Website of the Department of Health

A Credo for Care: White Paper into Action

Thank you.

Allow me to start with a little audience participation.

This is 'Our health, our care, our say.'

This is what you've paid your money to come and hear about today.

You've all read it haven't you?

Raise a hand if you've read all 230 pages.

Quite a lot... but not all.

So raise your hand if you were hoping I would tell you about it.

OK, one!

I will tell you what it means to me.

This document is the most comprehensive description yet published of where this government is taking social care and health.

For many of you in the audience this morning it proposes a new way of working and thinking.

It states clearly, that you, the people who commission and provide health and social care services in this country, have to think more broadly.

It sets out very clearly, that the functions of organisations are subordinate to people's needs and wishes.

It says, in the future, the NHS and local councils will have joint teams, make joint appointments and commission services in partnership.

And for you today this white paper represents no less than a fundamental change in the way you do business for the benefit of your customers.

And they are customers. I used to have to check myself when I used that word in relation to people who use social care and health. And I'm comfortable with it now.

Because the NHS and local authorities are providing a service. People who receive services are customers. That's not all they are - they are citizens too. But as customers it doesn't matter if they are unwell, mentally ill or disabled.

I think, in truth, in many ways, over the years, we've used our customers' disposition to excuse the fact that we weren't providing a good service.

This white paper changes that. Standards should be high in social care and health. They need to be the highest in the world.

If you haven't got a copy of 'Our health, our care, our say' go to the Department of Health's website... and read it.

Nestling within it - page 204 - is actually the best description of the future of social care in England I've read.

And it's a great vision.

Great because it represents the desires and aspirations of ordinary people.

Visionary because it recognises that solving ordinary problems is the key to making people's lives better in an extraordinary world.

For me, as a young minister, what is humbling is that the oldest, frailest and most vulnerable in our society ask for very little.

What underpins this White Paper is the belief that everyone in our society has a contribution to make and has the right to control their own lives.

Let me go off script. When I was in Newcastle on Monday I met a group of older people. I wanted their examples of good care. A lady that morning said her best example of good care was transport to take her to a day centre. We asked why. She said because they sing to us, they serenade us. We look forward to that every week.

This single value drives our society and I am determined that it will drive the way we provide social care.

It is a vision that includes older people and younger adults who need care and support, people who are frail, people with a disability and people who care for and support others.

It is also a vision for those who provide care services, the kind-hearted, long-suffering, forgotten workers in British society, people whose effort I intend to see recognised by professionalising social care.

This White Paper describes how the services people receive should be centred on their needs and be provided seamlessly and proactively:

This is our credo for care that will shape what we do in England over the next decade.

And you read it here first.

So what am I doing here today? Let me tell you.

I am here today because I want you to use this White Paper as a blueprint. I want you to work with people who use social care and health to help them transform their lives:

And this will be something which we achieve together:

We don't deliver this vision at the moment. Do we?

Sadly, the organisation and provision of our services do not help everyone meet these goals consistently, today.

So we want to use this vision to demonstrate where we need to change and to guide the way we provide care.

Practically, that means we have to find ways of becoming familiar and comfortable with initiatives like direct payments and individual budgets.

It means forming cross-disciplinary teams that can think laterally and dip into the myriad of budgets that are available to help people.

For instance, if an elderly person keeps falling in their home, that is an issue that concerns both social services and the NHS. There is a cost benefit to the NHS in providing that person with equipment to prevent them falling and the NHS should be willing to contribute financially.

I believe, very strongly, that the NHS should be using some of its unprecedented increases in resources to do more prevention through social care.

Now I've described in the past this relationship between health and social care as a marriage.

We don't want to be prescriptive about health and social care's partnership, just as we wouldn't wish to be prescriptive about any marriage. You need to take the initiative. Be proactive. Like all good couples you need to talk about money. Talk openly to each other about how, together, local authorities and the NHS can provide more effective services that represent value for money.

By 2008 we will have done some common sense things that I hope will help this marriage grow stronger. Like align health and local government budget cycles, so that health budgets are set at the same time as those of the local authority, and create joint networks for the management of health and social care needs between Primary Care Trusts and local authorities.

We have a responsibility at the Department of Health to provide leadership and so we will. So today, I can announce just what role we see for a new Director General of Social Care in the Department of Health.

This individual will fulfil one of the biggest jobs in social care.

They will give a new and deserved prominence to social care within the Department.

They will provide national leadership for those who work in social care.

They will ensure social care is integral to the Department's system reform agenda. They will make the links across government.

And they will strengthen social care's impact at a local level. Making sure we are using Local Area Agreements realistically and effectively.

But our responsibility stretches wider doesn't it? We also have a responsibility to help the social care workforce do their job. This workforce is not just crucial for me - it's crucial for you and it's crucial for us, together. We both need to professionalise the social care workforce.

You know that last July, I and Beverley Hughes at the Department for Education and Skills, set up the Options for Excellence Review.

The Options for Excellence Review Board will build on the initiatives the government has already taken to improve the social care workforce, like registering social workers and the Bichard protection bill.

The Board, which includes Vic Citarella, from the Local Government Association, Jo Cleary, from the Association of Directors of Social Services and David Behan, from the Commission for Social Care Inspection, is looking at four areas:

I hope to publish the board's interim findings later this Spring. I hope to publish a full report in the Autumn and we will use it as a catalyst for change within the workforce.

But we're not waiting until Autumn to get this agenda moving. This very week we have launched a nationwide TV Ad campaign to attract more people into social care. It had a very effective message, 'Can you do the little things that matter?'.

These steps are a recognition that we cannot provide the aims and objectives of the White Paper without a world class social care workforce that is skilled, dedicated, valued and supported.

In part, it is also a tacit recognition that we haven't struck the right balance between caring for the needs of the NHS workforce and the social care workforce, which is just as big and just as vital for implementing the proactive, preventative agenda the government is advocating.

So we are going to ensure that the social care workforce is up to the challenges set out in the White Paper.

And frankly, we can do so with the confidence that comes from having listened first and listened hard.

This White Paper represents the culmination of one of the most comprehensive public consultation exercises ever undertaken by a government.

At regional events around the country we talked to hundreds of everyday users of health and social care services face-to-face.

We made sure that the quiet, seldom heard voices of our communities were included - not just the usual suspects.

In total, if you add in to this consultation the consultation that went with 'Independence, Wellbeing and Choice,' the Department of Health spoke to, questioned and considered the views of more than one hundred and forty thousand people.

And at the end we packed one thousand people into the Birmingham International Convention Centre and the Department of Health's entire ministerial team spent the day listening and listening and listening.

The stories and ambitions we heard were more powerful than any powerpoint slides.

For example, people told us we needed to do far more to increase independence and inclusion within communities. To strengthen personal control of care.

What does the white paper say?

Page 83.

"We are going to develop individual budgets alongside direct payments and spearhead, with 13 pilot projects, what I hope will be a national implementation as early as 2010."

We gave in the White Paper the example of Joseph Tomlinson whose Mum I met recently.

He has severe learning disabilities and challenging behaviour. Aggravated by a succession of carers.

Through controlling his budget he has put in place something that money can't buy.

His support workers now come at regular times and it has meant that Joseph can go to his local college, go to the gym, and quite simply enjoy his life.

His say, his care, his health. The views of citizens translated directly into government policy.

Let me give you another example. People told us they didn't understand why, when over 50% of the 500,000 adults who die in England each year expressed a wish to end their days at home, only 20% managed it.

What does the White Paper say?

Page 103.

'We are going to have more community based palliative care. More co-operative working in networks. And more use of best practice approaches to caring for those at the end of their lives.'

Your say, your care, your health. The views of citizens translated directly into government policy.

Let me give you another example. People told us that we should give more support to carers.

There are six million carers in this country. More than one and a quarter million of them spend 50-hours a week caring for people that they love.

And it takes its toll. Carers are twice as likely to be in poor health as those who are not carers. Three-quarters of all carers are financially worse off because of the decision they've taken to care for someone.

Not surprisingly, when we asked the public, they told us bluntly that we needed to do something to recognise their contribution.

So what does the White Paper say?

Page 124.

'We propose a new deal for carers.'

In every council area we will ensure that there is short-term, home-based, respite support is available for carers in crisis or emergency situations.

We will establish a national helpline for carers, something that carers organisations have been calling for for some years, and fund an Expert Carers Programme to provide training to help carers take control of their own health and the health of those in their care.

Again, your say, your care, your health. The views of citizens translated directly into government policy.

So we think we have got this agenda right because of a great collaboration. That collaboration will continue.

So this collaborative approach to writing, we are going to replicate with the doing. How to implement the White Paper isn't going to be decided by me - but by us.

So this week I started regional round-tables to talk with you about how we're going to translate policy into action.

But if we don't get the implementation right we will be held to account.

Last week, myself, Patricia and Norman Warner met with over a hundred people who had been involved in the White Paper consultation.

97% said they had had their say. And over 70% thought what they said had been influential and was reflected in the White Paper. But they also told us what mattered now was action.

So we agreed to meet them in a year's time. To tell them the progress we have made. And ask if they have notices the difference.

Now putting policy into practice will be hard work, but when the going gets tough we need to keep motivated by keeping our eyes on the prize to be won.

And I guess I first began to understand this a year ago.

I was not yet a Minister. I was on the Bill committee for the Mental Capacity Act. I went to meet a group of people in my constituency that went to a church I sometimes go to.

As I sat in the front room of a Catholic Priest, I listened to a retired nurse describe the way she had seen terminally ill patients treated.

Her story made me cry. Everyone in the room cried.

For the first time in my life I truly understood why people get angry about the manner of another person's death.

The bitterness and resentment towards witnessing a sorrowful end is implicit.

What this nurse expressed was actually far more profound.

Inherent in society's daily acts of neglect is a violation of our shared humanity and obligation to each other.

I came into this job with clear priorities. First and foremost among them was that people should receive dignified care and dignify for life.

And if we can't do that, I ask you: 'What does it say about the society we live in?'

If we can't provide the oldest or most vulnerable in our society with dignity than we might as well pack up our bags.

And the vast majority of older people describe dignity as the ability to remain healthy and independent for as long as possible.

We will one day make dignity a reality for all. In the process we will create a more equal society for older people. One where their age is not an impediment to living an active life or where their age determines the services the state is willing to provide.

The measures in the White Paper will take that equality a step forwards.

They will ensure everyone understands what they are entitled to and give them the power to ask for it with their own voice.

We are trying to bring consumer power to the aid of public services and by using public services to empower consumers, we have a real chance of making equality the hallmark of our social care and health services.

A system where people accessing services expect the very best and where the provider meets that expectation.

I tell you this. In the age of the internet and instant world-wide comparison shopping, telling someone, even an 80 year-old 'this is what you're getting, like it or lump it,' is simply not acceptable.

What this government is talking about is the biggest, historical realignment of our health and social care services since 1948.

But, you've been in this business for longer than me, and you will know that we've tried this before.

One of my great heroines, Barbara Castle, tried it in 1976 with Priorities for Health and Social Services.

She may not have envisaged individual budgets and choice but she knew this: the closer you take services to people the more likely they are to meet their needs.

Four years later, though, The Black Report found that health inequalities had not changed. It judged that the government had failed because of a lack of clear objectives and a failure to assign responsibility to ensure the shift took place.

Well, I'm clear about where the responsibility for delivering this White Paper lies.

It lies with me. It lies with you... in this hall today. It lies with the over 2 million people who deliver health and social care.

It is our duty to make sure these historic opportunities make real changes to people's lives.

It is our duty to leave this room today and take individual responsibility for driving up standards and delivering a new credo for care, not just to a lucky few, but to all.

Thank you.