Website of the Department of Health

This Government inherited health and social care services facing profound challenges.  Years of under-investment, widening inequalities, soaring waiting lists, critical staff shortages, inflexible and unresponsive services - all needed tackling.

So we launched a major programme of investment and reform. Unprecedented investment in services, equipment, buildings and staff; demanding clinical standards; people's needs and wishes put at the heart of services, through choice and a greater drive to support people at home.

We focused first on improving hospitals and stabilising social care - and the results are there for all to see: more staff in more hospitals, providing better care for more people than ever before; our target for delivering home care was reached two years early; waiting lists tumbling, with waiting to be virtually abolished by 2008; care increasingly responsive to public needs and wants; the future of the NHS again seems secure.

But there is still more to do. These achievements bring us to a greater challenge still: of achieving health for all, not just improving health care. Our central question: how do we help every individual and every community get the most out of life in a country that has never been richer in opportunity than today?

And new challenges are emerging.  A nation getting older - and sadly more obese. Fifteen million people with long-term needs - such as diabetes, stroke, high blood pressure or cardiovascular conditions - needing better prevention and earlier care. The poorest areas too often with the poorest health and the poorest care. And people wanting a different approach to services, looking for real choices, more local care, taking greater control over their health, supported to remain independent wherever possible.

We will not meet these challenges by improving hospitals alone. Ninety per cent of people's contacts with the health service take place outside hospitals. Some 1.7 million people are supported by social care services at any given time. Increasingly, our primary, community and social care services will need to take the lead.

This White Paper builds upon the foundations we have laid in the last eight years, in particular our vision for public health set out in Our Healthier Nation and Choosing Health. It lays out a lasting and ambitious vision: by reforming and improving our community services, to create health and social care services that genuinely focus on prevention and promoting health and well-being; that deliver care in more local settings; that promote the health of all, not just a privileged few; and that deliver services that are flexible, integrated and responsive to peoples' needs and wishes.

And because we put people and patients first, we have held two unprecedented and innovative public consultations. Nearly 100,000 people were involved in the consultation on the adult social care Green Paper, Independence, Well-being and Choice. Over 40,000 people from all parts of the country participated enthusiastically in our deliberative consultation on this White Paper, culminating in a landmark, 1,000-person Citizens' Summit in Birmingham late last year.

I am very grateful to everyone who has contributed to the development of this White Paper. But I particularly want to thank our Citizens' Advisory Panel - the 10 people who worked with us throughout the public engagement process. As we listened to people and developed our own policy thinking, we went back to the panel to seek their views on our proposals. The next stage will be a further meeting with a larger group of participants in the summit and other 'Your Say' sessions, where my ministerial colleagues and I will present our White Paper and be held to account for the way in which we have responded to what the public have asked of us.

At the Citizens' Summit, I heard people clear in their desire for services to support them to stay healthy and give them more control of their lives; clear about their need for services that are convenient and closer to home; strong in their demand for greater access to GPs and other services; fair in their desire for good services to be available to all; and compassionate in their demand for services that give most help to those who need it most.

These concerns are at the heart of our proposals. And as a result of the measures in this White Paper, we will see real change.

Year on year, as health and social care budgets continue to rise, we will see more resources invested in prevention and community health and social care than in secondary care.

Previous governments have aspired to parts of this vision. But we are the first government to lay out both a comprehensive and compelling vision of preventative and empowering health and social care services and an effective programme for making this vision a reality. This White Paper truly represents the beginnings of a profound change: a commitment to real health and well-being for all.

Patricia Hewitt
Health Secretary