The ground-breaking social care reform concordat and 10 year children’s plan announced this week have demonstrated it is Labour in government which continues to have the ideas and vision on the big issues which will shape the future of our country.
It is true that the last few weeks have been difficult and should be a wake-up call to all of us who have been entrusted with the privilege and responsibility of representing our great party and ensuring Britain is fair, successful and supportive of the mainstream majority who play by the rules and want to do the right thing. Equally, our unity and discipline are more important now than ever before and continue to both surprise and frustrate our political opponents.
Vision, passion about our values, effective delivery and a new authentic engagement with the public are all essential if we are to defeat the shallow but seductive ‘it’s time for a change’ strategy of the Tories. This week we began to regain some confidence and perspective giving us the opportunity to once again have a dialogue with the electorate about why they should trust us with the future.
Turning specifically to the social care concordat: it represents a historic advance in the relationship between central government, local government and the NHS. It is the first significant attempt to ‘co-produce’ public services and responds to one of the most important challenges now facing many families and society. Our commitment to put maximum power and control in the hands of people who use services and their families through personal budgets has the potential to be one of the most radical public service reforms for a generation. It represents a major redistribution of power from the state to the citizen which is consistent with our eternal belief in every individual’s fundamental right to self-determination. This is 21st century social justice with an active state empowering and supporting people to control their own lives. Enabling people eligible for public funding to have the control and choice self-funders take for granted.
The challenges are clear. Demographic changes mean people will live longer and increasing numbers will live with chronic conditions such as dementia. Disabled people have the right to live independently as equal citizens and people with mental health problems have the right to a life free of stigma and discrimination. Millions of people make sacrifices every day to care for a relative. The care system which was once of concern to a few is now touching the lives of an increasing number of families from all sections of society. The ‘baby boomers’ are not only contemplating their post-retirement lives but frequently find themselves having to make difficult choices about care for ageing parents. Moreover, the vast majority of people wish to remain in their own home for as long as possible.
Our ambitions for social care and independent living must now match the scale of the challenges we face and the aspirations of service users and their families. This requires a personalised and integrated system. Personalisation means local government, health trusts, other statutory agencies like the DWP, the pensions service, housing authorities and the learning and skills councils must come together with the third and private sectors to focus their shared resources and expertise on improving health and wellbeing in every community. We need to hide the ‘architecture’ and ‘the hard wiring’ while re-organising the system around the needs of each individual requiring support. This means putting people first rather than organisations, systems and artificial professional boundaries.
Alongside significant ringfenced reform funding of £500 million over 3 years, local authorities will be expected to spend some of their existing resources differently, utilise mainstream services to ensure the health and wellbeing of their communities and work in a genuinely collaborative way with third and private sector providers.
NHS organisations in every locality need to match the best collaborative practice in others on issues such as commissioning, local area agreements, co-located services, high quality information and advice and personalised support packages including streamlined assessments and workforce development. This must equal an authentic partnership for a purpose as opposed to a tick in the performance assessment box. Most people never believed it possible, but the Berlin Wall did come down in 1989. If we are to truly personalise public services we will have to finally make a reality of the long-standing and often-stated ambition to ‘demolish the Berlin Wall’ between statutory agencies and their partners in the third and private sectors.
The concordat and the next stage review of the NHS led by Lord Darzi, will demonstrate our determination to create a single health and wellbeing system in every community. A goal which can only be achieved through consistent national policy, effective local leadership, skilled front-line staff and listening to the aspirations of those who use services and their families. Our success will no longer be measured by the synergy between health and social care alone, but the interchange between the NHS, housing, employment, education/training, leisure, transport and environmental services.
There are five elements of our shared vision for transformation:
1. A new relationship between the government, local authorities, the NHS, independent sector providers and the regulator;
2. A major shift of resources and practice to prevention, early intervention and re-enablement;
3.High quality accessible information and advice available to all irrespective of financial means. Self-funders should not be left on their own to make difficult choices about care for themselves or a family member;
4. A commitment to treating carers as expert partners; and
5. Maximum power, control and choice in the hands of people who use services and their Carers.
There is a final element – ‘people power’. We must ensure that every individual with a personal budget and those utilising direct payments have access to advocacy and support according to their particular needs. This must also be available to carers who are in control of a personal budget for a relative or friend. As we move towards personal budgets for all, there will be cultural and regulatory barriers that have to be tackled and ongoing debates about minimum levels of protection for vulnerable people and safeguarding public money. The right to self-determination will on occasions lead to poor or unconventional choices.
Looking to the future, we must ensure that as we explore whether in certain circumstances NHS funding could be included in personal budgets, as suggested in Lord Ara Darzi’s interim report, there are no ‘no-go’ areas. People have been telling us for years that they want integrated support which enables them to have a life not a collection of different services. Personal budgets make that possible by bringing together funding streams from different sources which support individuals wellbeing and capacity to live independently.
The need for system-wide change will cause people to feel anxious and insecure. But, our individual budget pilots, the pioneering work of ‘in control’ and other initiatives undertaken by local authorities have demonstrated that self-directed support leads to better outcomes and a much higher level of user satisfaction.
Many front line professionals, managers, social workers, care workers and personal assistants will want to know what this means for them and it is essential that they are engaged as active participants in every stage of the change process. I believe this agenda has the potential to reinvigorate the social work profession – allowing social workers to act as advocates, advisers and navigators rather than box tickers and form fillers. This will mean less time on assessment and more on helping people to get the support they need. Social workers must no longer be based in office blocks and town halls but in primary care centres and community centres working alongside health and voluntary sector colleagues.
Earlier this year we acknowledged the need for a fundamental review of the adult care funding system in this country. An extensive public consultation will be followed by the publication of a Green Paper in 2008. Our long-term challenge is to secure a new consensus for a new funding settlement between the state and the citizen which is fair and sustainable in the context of rapid demographic change and rising public expectations.
Building on significant extra support for carers over the last 8 years, and following a major countrywide consultation exercise, the prime minister will announce a ‘new deal for carers’ next year. The new standing commission on carers set up by the prime minister to consider long-term challenges and give carers greater recognition and a strong voice in policy development held its first meeting under the leadership of Phillipa Russell this week.
We recognise that our changing society needs a commitment to long-term reform.
But equally those who need our support to live independently and have a good quality of life cannot wait for long-term solutions.
Social care reform opens a new front in New Labour’s commitment to social justice. We are the only party with the ideas and vision which can respond to one of the issues which will most impact on the lives of an increasing number of families in the future.