we launched a consultation aimed at enabling CSCI to target more of its resources on helping poorer providers to improve. The present inflexible rules oblige it to treat good quality care homes in much the same way as less good ones. This is not a sensible approach.  It wastes scarce resources.  So I intend to change these rules.

We want CSCI to be able to decide how often it inspects particular providers, using a robust system of risk assessment.  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.

Of course, this means less inspection for providers that are good.  It means less of a burden.  For those providers who are not so good it will mean more inspection.  Good providers should, I think, be trusted to self-improve without compulsory external challenge and inspection must be free to be at its most effective, targeted at those who are below the standard.

But this can be only the first step. Last year, my predecessor began the review of these national minimum standards for adult social care. The standards contain much that is valuable. But they don't focus sufficiently on the outcomes that people want. I think CSCI is right when it says that outcomes should be described because I want care providers, and people who use the services, to be able to understand the outcomes - without having to rely on CSCI to interpret them.

But to go further, a fortnight ago, my colleague Jane Kennedy announced that we will explore alternative models for the regulatory system from 2008 as part of the wider review of health and social care regulation - a review which gives us the opportunity to think more widely about the kind of system of regulation we want for social care and health, using the best of what we have now, but reflecting better the way that services are organised and provided in the modern world, and the outcomes that people want.

In conclusion, in our first two terms in office, the Government made great strides to modernise social care. A new framework of entitlements were set out in fair access to care, and in national service frameworks for older people and long term conditions. The right structure of regulation was established and resources were doubled. In a month and half's time the new White Paper will herald a second phase of reform. It will confirm just how central social care must become not only to meet the ambitions of individuals in the 21st century but to the regeneration of communities, helping make sure we meet the challenge set in our neighbourhood renewal strategy that in 10-20 years time no-one will be disadvantaged by where they live.

Last week, the Prime Minister's strategy unit finished some analysis I asked for to support our white paper work. They made a powerful point to me. When we add in benefits, this country spends not £12.5 billion on social care - but more like £25 billion. More than twice times our spending on the police. A force of such scale can be a powerful force for change in this country. It is our job, yours and mine, to make sure it is.