Website of the Department of Health

Compassion As Standard

I'm sure everyone here this morning will want to join me in wishing Her Majesty the Queen very many happy returns for her 80th birthday on Friday.  Don't worry, I'm not about to start a chorus of 'Happy Birthday'. Today she is holding a lunch and reception for others born in 1926.

The queen has lived the most extraordinary life. 

Since 1952 she has conferred over 387,700 honours and awards - some of them, I happy to say, to people in this room.  She has made 256 official overseas visits to 129 different countries.  1.1 million people have attended royal garden parties - I expect some of them are people in this room too.  She has sent around 100,000 telegrams to people celebrating their 100th birthday - although I don't think to anyone in this room.

In a way her birthday this week tells us something extraordinary not only about her own life but about our country.

When we look back over her reign, what is most striking is actually how dramatically the world has changed, not just since her birth, but since her coronation in 1953, and how in an era of global community and accelerating technology, Britain has become an island of extraordinary opportunity.

Today, we are one of the world's most open nations.

Our capital is a hub of global trade - with the Stock Exchange being worth 1.5 billion pounds

We have a world class environment for e-commerce.

Our biotechnology industry is second only to the US. Thirteen million British nationals live and work overseas. And on the international stage we have a track-record of leadership, from Kyoto to Africa. 

Yet the next two decades are set if anything to be more extraordinary still. 

By the time my baby daughter goes to work, a revolution in trade and technology will boost our national wealth by half again.

A revolution in genetic science and medical technology will transform the possibilities of health and wellbeing.

And there will be more people over the age of 80 than under the age of 5. 

So I want to argue this morning that the great challenge for our care and health system is how we help all of our citizens - not just the Queen - get the most out of life in this extraordinary new society.

People and parties have different debates about equality.

But perhaps the most basic equality is the very capability to live to a mature age, without succumbing to premature death is perhaps the most basic equality we could agree.

Yet as we look across England today, some wards have the same mortality rate as the national average in the 1950s.

Male life expectancy in Liverpool today is lower than a female in Libya.

Life expectancy for a man in Manchester is lower than a woman in Mexico. 

And in an aging society, our challenge is broader still.

Why?  Because as the House of Lords reported last summer, it is not yet clear that the boost to life expectancy is yet matched year for year by the boost to healthy life expectancy. 

So, our challenge over the years to come is to create a care and health system that not only delivers equality of health but quality of life - not just to the lucky few, but to all.    

This ambition is what frames our national priority to develop the care and health services that supports us in Britain to age positively.

This is the ambition that set the stage for our white paper in January - and the inspiration for new proposals that I'm proud to announce today. 

Investment in active aging

The first great challenge that we have when we look ahead is to deliver new investment for active aging.

Too often, the public debate in this country portrays aging as some kind of burden.

This has to stop.

Older people are individuals who have earned the right to rest; who are not a burden - but a gold reserve - with a lifetime's experience to contribute to our society.

And in fact we have to avoid the trap of what Alan Walker calls 'apocalyptic demography'.

Yes, many older people suffer chronic conditions; but chronic conditions often don't need the highly expensive medical technology which has been the key historic driver of healthcare costs.

What's more, the incidence of the so-called geriatric giants, (cardiovascular disease, stroke, COPD, musculoskeletal conditions, mental health conditions and sensory impairment) can all be reduced by tackling the key risk factors - like tobacco use, lack of physical exercise and inadequate diet. 

But when we're thinking about prevention we need to think widely. This is why we look to the ADSS and the work that Julia has done if we are to deliver a renewed alliance of the NHS and local government, and why it is so critical to the future;

Transport is important because 91% of single pensioners (and 53% of pensioner couples) don't own a car.

Domestic security is important because a third of older people say fear of crime affects the quality of their life.

Housing repairs are important because older people spend 70-90% of their time in their own home, and one third of people living in non-decent homes are over 60.

Leisure is important because 40% of over 50s are sedentary. They don't do enough exercise to benefit their health.

Mental health services are vital because more than 1 million older people suffer from depression.

This is a big job that does need a strong marriage.

The citizen in control of their care

The second great change that I would argue is required is that care in the future has to put the citizen in control.

By 2020, many over-60s will be better off, better educated - and with higher expectations of public services than retirees before them.

Already, people are already 50% more likely to complain about bad service than 5 years ago. I know. I serve 77,000 in my constituency and people don't hold back, when they don't think you've done a good job.

Today's baby boomers will quite simply expect more control of their services.

So we have to find new ways to make sure that older peoples' voices are heard - and structure the choices that people will expect as a given.

Wider and simpler access

Third, I believe we have to have a far sharper way of tackling inequalities in access.

What the public said to us during the white paper consultation about social care was that all too often they simply did not know where to go when they needed help.

Let me give you one example of the complexity confronted by one old lady, highlighted in the Social Exclusion Report published recently.

Warm Front provided help with central heating; the housing department repaired the kitchen; social services provided a home carer; the PCT provided a community nurse; a ramp and walk-in shower came from the Disabled Facilities Grant; Supporting People provided an alarm and advice, and the local Age Concern provided befriending, a lunch club and home visiting.

Yet, as both the OFT and the Kings Fund pointed out, we risk asking people to navigate this complexity to make potentially life changing decisions at a time when they are feeling vulnerable or under pressure.

So if we are to widen access we must find ways to simplify it. 

This is more important for older people than anyone else - older people may lack day to day contact with mainstream public services.

This agenda of personalised care is not just about serving the articulate middle class, but also about improving these services to the least well off.

In fact, personalised services are even more important in lower income areas precisely because people have less power to articulate precisely what their needs are.

Zero tolerance of low standards

Fourth, and finally, I would argue we need a zero tolerance approach to abuse in care especially as we give individuals greater control over their own assistance.

Elder abuse is simply unacceptable.

Abuse that ranges from physical violence to simple neglect such as not ensuring older people can eat their meals when in hospital. 

This we cannot and will not tolerate.  We will stop it.

That is why since January I have set out an ambitious programme of reform to build and build again the standards of care we expect. That is why we are working jointly with Comic Relief; that is why we have introduced the Bichard bill into the House of Lords; that is why we have set up a new Dignity Guardians group;

As we set about these changes, we have the benefit of terrific momentum. 

I met a man in Leeds who told me that he once was going to see a doctor who said to him - 'well, what do you expect me to do for you, at your age?'. We have begun stamping that attitude out.

Now older people enjoy far higher rates of cataract operations, hip surgery and cardiac procedures; breast cancer screening in older women has doubled and a four-fold increase in smoking cessation amongst older people.

Death rates for heart disease, stroke and cancer amongst older people are down.

GPs and consultants are actually now far less likely to arbitrarily deny a person over 70 treatment because of their age.  For instance, heart surgery in the over-75s has risen from two per cent to 10 per cent.

When people get treated we get them home faster, because we have cut delayed discharges have fallen from over 7,000 on any one day in September 2001 to 2,200 by December 2005.

And when they're at home they get supported.  Since 97 the number of over 65s has gone up by 4.5%, yet the number of homes with intensive home care has gone up by 52%.  40% more older people are now supported at home.

But, I didn't come here this morning to tell you that everything is fine - I came to tell you that things have to change.

For the last 8 weeks, I have been on a personal journey, talking to older people around the country about their vision for the care and health system in the 21st century. I have heard the most extraordinary stories about care - about people going that extra mile, and also the saddest stories of failure and neglect.

A man in Stoke told me about going to visit his mother and watching a nurse lie down next to one of the other patients, an elderly lady who was dying, and talk to her about her childhood memories - because she wanted her last memories to be happy memories.

In the other extreme, I hear tales of nurses taking trays of food away before they are finished.

Now no-one would expect to experience that kind of treatment if they were paying for private medical treatment - and we will not tolerate it in the NHS.

Next Steps

That is why today, I can announce details of our five year plan for older people's health

A New Ambition for Old Age, is Professor Ian Philp's report on Implementing the National Service Framework for Older People

It marks the second phase of the government's 10-year plan for older people's services.

A New Ambition for Old Age is strong because it does not stand alone but as part of a wider doctrine - a programme to transform personal control of care; a programme to shift our focus to prevention; a programme that will weld together as one, the specialists and professionals that often orbit the individual rather than joining together as a ring. 

So we will....

Ensure older people are treated with respect for their dignity.

We have asked both the Healthcare Commission and Commission for Social Care Inspection to make dignity central to their inspections.

We will also be working in partnership with older people as citizens and service users to tackle dignity and we will be reactivating the Older Peoples' Champions network to help with this.

We will...

Improve stroke services.  We have started an 18 month programme to develop a new national strategy for stroke.

Underpinning this is a new £20 million research network, which will tell us what works and how to improve.

We will...

Tackle the plague of falls.  We will improve emergency response to falls with a key role for emergency care practitioners to assess people who have fallen prior to them going to A&E.

We will increase the number of DXA scanners for bone density.  £17 million is available over the next two years, to help in the treatment of falls.

We will...

Ensure good mental health care for all ages.   There will be specialist mental health services for older adults, with a particular emphasis on community mental health teams and memory assessment clinics.

We will...

Co-ordinate care for people with complex needs. Over the next two years we will, through the common assessment framework, joint health and social care plans and joint teams set out in the White Paper.

We will...

Encourage active ageing.  We will seek to improve older people's physical fitness through encouraging and communicating the benefits of moderate regular exercise for all, such as dancing. 

And we will remove the barriers to active life by focusing on services such as footcare, which have sometimes been overlooked.

This is all in A New Ambition for Old Age.

Tomorrow we will go further still. I will be setting out our plans for a dignity in care campaign.

For those of you who know your history, you may know that it was Seneca the Younger who observed in 1st Century AD that 'There is not one type of old age for all people'.

It was the same conclusion as that of the Mass Observation studies of the early 90s. Old age is different for us all because we are all different.

That is why the leitmotiv of our doctrine for change is dignity in care; a notion which at its heart has the idea that we don't treat people as we want to be treated - but as they want to be treated. 

Conclusion

I'd like to close with one idea.

In a survey published last year by the Fabian Society, on what makes the British proud of their country, there was an unexpected winner. Not the monarchy - but the NHS.

Why? Because it epitomises what, on the whole, each of us thinks is best about Britain - compassion in action.

Not a grand theory that doesn't work or a slogan that is ultimately empty.

But a reality, inspired by values and delivered by the forces of good nature of the people who work in social care - for a million people every 36 hours.

And that is precisely why we have to work so hard to change the social care system and the NHS to meet the needs a modern Britain that is rapidly changing.

To sustain the consent of the better angels of our nature, universal services have to deliver personalisation of the information age because that is simply our ambition - our expectation - and how we unlock our potential.

Not just for the generation of my parents, but for my generation and the generation of my children.

This we will only achieve by having the courage to change and by staying true to those lifelong principles that inspired so many of you to enter public service, in a world that is changing out of all recognition.