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08 February 2010
Shotlist Ref: R08021003
POLITICS / HEALTH: Gordon Brown speech on health and social care reform
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PM Gordon Brown gave a speech on social and personal care at Kings Fund, Cavendish Sq. Brown announced new measures so cancer patients would get one-on-one personal care throughout their treatment.
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ENGLAND: London:INT
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Gordon Brown MP (Prime Minister) along into room, shaking hands with delegates, then along to take seat on stage / Anna Dixon (Acting Chief Executive, King's Fund) introduction SOT
Gordon Brown MP (Prime Minister) speech SOT
- Let me begin by thanking the King's Fund for hosting this event today. And let me pay tribute to your work. At a time when we are discussing the future of health and social care in Britain - it is fitting that we should meet here. For more than a century the King's Fund has been at the cutting edge of analysis and original thinking on healthcare policy. And I chose to launch the biggest debate we have ever had on the future of our care system - here at the King's Fund because you are at the forefront of thinking on this too....
- Today I want to talk frankly about the demographic and social changes happening in Britain today - with its ageing population and rising expectations - and the choices we face as a country as we respond to them. In particular I will set out how our NHS and care system - on which so many families on middle and modest incomes rely - will need to be reshaped in response to these changes. But we should remember that huge reforms have already taken place. From the earliest post-war days onwards, when the state provided key services, but choices were few - take it or leave it. That was the first generation of public services. More recently, a second generation of better public services has been developed through increased investment, greater choice for service users, and the introduction, where appropriate, of contestability and competition. Now we stand ready to build on this platform of reform to create third generation services that through continued reform will be shaped and driven by people themselves, meeting their needs throughout their lives, not just in institutional settings, but in the community, the workplace and, crucially too, in the home. Services that meet the challenges of our ageing society, where personalised care and a commitment to maintaining independence are vital. Services that will be affordable as we ensure the deficit reduction plan halves the deficit over the next four years. And services that will match not only the changing needs but the rising aspirations of the British people.
- Families want public services that are not 'take it or leave it' but personal to their needs; tailored to their aspirations and responsive to their choices and decisions about how they want to run their own lives.
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Brown speech SOT- So there is a choice. Either we settle for public services that do not continue to demand of our public services the highest of standards and are more like the days of the 'take it or leave it' approach, putting the citizen second and failing to meet the aspirations of middle Britain for personalised and individual care. Or we enter the next stage of reform - to offer services which are universal - but also personal to people's needs: public services which are effective and affordable because they are cost-efficient too; personal services that are in tune with the aspirations of modern families. Nowhere is this more important than in our NHS and social care services. One future is the path which puts services firmly on the side of users and in the hands of the public - and the way to do this is to ensure for every family the personal guarantees of NHS treatment and through the National Care Service guarantees of care also. And another future is to take the NHS backwards. Away from demanding standards and rejecting guarantees - instead allowing a lottery of care - and the result will be a failure to meet the rising aspirations of millions of people who depend for themselves and their families on the NHS.
- So this is the choice our country now faces: a choice that Britain cannot put off, because it will define the future of health and social care for generations. But as we begin this debate - let me first pay tribute to the many thousands of Britons working day in day out in our NHS and in our caring professions. And let me say how pleased I am to be here with so many of you this morning. Because you are our National Health Service and you are the future of our care system. The care that you give makes a difference to millions of people. The compassion you show will make the NHS a genuinely personal service and will offer the greatest hope for better care.
- Too often governments can seem to under-estimate the critical importance of the partnership with the front line. But it is you who have made possible the unprecedented improvements we have delivered in our National Health Service over the past 12 years. So any discussion over the future of health and social care has to begin with you. And - as we think about the challenges we face together and the changes we must bring about in our NHS and in social care over the next decade - I am clear that it must be in dialogue and in partnership with all of you. This is why I have come here to set out our third stage of reform in health and social care. And we are committed to showing how we can combine the universal and the personal - across our NHS and our wider system of care and support.
- Our deficit reduction plan will ensure we halve the deficit in four years. In 1997 I had to cut public expenditure to reduce our debt. And in the last spending round we cut public expenditure for seven departments. In the next few years - and because of our decisions on national insurance - we are committed to maintaining real term spending on the front line services of the NHS. To make the most of these resources the NHS will have to become more cost effective in its use of money but the investment we have made and are making is the foundation in which we will offer a service that gives new guarantees about personalised care. So let me talk about our NHS and how our reforms for the next five years will seek to strengthen this universal offer but ensure it is also personalised to each individual. Through our investment and reform - and through so much of your hard work - we have together changed the NHS for the better over the last decade.
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Brown speech SOT- We've increased the health budget in real terms by over 100 per cent. And today there are over 89,000 more nurses, over 44,000 more doctors, over 13,000 more consultants and 7,000 more GPs. But the results of that are big too. Only by working with you have in-patient waiting lists come down by over half a million — with treatment waits down from 13.2 weeks in 1997 to 4.9 weeks today. But, having improved the NHS, we know that people's aspirations for personalised care are much higher than once they were; and that people want to know the NHS will be there for them when their families need it, and that its care is of a world-class standard. They want more than the hope of that high standard care, or even the objective to deliver that high standard care. They want the guarantees. So we must push forward with new and ever more stretching guarantees to secure for every family the right to get the best possible personalised health care when and where they need it. Our aim is personal care whenever you need it, to the standard you need it - and as quickly as you need it. Others reject this idea of the way forward for health care and would deny families this right - we are clear. We believe in offering everyone a personal guarantee not a gamble - legally enforceable rights to protect people in an uncertain world. Rights matched by responsibilities, yes - rights that match people's aspirations also. Some will question whether we can afford these guarantees given the fiscal constraints we face so let me answer this directly. The unparalled investment of the last decade, together with our decision to protect the whole of the frontline NHS budget, has put the NHS in a stronger and more resilient position than ever before. New hospitals have been built, new services delivered, the backlog of waiting times brought down. Most crucially though, we have the strength and commitment to see through further tough reforms - fundamental changes to community services, the necessary decisions on pay, better ways of working, a shift in emphasis to keeping people healthy and active and a shift in care from the hospital to the community.
- Over the next few years we believe we can save up to 20 billion pounds - reinvesting this in the NHS in pursuit of the highest healthcare standards in the world. So through the NHS constitution we are moving beyond the old regime of targets - necessary to push for the higher standards we have achieved - and establishing clear legally backed individual guarantees to care: universal, wherever you live, whatever your background, guarantees based on need and not ability to pay. Underwritten by a simple pledge, the NHS will meet these guarantees or we will ensure that you can receive them from the private sector. Guarantees that are a new incentive for reform that will ensure NHS staff deliver the highest standards possible.
- The Cancer Guarantee is the right for anyone with suspected cancer to see a specialist within two weeks of diagnosis. We now know the evidence: early screening, early diagnosis and early treatment mean that instead of cancer of the breast or bowel being the death sentence it once was, survival rates in excess of 90 per cent are now possible. So in the coming Parliament we will take this guarantee further to ensure that in addition to rapid access to specialist care, all cancer tests will be completed and results given in just one week.
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Brown speech SOT- The Waiting Time Guarantee: that there will be no return to the long-waits which plagued the NHS before 1997. Our guarantee is that no-one should wait longer than 18 weeks from the moment of GP referral to hospital treatment. Today in fact the average wait is less than 10 weeks. The GP Access Guarantee: we intend that everyone will have the choice of GP services open on evenings or at weekends in their area. And to back this up we will abolish GP practice boundaries so that everyone can register with the GP most convenient for their needs, be that near their home or place of work. And a Health Check Guarantee. In the next parliament everyone between 40 and 74 offered a regular health check on the NHS - something for too long available only if you paid in the private sector. So we choose, through guarantees, to provide a universal service of high standards personal to all - not a lottery of care where those most in need are most likely to suffer. If we are to offer people truly personalised care we must also commit to far wider reform in our community and primary healthcare services. In the NHS as well as through a new National Care Service we want to extend the offer of care in the home. This will be at the heart of our vision for the NHS and for social care in the next Parliament. Choice, control and personalisation is not just something for the young - the choices people make later in their lives might be different, but the right to a choice, to personalised care is just as important if not more so.
- So Andy Burnham will bring forward proposals to extend the entitlements that people have to specialist care in their home - care in chemotherapy dialysis and in other areas too.
- And let me take this opportunity to pay tribute to Marie Curie Cancer Care who are doing so much across the NHS to ensure that everyone who wants to die at home has the right to do so, and let me say now that we will commit ourselves to support them in this work of change. A clear entitlement to this choice is possible within the next few years and we are determined to deliver it.
- But perhaps the greatest potential to transform the experience of patients is access to personalised one-to-one care when they are most in need. When faced with the fears and uncertainties of a serious illness, dedicated nursing, such as that provided by Macmillan Nurses, has the potential to transform the experience of care for the patient and their family too. Not just improving the outcomes of care, but helping them to understand their choices and options.
- At the centre of our vision to transform community services will be a commitment to dedicated nursing for those who need it. And nowhere is this more crucial than for cancer patients. So let me be clear today, our plans to reform our community and primary care services will include a commitment to deliver over the next five years dedicated nursing for all cancer patients - a commitment that we expect will benefit around 1.6 million patients, offering truly first class care, in their own homes.
- These bold plans for reform will be part of our ambition to create an NHS which focuses far more on prevention and early intervention; keeping people healthy wherever possible. By better preventive care we believe we can save 10,000 lives through a greater focus on early detection of cancer and a guarantee of one-week cancer tests. We believe we can prevent as many as 10,000 heart attacks and strokes each year through a guarantee of health checks on the NHS for those over 40.
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Brown speech SOT- Our plans for an improved offer for patients with long-term conditions will mean fewer people needing to suffer acute admissions to hospital, and many more of those who are elderly and frail avoiding unnecessary emergency care. If we are successful we believe we can improve millions of lives and by better management of long term conditions -with less need for acute admission, more people managing their own conditions in their own homes, fewer emergencies - we can save more than 2 billion pounds over the next three years all of which can be reinvested into the NHS, into services with the personal benefits of new dedicated nursing.
- So in our NHS we must increase the pace of reform to deliver. But let me be clear today. Nowhere is the need for guarantees greater, nowhere is the case for more personalised care stronger - and therefore the need for reform more pressing - than in the delivery of health and social care for older people.
- Let me explain why. Since the foundation of the NHS in 1948, the percentage of over 65s in the population has risen by more than half. That of over 75s more than doubled. And that of over 85s more than quadrupled Too often the change to an older society is seen by our sometimes youth-focused culture as a threat or a burden. As a country we need to recognise that it has the potential to be a far more positive change affecting not just our public services but also the shape and character of our society. For our families, I believe it can be a change for the better. More children will know their grandparents and even their great grandparents. We will see a much bigger role for extended families.
- Informal caring, which is already so vital in so many of our families and communities, will become even more important - one of the intangible assets on which our prosperity and health as a nation depends. And with new opportunities in later life, to work, volunteer, and contribute in retirement, our older people can find themselves much more at the heart of our communities, and less and less isolated on the fringes. How we respond to this change will define Britain for years to come. It's a response which cannot be made by government alone, but to which we, a society as a whole, must find an answer.
- If we are to be a successful country in this new era we need a society which: Values the contribution of older people, of wisdom and experience - not diminishing or marginalising people because of age alone; Never sees age as a bar to success or to a meaningful contribution but rather makes the most of people’s talents for the whole of their lives; Recognises our duty to offer dignity and security in old age to all and the vital importance of care in ensuring that.
- So my message today is that as a society we must see this profound demographic change in Britain as an opportunity and not a threat. But if we are to greet this future with the optimism it deserves we must be prepared to make radical changes in how we think now about the future of not just our NHS but our system of social care - and of how they work together. And the same challenge of providing services which are universal but personal to individual needs is even more essential here. Caring for older people well is the hallmark of a civilised society.
- Last summer Sarah and I spent a few days helping in a local hospice near our home in Scotland. It was a humbling experience to witness first hand the care and compassion shown by volunteers and staff for some of our most vulnerable people in their final weeks and days. And I can tell you now that it greatly strengthened my personal resolve to make better care for older people a priority.
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Brown speech SOT- It's not enough for people to hope that care will be there when they need it; or for government to have vague aspirations and good intentions that most will receive the best of care. If people are to be free of worry, and to get on with their lives, they need assurances about the care they might need in future: assurances in the form of guarantees that they know will be there for them; and that they can see being enforced if things go wrong. The fundamental premise of the National Health Service, when first created over 60 years ago, was that it would protect middle and modest income families from the fear of the catastrophic costs of health care.
- We made these decisions as a nation in the post-war era and at a time of great economic difficulty. We could have written off the proposed NHS as unachievable. We could have said it was too expensive. We could have said it was beyond our grasp. And of course there were some who said exactly that. But the visionary architects of the first welfare state had the courage and resolve to set in train the greatest universal healthcare system in the world. Our conviction today is that in our ageing - but no less aspirational - society, we should now match the values of the national health service with the creation of a national care service - one which enables the National Health Service and local government social care services to work together to shift decisively from a model which sees too many people in hospital or residential care, and too little support and care at home; to one which intervenes early to keep people active and healthy wherever possible - and provides the care to enable them to live with dignity - and far longer - in their own homes.
- And as with our health guarantees, our new National Care Service will set and achieve guaranteed standards of care for all - and bring to an end the current postcode lottery. Too often the right kind of care is not there when it matters most - when a frail patient with a simple infection who can be treated at home by her GP has to be admitted to hospital because a few days of simple nursing, rehabilitation, and social care is not available at home. And too often, that hospital admission may mean she will never see her home again, but go from hospital direct to a care home. Or when older people in hospital linger when their treatment has been completed because the services they need to return home - nursing care, rehabilitation, and simple domestic support - are difficult to organise, or simply not there at all. The absence of care at home has consequences - often in the form of unnecessary and expensive care elsewhere. Consider this fact: some NHS trusts use four times as many bed-days a year than others for older people admitted repeatedly and often unnecessarily. And for too long in England we have tolerated a care system which sees tens of thousands of people who would prefer to be cared for in their own homes go needlessly into residential care, with all the cost and losses that entails.
- As a landmark study from the Joseph Rowntree Foundation put it, older people make a "clear distinction between being at home and being in a home. Being at home meant they could exercise choice and control over what they did, when they did it and with whom. Being in a home would mean following a regime set down by the institution".
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Brown speech SOT- So I make no apology for saying that the central aim of reform should be to enable many more people to be cared for longer in their own homes. We have already set out our first Care Guarantee - that those with the highest needs will be supported in their homes, avoiding charges and fees, regardless of their means, benefiting from additional services to ensure they have the choice to avoid residential care if they want. Our Personal Care at Home Bill now passing through Parliament is intended to achieve exactly this goal. From this October, we will remove charges and fees from 280,000 people with the highest needs for care in their own homes. And we will begin the process of offering national access to re-ablement and rehabilitation services which offer people - who may have had a fall or a minor illness - the kind of intensive support that can help them recover, and remain in their own homes. In this way, the Bill marks an important step on the road to fundamental long term reform of social care: It helps people stay in their own homes for longer and out of unnecessary residential care or hospital stays, an objective which must be at the heart of the National Care Service; It establishes new national rights to care, overcoming local means-tests and charges, without which a truly National Care Service is impossible; and It promotes a key element of the long term fiscal sustainability of social care, which is to prevent escalating costs from unnecessary institutional provision. And I can confirm today that our plans for a new national care service will include a clear commitment to roll out to every area of the country the kind of re-ablement and rehabilitation services I saw this morning in Newham. This means that to help with the transition back home after a hospital stay, a residential care stay, or simply a fall or accident, people in every community will have access to intensive support services, for between four and six weeks. And the vast majority of beneficiaries will be older people on middle incomes or with lower incomes who struggle daily with the costs and problems of living with frailty and disability. They manage now, often with the help of their families and communities, but to imagine them as affluent is simply wrong. The truth is they ask for so little and deserve so much.
- Full reform of health and social care for older people will take some time. But by acting now - with free personal care and more practical help in the form of rehabilitation - we can help more people stay in their own homes, and do so right away, giving many thousands the chance to avoid entering residential care against their wishes and at great human and economic cost.
- Central to a National Care Service is more personalisation, more choice and more control for people and their families - with the right care in the right place at the right time. So universal guarantees, but also a more personal offer, will be the guiding principles of care reform and our new National Care Service.
- Of course a national system does not mean a huge top-down bureaucracy. As with the NHS, we believe in a plurality of provision and in local decisions - the NHS working in partnership with local care services to secure effective and efficient provision - with creative and innovative approaches to this challenge spreading from the best around the country. However, as with the NHS, we are clear we need guaranteed entitlements. And just like our NHS, are National Care Service must also focus on prevention and early intervention. This is the only way we can be sure of achieving the outcomes which we all want for those who need care. And it is the only way in which we can ensure reform is sustainable and affordable.
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Brown speech SOT- Without reform we face as a nation rising costs from care - as individuals, as families, and as a state. As today's report from the team at Birmingham’s health services management centre tells us: if we do not act, costs of care could double within two decades. But the same report argues explicitly how a radically improved social care system could generate significant savings - with costs as a share of GDP contained close to their current level by: Cutting hospital admissions of over 65s by more than a fifth. Saving 1.20 on emergency bed days for every 1 pound invested in prevention. Generating 800 million pounds extra spending capacity and reducing inactive benefit spending by £300 million by supporting users of social care back into work.And adding 1.5 billion pounds to the economy by giving greater support to carers to carry on working for longer.
- And just last week the CBI too argued that much more care could be delivered at home or in the community and by a range of different providers and that this would reduce the number of costly hospital admissions and could save around 15 billion pounds by 2015. So not only can a National Care Service be the guarantor of better quality and personalised care for all, but it also gives us an opportunity to move on from costly and inefficient forms of care. Opposing reform is the fiscally irresponsible course of action at a time when we must be looking to ensure that every pound, whether public and private, is used wisely - when failure to act increases the costs of ageing and simply wastes money. We know also we are not asking for the impossible: already a number of pioneering local authorities and PCTs have achieved great things - providing dignity and support at home, reducing unnecessary care elsewhere, and reducing overall costs too. In places as different as Knowsley on Merseyside and the Isle of Wight off the south coast they have shown the way in what can be done - with highly effective partnership working between NHS and local social care practitioners, overcoming traditional demarcations between professionals and the services they offer - and putting people first. It would have been easy in 1948 for government to concede meekly that our public services and welfare systems could not be a priority in such times. But they kept to their vision, and we all know what they achieved. An NHS that delivers quality, equity and cost-effectiveness in health care: a remarkable and internationally lauded achievement we must now match more widely - for the better care of our ageing society.
- Today the challenge could not be greater. We face a clear choice between: Reform and a radically improved health and care services with guarantees that meet the need for more, better, and more personalised care at home. And the alternative - rejecting our guarantees for personalised care, undermining high standards in the NHS, and sending our country back into a spiral of poor and fragmented care, damaged growth, greater means testing and rising costs because they do not understand the needs and aspirations of families today. Our choice is clear. For personalised, reformed and guaranteed health and social care services that meet the aspirations of the people of Britain
Brown along to take seat on stage / Brown thanking delegates and departing room
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