Website of the Department of Health

1. One sunny Monday morning a few weeks ago I had one of those experiences that help you put things into perspective.

2. On a visit in my home town of Birmingham, I met an inspiring man named Kevin, who had just been given the chance to set up home independently. Lots of attempts had been made at resettling Kevin in the community before, but these all failed, and when the long stay hospital closed, Kevin ended up in a Mental Health Trust home.  But thanks to an extremely innovative supported living outreach team operating in Birmingham, supported by the local PCT, Kevin has now moved into his own flat.

3. From needing 24 hour supervision and support, Kevin now only needs support during the day, and has settled well into his local community.  Not only was he happy, he was trying courses at college and starting to experiment with getting a job.  And when I asked him what the one difference was between his new life and his old life on a ward, he said quite simply that it was the chance to enjoy his own peace and quiet.

4. Later that day I visited Sandwell Community Caring Trust, who offer a range of sheltered housing, and children's respite centre services to the local population, enabling people who had lived in long term hospitals to have their own homes.  There were two children there, who had finally been given a permanent home.  Their rooms were covered with West Bromwich Albion football paraphernalia. For the first time these residents were given the chance to make real decisions, such as how to decorate their rooms.

5. Now, I know what that some of you here are politicians like me.  And I'm afraid that I have to confess to having read a bit of Machiavelli!  (That father of European philosophy!) And in fifteenth century Florence he said something interesting.  He said there is nothing so hard in this world as to seek to introduce a new order of things.  Well he was absolutely right.

6. So, here we have British residents on the one hand desperate for a different life - the quiet miracle of a normal life you might say; and on the other, committed social entrepreneurs with a vocation, a passion and a calling desperate to make a difference.  But in the middle is the system.  Both are frustrated - which tells us that we have to change the system.

7. Now I know what you're thinking.  That sounds a bit glib.  Politicians have said this before, but the truth is that this is something different.  We have to realise the imperative of reform has never been stronger.

8. The truth is that our health and social care system in England is at an inflexion point.

9. Life expectancy at birth in New Lanarkshire is lower than the Lebanon.  And although there are different interpretations of data, it's not clear that in this country at least advances in life expectancy are matched by advances in healthy life expectancy.

10. In our first two terms in office, this Government made great strides to modernise social care. A new framework of entitlements was 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 our second phase of reform we have to build on these foundations.  We have to take the NHS and local care system into every corner of every community.  We have to match advances in medical science with advances in the salve of care.

11. In a month and half's time the new White Paper will herald a second phase of reform in this country.   It will confirm just how central social care must become, not only to meet the ambitions of individuals in the 21st century but actually to the regeneration of communities.  We have to use this white paper to help to meet the challenge set in our neighbourhood renewal strategy that in 10-20 years time no-one will be disadvantaged by where they live.

12. Or course resources will always be constrained.   In Britain we spend some £35 billion on long term conditions in the NHS, we spend £12.5 billion on social services and possibly another £10-12 billion on related benefits - if we pulled all that together its nearly £60 billion.  The challenge is how we use resources differently to put the individual at the centre.

13. We know that 50% of people end their lives in a hospital bed, a fifth at home and a large number in nursing and residential care or hospices. Yet, surveys tell us that the majority of people would prefer to be supported at the end of their life in their own homes.

14. For example, we know that 90 per cent of older people want to live in their own home.  The reality is that approximately half a million older people live in residential/nursing care. But we also know that as many as 35 per cent of those people might want to be supported to live at home or in extra care housing schemes through the use of telecare.

15. This is why telecare is so important; because it actually helps give people the confidence to live their lives in way they want - independently; on their own terms; and with the peace of mind that comes from knowing that if something goes wrong, help is genuinely at hand.

16. And the irony is that in equipping people to live their lives in the way they want, is actually much less expensive.

17. In 2003/04 in this country there were over 1.6 million emergency admissions for patients aged 65 years.  The industry estimates that night falls by older people could be reduced by around 30 per cent with the introduction of telecare.  But what does that actually mean?  Let's assume for a moment that there are 480 falls a night saved. Let's assume for the sake of argument that each one saves one ambulance visit and one day in an acute care bed. There would be 175,000 fewer falls a year and the NHS would be saved in the order of £260m per year.

18. If that were only half-true it would represent a massive reduction in individual suffering and it would represent a huge saving in financial terms to both health and social services, especially for those families and professionals living in remote rural communities.

19. But, finally, the real answer to the question - how do you change the system - is to say 'put the citizens in the driving seat'.  They are after all paying for it.  That's why Anne and I and our colleagues are so committed to individual budgets.  Many of you will have already blazed the trail and we have a lot to learn from you.

20. The concept behind individual or personalised budgets is, like most of the best ideas, a very simple one.  The proposal is to bring together the different sources of funding available to disabled people in the form of individual budgets, allocating existing resources differently, delivering services in ways that are personalised to need, and give disabled people choice over how those needs are met.

21. There are inevitably many different sources of funding and support for disabled people.  The Life Chances report focuses on a range of support related to social care helping people to live in the setting of their choice, by providing housing adaptations for example, and support to help disabled people enter or maintain employment, this is a joint piece of work between Anne and I and the Office of the Deputy Prime Minister and the Department for Education and Skills.  We have agreed between us to put together a number of income streams that support disabled people and to see if we can work out a feasible method of delivering this support in the way that puts the disabled person much more in control of their own destiny.

22. We have a lot of detailed, difficult work to do to turn the broad vision  into workable reality.  But the response from local authorities wanting to pilot the individual budgets approach has been fantastic.

23. And when you hear of the changes that are possible, its not hard to understand why.  Individual budgets are not a totally new idea.  We have been drawing heavily on the work done by the In Control programme and the DH Valuing People project team.  This project was very influential on the thinking behind the Life Chances report and Independence, Well-being and Choice.  In Control is a joint project run by Mencap, one of our largest disability voluntary organisations, which focuses on the field of learning disabilities, and my department's Valuing People Support Team.

24. I know of one example, where an individual budget transformed someone's life.  A young man with very limited communication capacity who had been placed in a residential college some distance from his home was making it increasingly clear that he was unhappy with this placement.  Because he lacked speech with which to communicate his unhappiness, his frustration tended to boil over into so-called 'challenging behaviour'.  It was becoming increasingly clear that his placement (which cost many thousands of pounds a year) would soon break down.  Local social workers would then be faced with the difficult task of finding him somewhere else to stay.

25. Fortunately, in this case the In Control project was already operating in other parts of the county.  The young man and his family were introduced to the idea behind it and after discussing the level of funding they could expect to have at their disposal, were able to develop a scenario in which he moved back to the family home and was supported by somebody he knew well and trusted.  In this case, it happened to be an aunt.  The flexibility of In Control allowed the aunt to be properly paid for carrying out this support work and thus enabled her to give up her previous job.

26. A few months down the line, the young man is clearly enjoying life.  He is back in the family home with his pets and other familiar elements of home life.  His parents, who were never happy about him living away from home, but simply did not feel they could cope with him without support, are also much happier.  They are delighted with how settled he seems and are beginning to pick up their own life together after so many years of having to put their own needs on hold in order to support their son.

27. Valuing People was a groundbreaking, cross-government policy paper on learning disability, published by this Government in 2001 and the central message was one of independence, choice and inclusion in society for people with learning disabilities.  It's a very bold vision but through policies like individual budgets we make it a reality.

28. In conclusion, it is our Government's ambition, shared by many of you, 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.

29. I was lucky in that I had two parents who loved me most of the time! And that I grew up with the privilege of two parents in public service.  Both worked all hours God sent.  But both would never have had it any other way because every so often they had that experience of working for someone whose life they changed forever. 

30. So I grew up seeing at first hand the passion, the intelligence and commitment that public servants can put into their work and the way that we need to give them a system through which they can make a difference.

31. Because with that system, we will bring forward that day when here in this continent every man and woman, regardless of their background or the circumstance into which they were born will be able to live out the full measure of their potential.