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Secretary of State for Health's speech to the 5th International Carers Conference - ‘The principles of social care reform’

  • Last modified date:
    7 December 2010

(As delivered)

Jill [Baroness Jill Pitkeathley] thank you very much and for that kind introduction.

And thank you to all you for inviting Paul [Burstow] and I to be here – we’re delighted to have the opportunity.

Paul has a long record of commitment on these issues. I feel the man from the AA advert – I may not know all the answers but I know a man who does!

There are carers here this morning not just from around the UK, but from around the world. And I understand many more are watching us live around via Carers World Radio.
I might be a bit old fashioned, but it seems strange to me to be being watched via the radio, but that’s the wonder of the internet!

We’re here to discuss some very important issues. But in the past, as we’ve debated the policy on social care, we have sometimes overlooked what a very personal thing it is.

For each of us it is about the most important needs of those we love and care about the most. 

For everyone here today, or tuning in to this debate, there is a different story, a different set of needs, and therefore a different approach.

But, we shouldn’t forget, that many of the challenges carers face are the same.

Many of you, in this country and elsewhere, deal with social care systems that are deeply stressed, derived from other – perhaps simpler – times, systems that are struggling to provide the service you deserve – and that often leave you to bearing a heavy and sometimes excessive burden.

So now, we – in government – have a duty to carers, and those they support, to provide a better system.

And we know that the demands on it are only going to increase. Like so many other countries, our population is rising – and it is ageing.

Today there are around 6 million adults in the UK providing unpaid care and support to family members or friends – that’s one in ten people.

In 30 years time that number will be 9 million. A 50 per cent increase.

In England, 1 million people provide care for 50 or more hours per week – a third of those carers are themselves over 65 years old.

Already one in six carers – again, a million people – have given up work to care.

And the situation is not going to get better. Today for every one person in retirement there are four people working – in 20 years time that ratio will fall to just one for three.

At a time when we’re trying to rebuild our economy, and reduce our deficit, this is a serious problem.

Of course, it’s time we moved on from Mary Webster’s image of care in the early 1960s, when she said carers were effectively ‘under house arrest’.

We have to provide people with the support they need so they can continue to lead the life they want.

We have to give them the tools to ensure that they can fulfil whatever they feel is right in supporting their family members, alongside their other commitments – whether that means working, looking after children, or simply retaining a degree of independence

So, in our Coalition Programme for government, we enshrined our commitment to provide that support:

  • to extend the right to request flexible working;
  • to provide much more control for carers and the people the care for; 
  • to extend the roll out of personal budgets and;
  • to use direct payments to carers and better community-based provision to improve access to respite care.

So how can we deliver this? How can we create the stronger, more flexible and more sustainable system we need?

The system must be reformed – and in doing so we must be clear about the principles on which reform should be based.

First – prevention. We must place renewed emphasis on keeping people as independent as possible, for as long as they feel able, not least by providing earlier support. People need to feel help is there as soon as problems occur.

And we’ve made some good progress on this. We’ve changed the rules already so that hospitals are responsible for patients for 30 days after discharge – integrating the care that is provided in hospitals and in the community, giving the hospital a stake in the quality of reablement support for people as they return home.

Second – protection. We have to ensure that people do not have to worry about becoming vulnerable – that the support they need is there, that they will be safe and secure – so they don’t feel that everything they’ve worked for throughout their lives can be compromised by the care needs they could develop.

Third – partnership. We must ensure patients carers, families and communities can work together with health, care and support services – so that services can respond to the whole picture of a family's circumstances, rather than just considering their own specific area of expertise or responsibility. We need a partnership between the family and the state – balancing collective solidarity with state support.

Fourth – personalisation. We must give people control of their own care, so they can choose services that best meet their needs. So that carers, and the people they care for, feel they are in charge.

And I just want to say a word here about personalisation when it comes to palliative care.

In a compassionate society, patients – both adults and children – should be able to receive palliative care in the manner they wish, in the setting they choose.

Most would choose to be cared for at home, so we need to devise a funding system which is responsive to their wishes, while being fair to all providers and affordable to the public purse.

So today, I am announcing a much-needed review of dedicated palliative care funding to allow us – to support us – in introducing such a system. Tom Hughes-Hallett, the Chief Executive of Marie Curie Cancer Care, has agreed that he will lead this review.

Now, to bring together all those principles I’ve been describing – prevention, protection, partnership and personalisation – in the Autumn we will be publishing our vision for adult social care, including a renewed concordat on personalisation with the social care sector.

We are also already taking a fresh look at the Carers Strategy, to see how we can make it as effective and as fit for purpose as possible.

And, of course, we know that the state cannot rival carers in their detailed knowledge of a person’s needs, nor can it provide as broad a range of services as people require.

So we want to hear your views. And we want to tap into the capacity and commitment that already exists in our communities. User-led organisations, especially local organisations, sometimes formed of only a few people, can provide a much broader mix of services, without having to call on formal state-funded resources.

Now of course  when it comes to dealing with the repercussions of the financial legacy that we inherited – and I’m sure that many people here from around the world are dealing with similar debt crises, though ours is one of the worst – the role of the state is crystal clear. 

We must recognise the overriding need to reduce the deficit – and that this means tough choices on public services.
So we have a responsibility, with local government, to ensure that care is as efficient and effective as possible. 

We have to maximise the potential of reablement, telecare and other innovations which can dramatically improve people’s lives while also being highly efficient.  Some local authorities have picked up this challenge, others have not. We need to accelerate this change so that these services and this approach is the norm.

But, of course, increased efficiency in the system will only take us so far. We need reform for the long-term – we need to find a new settlement to for the funding of social care.

So we will establish an independent Commission to consider how we can ensure responsible and sustainable funding for long-term care – which strikes a fair partnership between the state and the individual, and takes into account the vital role of families and carers.

We have to move reform forward apace.

So the Commission will be established as soon as possible and will report within a year. We will then respond to the Commission’s findings in a White Paper in the Autumn of next year.

Despite, financial crisis – perhaps because of it – we can’t let long-term care be kicked into the long-grass.

It’s hard to overstate the importance of social care – or of the selfless contribution that carers make.

In this country, the carers’ movement has been building for half a century. You’ve come a long way – from an issue that was little known, to where we are today.

But of course the system hasn’t always kept pace.

It wasn’t so long ago, in 1981, that the Association of Carers was refused registration as a charity because ‘carers’ themselves were not considered a suitable charitable cause.

There is a much better awareness now, yet reform still has to catch up.

So today we are putting social care front and centre – it is recognised in the Coalition Programme – and it one of our five priorities for the Department of Health as a ministerial team.

We will reform funding, will reform legislation and will implement those reforms within this Parliament – within the next five years.  

By doing that I hope we will help you meet the challenges ahead – and not just because it is our duty, but also because, as individuals, carers deserve nothing less.

Thank you all very much indeed.

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