Hello everyone and thank you for inviting me to speak today.
The last time I spoke to ADASS it was at four different events at NCAS. And whilst I’m not speaking as much today, I’m pleased I’m able to be involved in two external discussion groups.
Last year I spoke for a long time, about many different issues. Today will be slightly different. What I want to talk about today is what we need to keep in mind in the run up to the Care Bill becoming law.
The Care Bill
When I last spoke to you – I was about to embark on the second reading of the Care Bill. Now, that has passed, and Royal Assent is on the horizon. That has passed, and Royal Assent can be seen on the horizon.
We can now start to look beyond the legislation itself, and what the legislation actually offers – what changes it will make. Its ‘well-being principle’ will make sure that the system is focused on the individual, on what they actually want out of their care.
The opportunities it offers local authorities to innovate and radically change the care they offer to their local areas are huge – I’ll touch on this later. And its goal – to put carers’ needs on an equal footing with those that they care for – is historic. Everyone in this room knows how integral carers are to the health and care system, which would surely collapse without them. So I’m proud that we are doing more to identify their needs are and support them to and help them to carry on their vital role. In short, it is the legislation that the social care sector has needed for a long time. But, saying that, there is still a long way to go.
We’re shortly going to be publishing a consultation on the regulations and guidance will underpin how everyone in this room works within the new powers within the Bill. This will be one of the first opportunities where the public have the chance to constructively criticise and offer their opinions on draft regulations and guidance that will help make the Bill a reality. What they’ll be reading through is the product of months of collaboration between the expert groups of representatives including the LGA and, of course, ADASS. Every time I discuss the work with my officials – which, believe me, is often – they tell me just how helpful and cooperative the expert groups have been.
So thank you, but the job isn’t over yet.
During this consultation, the same energy and passion we’ve seen up until now from the care sector needs to continue. It is that constant dialogue, leading up to the implementation of the Bill becoming law, and that law coming into force, that will make sure that people stay engaged with the Bill. My Department is continuing this dialogue, as we work with both ADASS and LGA to support local government to implement these reforms, setting up local teams to directly help them with any issues they encounter. This doesn’t happen very often in government – it’s a genuinely innovative approach of support.
It shows two things.
(Announcement – Funding support)
The first is how committed we all are to these reforms. And, today, I’m pleased to say we are supporting local authorities to put these changes in to action. We are now making available an additional £23m this year to help them get ready to implement their new statutory duties from April 2015. This will support local authorities to build capacity within their organisations to manage the changes in the Care Bill, and to participate in the joint implementation programme.
You’ll be receiving letters soon detailing out how and when this support will be available. But it’s important you have the right funding in place…
…because the second point this close working shows is just how important it is that these changes are instigated.
We know the pressures that the system is under – the fact that the first lecture of this conference was called ‘Leading in an Age of Austerity: managing the financial challenge’ speaks for itself. The Government has put more money into social care, transferring funding from the NHS worth over £1bn for the next financial year…
…And despite councils planning to spend, on average, an extra £2m on social care in that same year, it never feels like it is enough. There are some outstanding examples where directors of adult social services and councils are doing some great work during these difficult financial times.
Croydon have saved over £27m over the last six years through greater efficiency, like redesigning care packages.
Nottinghamshire, too, has saved over £4m in efficiency over just 9 months by working alongside Capita, helping 3,000 people move to personal budgets.
These are really inspiring examples, and we need every local area to be working in a similar way. But, crucially, the social care system needs fundamental changes to the way it operates, so it can use that money in a smarter way. The Care Bill provides this foundation – it offers local areas the flexibility and the freedom to commission innovative care.
This is already being realised across the country through the work we’re doing on integration.
I’m very privileged that, as part of my role as Care Minister, I get to go out and speak to many people about their care and what they want to see change.
They see it as just ‘care’, it doesn’t matter if it is from the local hospital, a community nurse, a local carer – to them it is just one package of care.
And they’re right – care should be more like that.
It should be a seamless pathway, with organisations working together to provide the best and most innovative care that meets people’s specific needs.
Our 14 Integration Pioneers are already working like this – they’ve shown what integration between health and care sectors can achieve:
• fewer delayed discharges from hospital for older people;
• more work in care homes to help people self-care and rely less on emergency services; and
• intensive home care support to help people to lead independent lives free from care.
These are huge achievements and, overall, it puts a greater emphasis on wellbeing, and improving people’s lives.
I want to pay tribute to the great local authorities that are leading on integration – not just those who are supporting the pioneers, but those doing more work on joining up the health and care systems.
And we know that more local areas want to achieve similar changes.
Our Better Care Fund will help organisations act earlier to prevent people reaching crisis point; to offer seven-day services; and deliver care that is centred on people’s needs. We originally estimated that, by pooling both Health and Social Care budgets together, we would have £3.8bn available for innovative approaches to integration. Since all the plans have been submitted, that figure looks like it will be over £5bn. This is a great sign of local health and care leaders being innovative – thinking big about what they can do to improve the health and care of their population.
But, with all of this potential for innovation, the Care Bill also offers us the opportunity to take stock of our current arrangements.
"It presents local authorities with a question: “Is the right care being commissioned in the first place?”
I mean care being commissioned poorly and organisations failing to deliver basic standards of care. As you know I am determined to stamp out any practice that leads to poor care, be it inappropriate 15 minute visits that result in care workers rushing their duties because they only have such a short time to work within, or providers who don't pay the national minimum wage. Some areas are leading the way in scrutinising their current care arrangements.
In Yorkshire, Calderdale is currently planning to re-commission its entire homecare service, after they visited all 896 people who receive that service. They want to focus more on what those people want out of their care. And they want to support the workforce to keep up their important work by making sure they work under the right terms and conditions.
And in Bradford, the council are scrutinising their commissioning of 15 minute care visits to make sure they are only used in the right instances, where they are appropriate for the person being cared for, and not as a blanket package.
I want to thank ADASS for all of their work around supporting local areas to improve their care arrangements.
I was impressed with the recent "Top tips for good commissioning" and the work the regional chairs have been doing to continue this has been excellent.
And I am pleased that my Department, ADASS and LGA are working together to improve the quality of care, to commission care that will improve the health and wellbeing of people. We are creating standards of what good commissioning for social care looks like, which will no doubt allow local areas to scrutinise their plans and help them to improve them. These should be completed later in the year, in time for the Care Bill coming in to action.
We also will announce later in the year further work to help us learn lessons from excellent commissioning.
The last point I want to make is that, when scrutinising commissioning plans, local areas should never forget why they are filling out this paper work, meeting with regional representatives and discussing plans with care providers.
It’s for the person who needs that care, it’s people like them.
There has been a tendency in the past for local areas to think about the system first and then what the people they care for actually need second. The person who needs care should always be at the centre of any design of care. The personalisation of services – taking account of what each individual person actually needs – should always be paramount.
Making care more personal can have an incredible positive impact. People have a say about what form that care takes and how, when and where they receive it. Yet it puzzles me that there is still such a low uptake of personalised care like direct payments or personal budgets.
For example, in some local authorities, 95% of people who are eligible for a personal budget have access to one. But there are huge ‘black out’ spots across the country, where only a small number of people who are eligible get them.
Why is this is happening?
Older and disabled people are redefining themselves in society. The Paralympics was a great example of this – people being celebrated purely for their athletic achievements. And older people aren’t limited by a fixed retirement age: they run marathons, appear and host television programmes.
Only last week did Sir Bruce Forsyth announce he was stepping down from a regular Saturday night slot – at the impressive age of 86. People aren’t defined by their age or disability – but our care system is still stuck in the past. Great leaders in this room have shared ambition to change that, but there are still too many instances where the care system fails to regard people as people, only as problems which need to be solved in 15 minutes.
And, with this attitude, we have taken people out of institutions but inadvertently institutionalised them in their own homes. Many people have care for years, often until the end of their lives – but too often, they are simply told what care they will get.
Care at home can be like solitary confinement. People can spend hours on their own, which is only punctuated by carers – who too often change from one day to the next – who help with the most intimate and personal of tasks – feeding, getting out of bed and going to the toilet. This is an assault on your dignity.
These people often have little or no choice and control over their care – every part of it is decided in a building miles away: when they’ll get the care, how long it will be for, how often they will get it, who will deliver it.
And if all your life consists of is being got out of bed in the morning, washed and fed and put in an armchair in front of your telly all day and then fed and put back to bed – without seeing anyone else apart from your formal care worker – that’s a miserable existence. And as a society we must not tolerate it.
We all want choice and control over every part of our lives – and this doesn’t stop when you get old or have a disability.
Care and support should be about helping people to live good lives, rather than just keeping them alive.
There are some great examples where wider society has helped enrich people’s lives. Whether that’s neighbours visiting them to keep them company, get out and about or help with shopping.
This spirit – helping people to live the life they want – should be at the heart of our care and support system. Anything less is an antiquated care service that has no place in a modern society.
I am determined to put an end to it. The Care Bill will achieve this.
Everyone in the system has got the drive and the will to make this change – in fact, many of you are already providing care that empowers people – but now we have the opportunity to make this a reality everywhere.
One of the founding principles of the Care Bill is that it places the person in the centre of care.
And I’m pleased that we are doing a lot of work with local authorities, carers and people who receive care to judge just how personalised care can become.
The ‘Making It Real Programme’ documents what carers and service users expect if care really is personalised, and local authorities can now check their services against these estimations.
They can also judge how effective their personal budgets programme is by using the POET evaluation tool, which measures the take up rate and satisfaction levels of personal budgets.
I cannot recommend these services enough.
Yet only 80 authorities are signed up to the ‘Making it Real Programme’ and less than half of that number are using POET.
Today, I want to announce that we will work with ADASS to make care more personalised, that any progress around this is not lost in the new system.
I want to build a clear direction with you to spell out exactly what we mean by ‘excellent personalised care’.
We need to get this right if we want to fully harness the power and potential that is inherent in the years of work and cooperation in the Care Bill.
I look around this room and I see people who have spent years improving the care they offer. And in you all is the potential to go even further, to achieve standards of care beyond what is currently possible.
And I will work alongside you to surpass even that. Thank you.