25 October 2012, Jeremy Hunt, NCAS

This speech was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

Thank you Sarah [Pickup, President of ADASS]. The importance of local authorities I think it’s appropriate that the very first speech I give…

Thank you Sarah [Pickup, President of ADASS].

The importance of local authorities

I think it’s appropriate that the very first speech I give as Health Secretary - the first beyond the confines of the Conservative Party conference - is not to an audience of doctors or nurses, but to local authorities.

The word I have heard more often than perhaps any other in my first month is “integration.” Our National Health Service is an extraordinary organisation of which we are all deeply proud.  But by itself, it’s not enough.

And given the challenges of an ageing population, our single most important partner is without question local authorities. The success or failure of health and care very simply rests on the success or failure of my relationship with you - and in particular the progress we make together towards building a sustainable system.


So before I go any further, let me talk about funding.

How we pay for social care - both as a government and as individuals - is one of the big questions of our generation.

The current system is entirely inadequate.

It’s not sufficient, it’s not sustainable and it can be deeply painful for many, many people.

Forcing them to sell the home they have lived in, had children in, made so many memories in.  It’s one of the worst things about being old in this country.

So I am so proud that next year’s Care and Support Bill will introduce deferred payments meaning that no one is forced to sell their home in their lifetime to pay for care.

A historic change.  But we need to go further in three areas in particular.

Firstly the Dilnot cap, which we strongly support and are committed to introducing as soon as we are financially able. We need to build a society where it is as normal to make provision for your social care as it is for your pension - and until we do so we will never have a truly sustainable system.

Secondly by working with you to help you deal with the huge pressures created by the cuts in your budgets that have come at a time of rising demand. The support for adult social care budgets that has come through the Department of Health - over £7 billion in this spending review period - is a mark of our commitment. But I recognise that for many councils significant efficiency savings will be needed on top of that.

So we need to do something else, a third vital step. Which is to forge innovative partnerships between local councils and local NHS services that build more sustainable services to keep people healthy and in their own homes for longer. The new structures of the Health and Social Care Act, with clinically-led CCGs, local authority responsibility for public health and health and well-being boards, will provide the catalyst to make that happen - and it will have my enthusiastic support.

20th century health

When we look back over the last hundred years or so, this country has made incredible progress in health.

From the start of the 20th century to the early years of the 21st, life expectancy has basically doubled.

The causes are many.

One, certainly, is our NHS.  But it is far from the only one.

Better housing, clean water and sanitation, better working conditions, food quality standards, even road safety - all had a huge impact.

And you have played a key role in every one of them.

But there are more gains to be had, through:

•    Better, more appropriate housing,
•    By health and wellbeing becoming an integral part of planning, of transport and of education,
•    By being better at reaching the poorest, the most vulnerable and the hardest to reach in our communities.


Now, the last couple of years have inevitably been dominated by a debate on structures.

But structures are only a means to an end.  What really matters is better health and care outcomes.

And for that we need a culture of cooperation across health and social care, with a person’s individual needs at its heart.

The old structures simply haven’t worked well enough.

•    GP practices not talking to hospitals.
•    Hospitals not talking to each other.
•    And the divide between the NHS and local authorities sometimes beggaring belief.

This lack of openness, of communication, of trust… means that too many people simply fall between the cracks.

All too often those with the loudest voices and the sharpest elbows - or at least those who have parents or children who have them - get the best treatment.

Of course, we can point to examples of excellent, integrated care.

Like Blackburn with Darwen Borough Council, which, with the local NHS, now provides free leisure facilities for everybody - that’s right, for everybody.

The result?  The number of people doing the recommended amount of exercise has gone up by almost half [up 46% from 16.3% to 23.8%].

And in Liverpool, where by bringing NHS staff together with social workers in integrated care teams, they have been able to cut unplanned hospital admissions and length of stay in hospital by a quarter.

Good things happen when the NHS and councils come together.

But where this happens, it happens despite the system, not because of it.

You can’t design care around, say, a child with cystic fibrosis or a woman with breast cancer -her chemo- and radiotherapy, her drugs, her nursing visits, her social care, her mental health - if there is no meaningful contact between her GP, her consultant team, her local authority and her social care provider.

That’s the great opportunity presented by Health and Wellbeing Boards and by Healthwatch, both of which go live in April.

Bringing people together to improve the health of their community and the quality of care within it.

Looking at the needs of local communities and working out how to meet those needs.

Figuring out how to work together - councils, NHS, providers and the public.

But also making sure that Health and Wellbeing Boards do not become ‘just another committee’.

The work has already begun.  And I want to thank all of you who are involved making this happen.

NHS number

And while I’m on the subject of integration, can I give a plug for the NHS number? We have long spoken about using people’s NHS number to join up their records across health and social care. So I have a challenge for you.  If your council is not using the NHS number, please find out what needs to happen for it to be adopted.  It will be at the heart of the data exchange necessary for effective integration to be a reality


As Health Secretary, I have been very clear about my four key priorities.

•    Giving Britain some of the best survival rates in Europe for the big killer diseases: cancer, stroke, heart, liver and respiratory disease.

•    Building a health and care system where quality of care is as important as quality of treatment.

•    Dramatically improving the care for people living with long-term conditions like diabetes, asthma or arthritis - who currently account for more than half of GP appointments and nearly ¾ of hospital admissions.

•    And transforming our care for people dementia so we become one of the best countries in Europe to grow old.

Let me talk about the last one.

A million people will have dementia by 2020. It already affects one in three over 65s.

But shockingly our system diagnoses less than half the people who have it, even when access to good drugs can help stave off the condition for several years.

There are some great examples of excellent dementia care.

Like Manchester City Council’s Shore Green Extra Care Housing Scheme.  There, they use technology and modern building design to reduce the impact of people’s dementia and memory loss.

Or the Meri Yaadain project in Bradford, raising awareness of dementia among the South Asian community.

Or Hampshire County Council working with businesses and others alongside the Alzheimer’s Society and Andover Mind to help them become more dementia friendly.

Dementia Compact

Earlier this year, we launched a Dementia Care and Support Compact.  An agreement - a commitment - by social care providers to deliver first rate care and support for people with dementia and their families.

In March, when we launched, 10 organisations joined up.  Today, we have 42, covering some eighteen hundred services across the country.

If you’re from a provider that cares for those with dementia - and if you haven’t yet heeded the call - please consider signing up.

That’s not an order.  It’s a heart felt request.  Because by making dementia care a priority, you will doing perhaps the single biggest thing that can transform the care of older people for whom you are responsible.

Just as I am asking the NHS to do, I ask all of you all to look at how you operate, at how you behave.  To be inspired by new ideas and to ask yourselves what more you could do.  And then to make that change happen.

Scandal of poor care

Because the need for change is urgent.

The best dementia care in England is exemplary.  But the worst is nothing short of scandalous.

We’ve all seen the reports - of people with dementia being criminally abused by their care-workers or drugged-up with a chemical cosh just so a care-assistant can get a good night’s sleep.

These may be extreme, isolated events but they do highlight a culture where those with dementia are not getting the dignity and respect they deserve.

The Prime Minister’s Challenge on Dementia sets out an ambitious plan to build a dementia-friendly society.

Yes, to invest in research and better treatment.  But more than that.

•    to end the stigma of dementia.
•    for people to feel comfortable talking to their GP if they think they have symptoms.
•    for people to feel in control of their condition.
•    for people with dementia to lead as near a normal life for as long as they can.
•    for those who care for them to feel supported and confident.
•    In short, for our communities to become dementia-friendly.

If we are to succeed, local authorities must take the lead.

And we will make sure we will give you every possible support.

Dementia friendly environments

So today I can announce that we are making £50 million available to support you and your NHS colleagues to create dementia friendly environments.

Carers tell us time and again that when it comes to hospitals, care homes, or other settings, it’s often small things - whether clear signage, light and airy rooms or good handrails - that make a big difference.  Whilst you could say that this is not a huge sum of money relative to the scale of the challenge, if it helps make some of the small things better it will be transformational.


Finally let me mention the one missing ingredient that will make the difference between success and failure.

Because it isn’t just about money or structures.

Most important of all is leadership.

Dementia friendly communities, better public health outcomes, deep and meaningful integration of NHS and social care services - none of this can happen without leadership.

Your leadership.

You are the ones who will make Health and Wellbeing Boards hot-beds of new ideas.

You are the ones who will work with your colleagues in the NHS to drive change.

You are the ones who will lead the charge on public health.

You are the ones who will ensure that people can lead a full and independent life, supported and cared for with humanity, dignity and respect.

You will make the difference.

I will play my part.  But real success will come from inspired local leadership. And I want to support you every step of the way.

Thank you.