Speech: 19/10/2011, Paul Burstow, NCAS 2011
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
Paul Burstow speaks at NCAS 2011.
I want to begin with some thank yous.
First, a big thank you to ADASS President Peter Hay.
Just like Richard Jones before him Peter has been a fully engaged critical friend. Challenging and championing on your behalf, making sure that the contribution of social care is not ignored.
Nowhere was that more so than in the NHS Future Forum this spring.
And now in working with the department to co-produce the Social Care White Paper.
Second, a big thank you to all of you.
The title of this conference says it all, ‘Tough times, good decisions’.
I know the last year has not been easy. And I won’t pretend that the next few years aren’t going to be tough too.
Despite the difficulties I wanted to thank you for achieving some incredible results.
The recent social care user survey showed that 90% of people who use services are satisfied with the services they receive, with 62% being extremely or very satisfied.
ADASS’s survey earlier this year showed how councils are protecting front line services by making 681 million pounds of hard won efficiency savings.
And all of you, up and down the country, showed leadership in responding to the Southern Cross situation. Reassuring residents and relatives, calming down alarmist media reports, and getting on with contingency planning and working together to ensure that residents’ care and welfare are secured.
We are not at the end of the road yet, but I am confident we will now see through a smooth transfer of care homes to new operators, and the role of Directors and Lead Members - and the leadership of ADASS and LGA - have been critical in getting there.
So I want to use this opportunity to talk about two things.
First, how can we meet the challenge of austerity; and
second, how do we realise the opportunity of reform?
MEETING THE CHALLENGE OF AUSTERITY
Starting with the challenge.
Last year I spelt out the priority the Government had given to protecting social care in the Spending Review, an extra £7.2 billion over four years up to 2015.
£7.2 billion to sustain a fragile system while we put in place plans for reform.
I said then that along with the money came a big efficiency challenge: Doing things differently.
Redesigning services, looking critically at overheads, investing in reablement and telecare, working with NHS and voluntary sector partners.
There are plenty of success stories out there and the work that you are doing on sector led improvement should help spread that good practice.
But I won’t pretend that it isn’t tough.
Overall spending on adult social care has fallen by around 1% this year. Even after cost-pressures the savings being made by councils are a lot less than last year’s doomsayers predicted.
Indeed the ADASS survey suggests that, within that 1 per cent, for every £10 reduction from adult social care, £7 has come from service redesign and greater efficiency.
What is interesting and instructive for the coming round of Council budget setting is how different Councils have coped.
Last month Demos and Scope published a report on how disabled people have been affected by cuts.
You might expect to find the biggest cuts in frontline services would be made by the Councils facing the most dramatic cuts in their income.
It isn’t as simple as that.
Demos’s report suggests there is no direct cause and effect.
The Councils they applaud for coping the best have not enjoyed the most generous settlements.
Nor are they concentrated in the most affluent areas. Rural and urban, rich and poor areas are found in equal measure at both top and bottom of the table.
So one council makes savings by cutting funding for services like the the local play scheme for disabled children, without consulting parents who depend on it, or providing any kind of suitable alternative.
In another, they have dramatically improved support for people with learning disabilities by taking them out of residential care into purpose built flats, in areas with plenty of amenities and support from paid staff. Not only has quality of life and health improved for former care home residents, this has also saved the council money.
Tough times, for all of us, yes. But good decisions by everyone?
In some places, yes.
But hopeless short-termism in others.
And let me be clear.
The same can be said about the NHS too.
Both shunting costs around the system. Pulling apart rather than pulling together.
I’m not here today to name and shame councils. The people in this room know who’s making good decisions, but more importantly they know who isn’t.
And I’m not here to tell you how you can best meet the needs of local people. Governments have tried that before and it hasn’t worked. And we know it hasn’t worked because you told us so.
There isn’t a formula that we can cook up in Whitehall that will make saving money without damaging local services any easier.
But there’s no evidence that I’ve seen that denying more people care and support in their homes will save money in the long term.
The need to integrate with health and other local services hasn’t gone away. Nor has the rationale for focusing more on prevention and personalisation.
No one will thank us if, because we’re on the cusp of major reform, we stop pursuing the things that we know make meaningful and positive changes to people’s experience of care and support.
THE OPPORTUNITY OF REFORM
That leads me to my second point: the opportunity of reform.
After the crucial votes in the House of Lords a fortnight ago the Health Bill is now moving forward.
And the essentials of the new NHS landscape are becoming ever clearer.
Affirming in legislation, the importance of integration of health and social care services - it’s explicit in the duties of the regulators, and the responsibilities of the NHS Commissioning board, health and wellbeing boards and clinical commissioning groups.
The changes made in response to the Future Forum’s report on the reforms granted even stronger powers to local authorities.
The NHS reforms offer a huge opportunity.
First, to make permanent local government’s central role in promoting health and wellbeing;
And second, to fashion a future where healthcare and social care come closer together: in developing and designing health and care services to meet the needs of local communities.
Over the past year, at every stage, the role of local government in shaping local health priorities has got stronger.
Health and Wellbeing Boards are emerging as the local system leader: bringing together councillors, their senior advisors across social care, children’s services, and public health with the leaders of the clinical commissioning groups and healthwatch.
Going well beyond just health and social care. With the potential to bring together all of the council’s services into one place - housing, police and others contributing to the boards.
In simple terms. There can’t be a local Commissioning Plan without a Health and Wellbeing Board.
The Board identifies the needs: today’s and tomorrow’s.
The Board sets the strategy.
The CCG translates them into an operational Commissioning Plan.
Both have duties to integrate services.
For the first time ever local government and NHS are bound together in one common commissioning cycle. An integrated process of dialogue and co-production NOT disputes and consultation.
And one that involves local people - we expect there to be public involvement in health and wellbeing board decisions.
I think this holds huge potential.
Potential to pool funds.
Potential to tackle the causes of ill health and dependency.
Potential to redesign services: crossing traditional boundaries.
And with 138 Councils volunteering for the early implementer programme I think you can see that potential too.
But while reforming the NHS is essential. It is not sufficient.
SOCIAL CARE REFORM
Social care must be reformed too.
Last year I set out the Government’s vision for adult social care.
At its heart are values of resilience, reciprocity and responsibility.
The goal a more personalised and preventative system.
It set out an ambitious programme of action.
So my challenge to you is simple: pick up the pace of personalisation.
There are still far too many people who could benefit from a personal budget or direct payment who are missing out.
A direct payment is not a luxury, it is a necessity.
Over the past year you have responded positively to the challenge through the Think Local, Act Personal partnership. And in many places, there has been impressive progress. But if sector led improvement is to mean anything you must be your own sternest critics and not flinch from turning the spotlight on those among you who are dragging their feet.
Putting personalisation on the back burner is not an option.
THE CASE FOR REFORM
There are those who think the Government has lost its appetite for reform. That social care reform can be put off. Like a tin can to be kicked along the road.
These critics of reform are wrong.
There is a hard headed economic case for embarking on reform too.
Today there are already over 3 million family carers who combine employment and caring, and the numbers are set to rise.
When their caring responsibilities become too much they quit their job - the trigger point for women is over 20 hours of care a week, it’s 10 for men.
This is not just about being nice to carers.
It’s also about UK PLC losing valuable workers and tax revenues.
And as we look for opportunities for growth to help us to economic recovery, care is a sector that we know will grow. That offers employment and career opportunities for a wide range of people, including for younger people and part-time workers. And, unlike some other sectors which are concentrated in particular parts of the country, the care sector is everywhere.
So taking steps to set reform in train now can prevent caring for the frail elderly from becoming a brake on the economy.
We know that as we look ahead there will be growing numbers of people in need of care.
We have to prepare now.
Today the baby boomer generation is navigating the care system for their parents.
They are finding out social care’s nasty little secret: that care is not free.
What’s worse there is no incentive to take responsibility and plan for the future.
So reform is as much about changing behaviour as it is about changing the system.
Both take time.
But getting this behaviour change right - for the right generation - means starting now, so that the baby boomers have prepared before they need care.
The alternative is to find ourselves in the coming decade with a care system that cannot cope, but with no time and fewer options to fix it.
That is why even though the deficit casts a long shadow, reform is not a luxury we can put off. It is a road we must start to travel down now.
Since we last met in Manchester we have also had the publication of the Law Commission and the Commission on Funding Care and Support, from Andrew Dilnot together with Jo Williams and Norman Warner.
In the work of the Dilnot commission, we are beginning to see some of the ways we can cast a new partnership between the state and the individual on how to pay for care.
But while the question of how we pay for care is critical and one we are determined to resolve, you know that there are many other things we need to address too.
That is why we launched Caring for our future. This isn’t just about the money, it’s also about issues like quality too.
That is why we have respected leaders from the sector jointly leading this work.
I hope that locally you will lead this work. Engaging with your community to work through the priorities for reform.
Our ambition is a comprehensive reform of social care.
So next April the Social Care White Paper will address law reform too.
The Law Commission - in their excellent report - confirmed what many social workers, care users and carers have known for many years. We have an outdated and confusing legal framework.
Written in the 1940s, looking back to 19th Century Poor Law principles.
In the noise about funding, sometimes the significance of the Law Commission’s work gets lost. But in reforming the law, we will be replacing a patchwork of 30 pieces of legislation attached piecemeal to Bill after Bill.
The law defines our rights, our responsibilities and our values. It is our touchstone - and if it doesn’t at least echo our aspirations for the care system, then we are failing carers and those who need care.
I started this speech with some thank yous. Now I want to end it with some challenges.
You will know from experience, the problems your local area has always struggled with. And the barriers - both cultural and structural - that you have to address.
As your past President, Richard Jones, put it last year, you have a choice: retrench or reform.
So my challenge to you is this.
Don’t wait for change to happen to you. Go out there and make it happen for yourself. Lead the local debate about how we reform social care.