Department of Health Skip to content

Please note that this website has a UK government access keys system.

You are here:

Speech by Paul Burstow MP, Minister of State for Care Services, 3 November 2010: NCAS Annual Conference

  • Last modified date:
    20 December 2010

It's six years since I last spoke at this conference.  I did so then as a Liberal Democrat shadow minister setting out a vision for social care.

I don’t think anyone could have predicted the events of six months ago.

The formation of a partnership government. The first coalition in over 60 years.

So I come as the unexpected Minister. And I come bearing an unexpected message too – a Spending Review that gives us the chance to protect and reform social care.

ADASS, the LGA, the NHS Confederation and many charities all told us that if you underfund social care, then you hurt the most vulnerable, and you undermine the NHS.

Well we listened, we understood, we acted.

The result is an unexpected settlement.

A settlement which means councils can meet cost pressures and maintain services.

Some have cast doubt about this. It has even been suggested that we are still £4 billion gap of what’s needed over the next four years.

Claims and counter claims are part and parcel of any settlement.  But the tone has been alarmist. So let me spell out why there is no gap.

But before I do, let me point out where we agree.

We agree about efficiency. The LGA in its pre-Spending Review submission to the Treasury said that social care could deliver 3% efficiency a year over the next four years.

That is challenging  and I don’t pretend otherwise. But it is achievable.

However, claims that there is a £4 billion gap even after the additional £2 billion announced in the Spending Review are based on some flawed assumptions and poor maths.

First, it is assumed that growth trends in pay and prices over the next twenty years are a guide to pay and prices pressures over the next four years.

That clearly is not true. These are not normal times. The reality is that there will be a pay freeze for the next two years in the public sector.

We also know the Office for Budget Responsibility tells us that independent sector wage increases will be slower than normal.

So, for the next few years, cost pressures won’t be anything like the long term trend.

The second flaw is to assume that reductions in central government funding mean an equivalent cut in revenues raised and spending power.

This is just not true either. Central government funding is just one part of the equation any Council Treasurer has to balance the books.

No one is talking about a 26% cut in Council Tax revenues or for that matter the income from charges and levies.

Yet this is exactly what has been assumed to arrive at the £4 billion gap!

Once these flaws are corrected the £4 billion gap disappears.

And let me, reiterate what Helen Bailey from Treasury said earlier about what the social care settlement includes.

First, Department of Health grant funding continues and will rise with inflation.  This year we allocated £1.3 billion.  By 2014 that will rise to £1.4 billion.

Second, on top of the inflation indexed grant from 2011 there is an additional £500 million rising to £1 billion by 2014.

Third, there will be extra money from the NHS.  Starting with £800 million next year and rising to £1 billion by 2014.

So no cut in social care grants. An additional £1.3 billion next year. Rising to additional £2 billion by 2014.

On top of this related areas, like Supporting People grant and Disabled Facilities grants, are both shielded from the 26% reduction.

Taken together with the 3% efficiency this settlement does meet future demands.  Does allow services to be maintained and reformed.  And does provide a clear path through to 2014 and the new funding system that Andrew Dilnot is designing for us at the moment.

Of course, the other charge levelled against the settlement is that the money won’t get through to social care.

That NHS funding will simply be hoarded within PCT baselines.

And that the extra money going through the formula grant will simply be swallowed up by other council departments.

Well, the Secretary of State will talk more about the first point later this week – when he is here on Friday. But rest assured, we will ensure this NHS support goes on social care.

On the second point, I have been at conferences and I have heard, “if only there wasn’t ring fencing.”

Taking off the ring-fence has been a constant refrain from local government for years.

And now we’ve got it. Real freedom for councils. Freedom to make their own decisions, to set their own priorities, to decide how money is spent.

So this Spending Review offers a secure platform for the future. But let’s be clear – it’s a platform for reform, not for business as usual.

THE BIG SOCIETY

Our care system has now reached a critical point and funding is only one part of the answer.

Pumping more money into an unreformed system to manage ever-rising demand isn’t sustainable.

We need to rethink our whole approach, and tackle the drivers of demand, the vulnerability and isolation that applies pressure to the care system in the first place.

Our society has changed massively in a short space of time.

Networks of community and family support we’ve relied on for centuries have declined.

In their place, the state has taken on an ever-bigger role in providing services and dealing with social problems.

And the result?

Communities have been disempowered and disconnected.

Councils have become infantilised by decades of targets and central diktat.

It’s taken us to where we are today, where costs are becoming unsustainable.

That’s why we talk about the 'Big Society'.  

Ending the dependency culture.

Building open, capable and confident communities is what we want it to be about. It is not just the individual citizen but local government too

Buttressing ties of family and mutual support.

That is our vision. Not simply looking upwards to the state for answers, but outwards to people and communities.

A Big and Open Society means a big shift of power.  A shift from the state to the citizen. From Whitehall to the Townhall. From provider to service user.

And it also means a big opportunity. Because if are going to give people the power, if we support them to deal collectively with new challenges, then not only do we get better solutions, we make our communities stronger, and people less vulnerable.

And if we do that we reduce the need for state help in the first place.

Just imagine the potential for social care. Imagine if we can develop local support networks to build on the good examples  and reduce elderly isolation and vulnerability.

Imagine the gains that can be made from supporting more older people in their community.

Imagine if we can build a social movement, built on protection and mutual responsibilities, so that fewer people end up dependent on acute services.

The answers are out there.

Some of you may have heard reports over the weekend about importing ideas from Japan.

We want to learn from all over the world. But actually you don’t have to go that far to see what’s possible.

Go to South London. See the Southwark Circle programme. Linking local services with voluntary ones. Like help with shopping or home maintenance. A simple model having a major impact on people’s independence and autonomy.

For example, the many Timebanks springing up around the country: practical, effective, affordable, recession proof ways of helping people create their own solutions.

We want to unleash the talent, time and power of local innovation and community support right across the country.

Through councils working with community organisations and others to develop innovative schemes like these.

With more investment in preventative support, like telecare and home adaptations, to prevent or postpone dependency.

And with more social enterprises. More user-led organisations taking the reins of service design and service delivery.

PERSONAL BUDGETS

Most important of all, we want people to get direct control of the money the state spends on their care.

It is, now, fourteen years since the first legislation for direct payments.

Yet still only 13 per cent of service users – 216,000 people – actually control the purse strings.

We know that personal budgets give people more control over their lives and greater satisfaction with the services they receive.

And in most cases they offer better outcomes at the same cost.

Just last week, the Audit Commission asked why we’re not seeing faster progress.

So, yes, we need to aim higher. To a point where everyone can benefit from a personal budget.

I know everyone here believes this and this should be the direction of travel.

But, of course, it’s not enough just to have personal budgets.

We need to be sure they’re there for individuals and their carers, giving people meaningful choice and control over their care.

Some authorities have been fantastic and models we need to see more of.

They’ve shown it can be done.

Tomorrow we’ll see that your leadership can make a real change at the launch of a partnership agreement that demonstrates this shared determination.

But let me be absolutely clear personal budgets should be a right.

PORTABILITY

The same is true of portability.

The lack of portability reveals a 19th century logic at the heart of 21st century social care.

The logic of the poor laws. The complete antithesis of a person-centred approach.

Again, it needs to change.

Again, it won’t be easy.

Again, we’ll need to come together to break down the barriers and deliver greater portability of assessments across geographical boundaries.

PLURALITY

Above all, we need to embrace plurality and partnership.

We need a new scale of collaboration between the NHS, local government and the voluntary sector.

Partnership like never before.

An end to paying lip service.

The beginning of the integrated, personalised services that we all know make sense but somehow have been out of reach.

It’s something the last Government promised, but with a few honourable exceptions never realised.

Why? Because the structures and incentives were wrong. Because the money followed the institution, and not the need.

We’re determined that we can and must do more.

The £3.8 billion from NHS capital over the next four years to support social care is a statement of intent.

As is the £70 million already allocated this year for reablement.

These sums are a catalyst but I don’t see this and these sums as the limit of collaboration.

See it as a catalyst, a trigger to do much more together in future.

And a trigger to bring on board the full range of organisations that can help you.

Vibrant and creative social entrepreneurs.

Voluntary organisations fully engaged as a partner and deployed at the grassroots.

User led organisations working with Council and NHS commissioners to design and deliver services that meet new needs.

Community groups committed to building those critical social networks that deliver results on a street-by-street basis.

The best councils are stepping up their role as exceptional leaders, place and market shapers – helping to spark and support innovation to meet emerging needs.

We need all councils to embrace this role.

And that means stripping out the barriers that stand in their way.

Let me give you some examples, like the lady in sheltered accommodation who is told to stop cooking for fellow residents because of environment health concerns.

Or the gentleman who provides an informal ‘taxi’ service taking neighbours shopping who is told he needs to get a taxi licence.

Let’s be clear. Where rules and red tape are an obstacle to realising a person’s freedom and providing them with the right care and support that is right for them.  We have to look critically at red tape. And whether that red tape should go.

And the same rigour must apply to custom and practice masquerading as rules and regulations.

We need a better attitude to risk.  Better safeguards against poor practice. Better protection against harm and abuse – absolutely.  But common sense and flexibility too in how we understand and manage risk.

It’s all the more important as we give more power and control to the individual.

Because giving people freedom of choice means they might make decisions that we disagree with, even disapprove of.

Yet if the outcomes are clearly set out in the care plan, and the risks fully understood, then we have to let people make their own choices.

Some might even call that liberal!

Finally, we need to trust and empower you much more.

Stripping out unnecessary bureaucracy.

And reining back on regulatory pressures that are needlessly burdensome on your day-to-day work.

You’ve told us that the CQC’s annual performance assessment of commissioning isn’t the best way of tackling under-performance.

We’ve listened, we’ve understood, we’ve acted.

And I can confirm today that we will not be taking forward these assessments from next year onwards.

In their place.  Continuous improvement.  Real time, ongoing, relevant measures of performance, not the arbitrary snapshots that currently the system takes in.

A more proportionate and constructive system. Built around local accountability. Driven by sector-led mutual support. Not the unhelpful stigma of ‘Priority for Improvement’ status.

ADASS and the local government group are exploring how this will work. And we are working closely with them as we put the new arrangements in place.

CONCLUSION

So yes, the coming years will be tough for everyone involved in social care.

Tough but not impossible.

Local government has shown, time and time again, that it can rise to challenges.

You’ve shown it in meeting efficiencies, year on year. Shown it in the leadership you brought to bear in shaping places and supporting communities.

You’ve shown that local government is a reforming force.

The Coalition is a reforming force too.

And the Spending Settlement is a reforming settlement.

The opportunity is there.

An opportunity for better prevention built on full partnership between health and social care. We are prioritising to protect the vulnerable.

For greater personalisation drawing on a vibrant and plural market.

For higher productivity based on innovation and autonomy in professional practice.

And a wider social movement in supporting our older people and preventing a need for high levels of services.

That’s our vision for social care.

It’s a vision that matters hugely to the hundred of thousands of fellow  citizens who rely on us.

And one that I hope we can fulfil together in the months and years ahead. Thank you.

Access keys