12 May 2008
Transcript of a speech given by the Prime Minister at the King’s Fund debate on the Future of Social Care.
Read the speech
Prime Minister:
Can I say first of all I am delighted to be here alongside Ivan Lewis, our Minister, this morning and I want to thank Niall and Cyril for hosting this morning’s meeting. Niall, Cyril and the King’s Fund as a whole have in my view been extremely influential over recent years in many of the changes that we have made and are discussing on social and healthcare policy and in particular the King’s Fund has raised the profile of social care, making the case for reform. So I would like to start by thanking all of you here for your contribution to this debate and by paying tribute to all of you - charities, NHS workers, local government leaders, trades unions, all represented here this morning - I want to thank you for the work you do that is literally transforming the lives of thousands of people all over the country.
I believe that this morning’s event is truly important. It is the opportunity to address one of the most significant and far reaching challenges now facing Britain - how best in the long run to provide care for a population that is living longer and quite rightly demanding better care in old age or where there is disability.
And that is why today the government is publishing a consultation document setting out the challenges we face and why we must now look again at the options for reforming our current system of care and support. This is an issue, I can tell you, that is at the heart of our ambition for a fairer Britain.
At one time or another social care affects all our families. It is something that is raised with me as I go round the country on almost every occasion. I was in Exeter in the south west only on Friday and the very same issues that have been raised with me in other areas, and no doubt will come up today, were being put to me at the events that I held: older people worried that they may become a burden on their families; middle aged people trying to help ageing parents while their own children are still on their way to independence; younger adults aware that much of their parents’ hard earned housing wealth may disappear into payment for long term care; disabled people of all ages who want to lead, rightly so, more independent lives.
And of course helping relatives is a challenge that most families rise to, however difficult it becomes. The family units we value so highly are still the mainstay of informal care for people and what they do in times of greatest need is invaluable. But that doesn’t make it any easier, nor does it remove family worries about providing suitable care, or take away people’s concerns that at some point in the future they may have to sell a treasured home to pay for their own care. And I fully understand these anxieties.
The fact is that despite changes over the last decade - year on year improvements in the quality of care provided by local authorities and private providers; over £120 million now being spent annually on adaptations to help people stay in their own homes; new personal budgets which I welcome to give those needing care the chance to choose for themselves the type of support that is right for them - despite all these changes our current care and support system still requires fundamental reform to ensure it is properly equipped to provide a high quality yet affordable service for all who now need it, and to do so for the foreseeable future.
In particular I think there are three central issues of reform which we need to address. First, as I think everybody here knows, our current system needs to respond to the new pressures - financial, demographic and otherwise. Thanks to better healthcare, new technologies and a more prosperous society we are all living longer. Life expectancy has increased by around 11 years for both men and women since 1948, and children today have the prospect of spending a third of their lives in retirement and seeing their own children retire. At the same time advances in medical science are enabling people with debilitating conditions to live longer and more active lives, and all this represents progress and success. It is a cause for celebration, but without radical reform the provision of care and support throughout later life and through periods of serious illness and disability, it will make even greater demands on both informal carers such as family and friends and on the care system.
There are now more than 15 million people in England with long term conditions ranging from chest disease to heart failure, and of course the after effects of a stroke. The average man now spends nine years living with long term limiting illness, compared to six years in 1981; about a third of all men and a half of all women upon reaching the age of 65 will need long term care and support as they approach the end of their lives. As a result we expect two million more people to have care and support needs in 20 years time.
Our second challenge is that the current system needs to be more personal to people’s needs and to their aspirations as individuals and to deliver the high standards of service people have a right to expect. Now quite rightly people’s expectations have risen in recent years, a generation of older people have shown that they can lead healthy lives well into retirement. With the right support they can remain active and make a full contribution to their society. And people with even severe disabilities have shown that the services which they need most, and appreciate most, are those which empower them and enhance rather than diminish the control they have over their lives.
So our care services need in future to be more responsive to the rising demand for personal care and for independence. We must make it easier for people to be cared for in their own homes so that far fewer people have to move out. We must do much more to give family members and friends who provide care the support they deserve to give it. To achieve this we must therefore put real power and control into the hands of the users of the service, giving them the independence we know they want to make their own decisions about their lives, as we have done with personal budgets.
I saw myself how much difference this makes when I met a group of elderly residents in a special housing complex in Plymouth only last week, and what I found truly impressive there in Plymouth was the help and support that each of them gave each other and the freedom that they now had living in their own self-contained apartments.
And the third challenge is that it is essential that in future there is fairness to those who work hard and save for retirement. We know that differences in entitlement between different areas of the country create uncertainty and anxiety for people when they are most vulnerable. Of course those who have the most need are given the most support, but we know that too many people fear the prospect of selling their homes and using assets which otherwise they would pass on to family members and friends, many of whom will already be contributing to their care informally.
Now there is no easy solution, but measures which succeed in supporting older people in their own homes for as long as possible will certainly help. And this can be matched by a greater use of personal budgets which allows people to get the care that they want and decide to have. But we can and must look to give people the opportunity and the support to save for their old age in a way that insures them and protects their houses and their inheritance.
There are ways forward and as the baby boomers and the NHS hit their sixties together, and as over the next decades the needs of that generation for both health and social care inevitably rise, we must consider both realistically and imaginatively how health and social care might work better together to meet their needs.
With more than half the NHS budget and over two-thirds of that of social care now spent on the over-65s there could be real added value, as everybody here knows, from the closer collaboration that most of us want to see.
So these are in my view the great challenges we face. I believe that now is the time to look at how we can create a new social care and support system fit for the 21st century, a service that is personal to individual needs, giving real control to those needing care and their carers, that values the informal care and support on which our society depends, that gives people who benefit from it access to care in their home, offers us all protection against the costs of care in old age or as a result of disability, and builds a new relationship between the individual, the family, the community and the state.
There are a wide range of options for reform and I am sure there will be plenty of debate and discussion between now and the end of the year and I encourage all those who care about our future and the kind of society we live in to participate. I thank you for the debate that you have ushered in and what you have done to push it forward, and for what you are undertaking to do today and in the future and I look forward to building a consensus in this country about the best way ahead.
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