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29 June 2011 King's Fund

  • Last modified date:
    8 July 2011

Speech to the Kings Fund on Social Care Reform
29th June 2011

INTRODUCTION
First I’d like to start by thanking the Kings Fund and Age UK for inviting me to speak to you today.
Ask any member of the public what they think of “social care”, and they will inevitably come up with; “old age”, “isolation”, and “illness”.
Ask many in the media that same question, and they will give you ‘demographic time bombs’ and ‘spending black holes’.
Little wonder then, that many older people feel increasingly like second class citizens.
Instead of celebrating the fact that people are living longer, society somehow seems inconvenienced by it.
Dismissing the human ingenuity that is delivering longer life, not as a triumph, but as a problem to fix.
Our older population should never be considered a burden on society.
We are living longer and healthier than ever.
And we should celebrate that.
It’s that success that demands a new settlement.
One that looks for the opportunities in an ageing society.
One that seeks to unlock the rich potential of our older population.
One that treats the frail and the weak with dignity and respect.


WHAT ARE THE PROBLEMS
Right now, local councils decide how to spend money on care and support.
This means there can be big differences between care and support in different areas.
Access to support can vary depending on where people live, even if they have the same care need.
All of this leads to a system where people are left confused about what help they will receive.
This complexity is one of the reasons that people don’t think ahead and plan how they will pay for any care they need as a natural part of growing old.

None of us know if we will need care in the future, or how much it might cost.

But we do know that if we do need care 1 in 4 of us will face care costs of more than £50,000, and that 1 in 10 will be unlucky enough to face care costs of more than £100,000 in our older age.

This is social cares nasty little secret.

COMMON GROUND
But social care doesn’t just matter because of the costs.
It matters because it goes to the very heart of our society.
A society where families care for one another.
From grandparents providing childcare.
To husbands and wives caring for each other.
And the sons and daughters dedicated to looking after their parents.   
Families are the bedrock of care.

Let me be clear I don’t believe its the business of Government to force people to care for their loved ones.
But it is the business of Government to help them to do so. 
Making sure that quality and outcomes are the benchmark of success.
Breaking down barriers to ensure that services are personalised and joined up.


WHAT THE GOVT HAS DONE:
That’s been our focus in Government over the past twelve months.  Laying the groundwork for reform.
First, the Spending Review secured an extra £2bn for social care by 2014.  A total of £7.2 billion extra support for social care over the next four years.
An unprecedented transfer of funds from the NHS to social care.
A recognition that health and social care are two sides of the same coin.
Of course we can debate whether the SR was enough.
I recognise the pressure.
But its purpose was plain.  To stabilise social care, to build a bridge between a broken social care system and a reformed one.
The second, is being clear as a Government about what social care can achieve.
Last November I set out the Governments vision for social care.
A vision grounded in values of self-determination, reciprocity and personal responsibility.
Demonstrating that social care isn’t just about rescuing social casualties. 
But about relationships, capable communities, and unlocking peoples’ potential, preventing and postponing dependency.
Giving people more choice and control over their care through personal budgets.
Putting individuals in the driving seat by allowing them to decide what service they need to carry on living independently and meet their care needs.

That’s why our Vision set out a commitment that everyone eligible should be given a personal budget, preferably as a direct payment, by 2013.

We also want to make sure that people get real choice and control in the way that councils roll out personal budgets to ensure that they are not simply a box-ticking exercise.

And supporting families to care means taking steps to identify more carers, we have already set out clearly our priorities to give them greater support to lead full and rewarding lives outside their caring role and to stay healthy.
That’s our vision for social care.
But the problems we face are also engrained within our outdated and confusing social care laws.
The product of 60 years of piecemeal legislating that means social care looks back to the Poor Law for its guiding principles, instead of looking forward.
The Law Commission’s 76 recommendations offer the prospect of a modern statute grounded in those values I set out in the Government’s vision.
Placing wellbeing and outcomes at the heart of 21st century social care.
One of the challenges is striking the balance between greater personalisation and effective safeguarding.
The Law Commission has made some helpful recommendations which the Government has already committed to act upon.

That’s why we are also strengthening safeguarding arrangements in Local Authorities, to increase the protection for the most vulnerable people in our society.

Making Safeguarding Adults Boards a mandatory requirement will make them more effective and ensure those at risk of harm or exploitation will be safer.

And by making this change, the Government is sending a strong signal about the importance of safeguarding and the need for the NHS, Police and Local Councils to work in partnership with collective accountability to local communities.

FUNDING REFORM
And of course there is funding.
Last July we set Andrew Dilnot and his fellow commissioners the challenge of answering the question:
‘How do we strike a fair balance between individual’s responsibility and the State in funding care and support?’
It was the right question then and it is the right question now.


THERE IS NO COST FREE ANSWER
So let me add a few thoughts about next week’s announcement.
Andrew and his fellow commissioners have been blunt.
Reform comes with a price tag.
There is no magic solution that can shield people from catastrophic costs, instantly reward thrift and make a rotten system fair.
That is why when Andrew spells out his plans the answer may not be easy.
Without personal contact, our social care system remains out of sight and out of mind.
That’s why most people think social care is free.
It is NOT.
Never has been, and never will be.
I agree with those who say the boat has sailed on a wholly tax funded social care.
So when Andrew tells us he has an answer to social care funding.  That all but the poorest will have to pay.  The reaction could be lukewarm, at best. 
There are, after all, no cheers for the bearer of hard truths.
So those of us who seek reform must be united in a common purpose. 
We must make sure people don't look at the Dilnot plan through rose tinted glasses.
Comparing his plans with the fantasy of free care.
And let me speak plainly.
If funding reform is to be secured during this Parliament it will require give and take. 
It demands recognition of the times we are in.
And the fact that the deficit casts a long shadow.

DIALOGUE
So although funding reform may be essential; it is not sufficient in itself.
The question that the Government put to Andrew Dilnot is just one of the questions that need an answer.
The events at Southern Cross pose questions about the market in care.
The abuse scandal at Winterbourne View raises questions about safety.
The Law Commission has posed questions about the social care law.
And we need to address questions of quality, regulation, and integration as well as law reform and funding.
There are examples of excellent care provided by dedicated and caring care workers. 

But there are also examples where the quality of care provided falls short of what we would want for ourselves or our family.

We need to ensure consistently good quality care is provided to all.

To get the right reform requires an open dialogue.
That dialogue has already started. And it should continue.
I hope the Kings Fund and Age UK, professional bodies, providers and others will work with us to do this.


CONCLUSIONS
I know that many of you have questions that are still unanswered.
And most of them will have to wait until after Dilnot has published his recommendations.
But let me be clear about one thing. 
Next week, don’t expect to hear the Government’s final word on funding reform.
The Dilnot report will mark an important milestone on the road to reform.
There are more milestones to come.
There will be challenges on the way.
But I firmly believe that by working together, we can finally begin the process of turning the page on social care reform.

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