Website of the Department of Health

Can I say first what a pleasure it is to be here at your annual conference. I can't think of a better place to make my first major speech of the year.

In such an enormous audience it is reassuring to be able to pick out a few familiar faces: and in fact I knew of many of you before I got this job.

In fact, when I was a student, I used to study Rodney Brooke's tracts on local government.

And I still am.

When I saw Rodney at Christmas, he gave me another little book. It's called 'The-Councillor-Victim or Vulgarian'.  You will know both kinds. Rodney's insight into local politics remains undimmed. I was especially gripped by the analysis on page 25:

' Folly has long been attributed to those who take part in municipal affairs. In his life of Solon, Plutarch quoted a visitor to democratic Athens as saying that 'in Greece wise men spoke on public affairs, but fools decided on them'...before he add 'Nothing has changed'

Today I want to talk about why your work is so important and will grow more important in the future.

One of the greatest pleasures of my job is to meet the people who tell you stories about how their lives have been transformed by people like you.

People like an inspiring man called Kevin who I met in my home town of Birmingham. He'd just been given the chance to set up home independently. Lots of attempts had been made at resettling Kevin in the community. All failed.

Now thanks to an extraordinary supported living team, that brought together people from the NHS, the local authority and the voluntary sector, Kevin has now moved into his own flat.

Once Kevin needed 24-hour supervision and support on a locked ward. Now he only needs support during the day, and 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. In a single phrase he conjured up the noise and turbulence of the life he'd left behind.

People like Guy who I met in Oldham when I went to launch our individual budget pilots with my friend and colleague Phil Woolas.

Guy described the place he once lived as Serviceland - a land of no choice, little say and frankly not a lot of hope and his story began with a tragedy; the death of his aunt.

But at his aunt's funeral he met a someone who started to work with him as an advocate.

And then his life then began to change.

First, by going out with friends to a pub. Then a move into his own home. Then he began sharing this home with a carer. Then he went to college. Then he got a job - not in a charity shop but on a building site.

At each step of his journey, he described the molehills that were made into mountains by the people who said Guy: 'you'll never cope in your own home - you can't keep your own bedroom tidy...don't go to college you're much too vulnerable...don't get a job you'll lose your benefits, and what if we have to put everyone you work with through a police check'.

But now his life is different. Having a learning disability didn't strip him of his ability to have dreams - and now he finally has the chance to live them out.

And I could give you example, after example, after example. And together these stories together represent a larger story about our work in a third term of office.

Britain today is a country of extraordinary opportunity.

In an era of globalisation and rapid change we are one of the world's most open economies and a technology leader. We are a hub of global trade. We have a world class environment for e-commerce. Our bio-tech industry is second only to the US. There are more people in work than ever before after the longest unbroken record of economic growth since records began.

We have never been better educated, better trained or better connected. We are a country strong enough to win the Olympics.

And in the future, exponential advances in trade and technology hold the promise of a dramatically more productive economy and medical science offers us the prospect of living longer to enjoy it. We face in this country a future in which we can be more ambitious not less for a society in which each of us can fulfil our potential.

But our needs are changing.

There are more people in Britain over the age of 60 than under 16. The number of over 85s is forecast to nearly double by 2020.

Nearly 17 million people in Britain live with a long term conditions; 10 million with hypertension; 4 million with heart disease; 1.5 million with diabetes; 5 million people with asthma.

There are nearly 2.5 million people with learning disabilities in Britain, and 2.5 million adults with sensory impairments.

Extraordinary advances in medical science and care mean more people with often severe disabilities are able to live longer lives.

Now when we were first elected in 1997, our first priorities in health and social care were to concentrate on hospitals - the public's number one priority - and to stabilise the social care system.

But after seven years work, hospital waiting lists are at the lowest point since records began and we achieved our target for intensive support of people in their own home two years early.

Thousands of extra lives are being saved each year as we advance against the big killer diseases. Millions of extra hours of care are being provided to support people living independently on their own terms in their own homes.

So our task has to be to build on these achievements to create a health and social care system that goes beyond simply saving lives to play a new, dynamic part in helping everyone - and every community - live life to the full in 21st century Britain.

So our primary and social care system is not just vital part of life for millions of people - but a dynamic force for change.

But in these stories too is the secret about what we must change; three changes in fact.

This agenda - of personal control and power, of tough standards, of investment in active living and positive aging - is what the new white paper on wellbeing is all about.

At its heart is a simple idea; that if we are to create in this country a social care and health system that powers people forward to get the most out of life in 21st century Britain, then we need a system that is based on people power;

This will be the hallmark of the changes you will see us make over this third term of office.

To transform people's control of their care, we will revolutionise 'personalised purchasing' in health and social care.

In social care we are already testing individual budgets; a powerful new way of bringing together six - and in time maybe more - sets of benefits to create a single account which people can decide how to spend - almost certainly supported and advised by social care professionals.

In health, practice-based commissioning will now give primary care professionals new access to a much bigger slice of their patient's NHS budget plus the flexibility to spend that budget as they and their patients see fit. Not just serving up what happens to be on offer; but adapting and innovating based on what the unique goals of each patient.

Now we spend £65 billion on primary care; £12.5 billion on social care; £2.5 billion on the range of other Individual Budget income schemes. Altogether, that's £80 billion. We only need personalised purchasing to touch 10% of this to completely change the way our system works.

Over time this will have profound implications for the choice people are able to take to put in place the things they need to live a life they have reason to value. But to give people the comfort to choose to confidence, the state must take action to secure high standards. And that is why we have to toughen the standards of care and services of protection we afford people in this country.

That is why we will introduce the Bichard Bill to the Commons next month to create a vetting and barring system that will embrace all NHS and social care staff.

That's why CSCI wants to sharpen its focus on problem operators with plans to free resource to target those that give them most concern.

That's why the review of National Minimum Standards is so important to give us a sharper focus on the 'outcomes' that really make a difference to the quality of care.

That's why the Equality Bill now in the House of Commons is so important - because it will give us force to enforce newer 'strands' of discrimination law, religion or belief, and age and give service users and their families more access to information and advice about their rights and the responsibilities of service providers.

And that's why we will shortly make a decision about the timetable for the next stages for GSCC registration of care staff.

All of these changes are part of one strategy; to give each of us the confidence to exercise new personal power which reform will bestow.

But, third I believe we have to change the balance of funding in the system so that more is spent on active living and positive aging.

Our evidence suggests that older people have been amongst the chief beneficiaries of the investment we've made in the NHS. Tackling age discrimination means older people are living longer because better care means fewer deaths from cancer, coronary heart disease, and stroke.

But as the World Health Organisation puts it, the challenge doesn't stop there. Because once 'years have been added to life, we must add life to years.'

Too often, the public debate about the aging of Britain portrays aging as some kind of burden. We need to stop this.

Older people with their skills and experience are a gold reserve - an enormous asset which the alchemy of new kinds of public service must unlock.

Alan Walker makes this point;  that we have to avoid the trap of apocalyptic demography.

With the right policies in place disability free life expectancy can advance with life expectancy.

Yes, older people are living longer and chronic conditions are increasing. But these conditions are often less needy of top end treatment and the expensive medical technology which has been the key historic driver of healthcare costs.

We should remember that for the reference cost of two heart bypasses at £21,000 you can employ a community matron for a year. And we should remember that the incidence of the geriatric giants, (cardiovascular disease, stroke, diabetes, COPD, musculoskeletal conditions, mental health conditions and sensory impairment) all can be reduced by tackling the key risk factors - tobacco use, lack of physical exercise and inadequate diet.  All of which can be tackled through different investment in prevention.

So we will have a lot more to say in the white paper about how we expect the NHS to shift resources into primary care and prevention, and how we expect the NHS and social care together to put new services in place.

Sometimes what is most striking about the people I meet is the frustration on both sides of the fence. Kevin spent 18 years on a locked ward before a new life fabric could be woven together.

The professionals who trapped Guy in Serviceland weren't bad people - they wanted a better life for him but didn't feel empowered to promote his interests.

But between Kevin and Guy on the one hand and the professionals on the other was something called the system.

But both sides were frustrated.

Which much tell us that we must have to change the system.

That is why in seeking one white paper on social care and health I wanted to go beyond simply confirming our values and vision for social care in the future, to address the great question of how social care and the NHS works differently together and how we need to develop our workforce of the future.

Professionals like you will need to work differently in the future; in a way that is far more in line with your sense of vocation; in new roles, with new skills and differently as a team, across the old divide of professional boundaries and different sectors.

Last year, together with my colleague Beverley Hughes, I announced a joint Ministerial Review of the Social Care Workforce, Options for Excellence.

What was clear to us is that achieving the ambitions of both Departments, for DFES set out in Every Child Matters, and for us soon to set out in the white paper will depend in no small measure on the contribution of social workers and social care staff.

80% of state funding for social care is spent on staff.  The quality of services therefore depends in large part on the availability and skills of workers.

Yet in recent years, we've seen 10% vacancy rates, the highest public sector sickness rates, and only 25% of staff having a relevant qualification. All statistics that are strongly associated with the poor quality of services found in many inspections and reviews of social care.

So Options for Excellence has a big job to do developing plans to translate our white paper ambitions into reality - a job we couldn't do without you, without employers, or social care workers.

When I talk to the people who worked with local residents like Guy and Kevin, you often sense the inner strength that marks out pioneers and people who want to do things differently.

I think the future of social care and health in this country will be a rich place for people like that.

People who are passionate about people; passionate about social change; passionate about renewing communities; passionate about social justice; passionate about helping people who were not born with a wealth of natural advantages - but who yet have an extraordinary amount to give the nation we have modernised.