David BehanDirector General, Social Care, Local Government and Care Partnerships, Department of Health

Health and Social Care: policy and resources 14 April 2011

“Our government’s purpose is to make two major shifts in our political and national life.

The first is a radical redistribution of power from government to communities and people, to reverse decades of over-centralisation.

The second fundamental change is that this government will govern for the long term – taking the decisions necessary to equip Britain for long term success.”Letter from the Prime Minister and Deputy Prime Minister to all Ministers (3 August 2010)

Power shift and horizon shift

Citizenship isn’t a transaction – in which you put your taxes in and get your services out. It’s a relationship- you’re part of something bigger than yourself, and it matters what you think and you feel and you do.

So to get out of the mess we’re in, changing the government is not enough. We need to change the way we think about ourselves, and our role in society.

Your country needs you.

PM Speech, Party Conference, October 2010

The Big Society

The Big Society

“Big Society is about a huge culture change …. … where people in their everyday lives ……don’t always turn to

officials, local authorities or central government for answers to the problems they face … but instead feel both free and

powerful enough to help themselves and their communities”

David Cameron, 19 July 2010

What actually is the big society, let alone is it good or not ? Exactly how big is it now or is it going to be ? Is it, in fact, Ann Widdecombe ? Is it a very British thing ? Or is it another American import ?Daily Telegraph 10 November, quoting Government Minister

The Big Society

Decentralisation

Public service reform

Transparency

Localism

Social Bonds

Behavioural change

Social action

Community empowerment

Mutualisation

Volunteering

The Big Society

The Big Society

CORE ELEMENTS

• Community Empowerment

• Opening up Public Services

• Social Action

PRINCIPLES

• Decentralisation

• Transparency

• Building capacity

Big Society policies and activity in social care

Social ActionOpening up

public services

Community Empowerment

Doing things differently in Social Care

Action on Dementia

• Dementia Declaration• WRVS Dementia Champions• Horsesmouth• Safeguarding becoming “everybody’s business”

• Personal Budgets

• Direct Payments & Individual Budgets

• Social Work Practices

• Munro Review

• Stimulating and enabling active social enterprise, including co-ops, mutuals and micro-enterprise

• Exploring potential of Social Impact Bonds

• Building community capacity through complementary currencies and Timebanking – Large scale test around social care in Royal Borough Windsor and Maidenhead

• New Outcomes Framework • Potential online ratings/feedback for social care

White Paper: Liberating the NHS

• Equity and Excellence: Liberating the NHS describes a system with:

– Patients at the heart of everything

– Outcomes among the best in the world

– Clinicians empowered to deliver results

• To achieve this, it proposes:

– GP Consortia;

– An autonomous NHS Commissioning Board;

– A new role for local authorities; and

– All NHS Trusts will become foundation trusts (FT), or be part of

an FT

Health and Social Care Bill • Secretary of State statement to Parliament• Natural break in the passage of the Bill• Pause, listen, reflect, improve• A pause, not a halt• Principles remain clear• Keen to hear views by 9th May

www.dh.gov.uk/health and care

A bigger role for Local Government

• Within the new NHS system, local councils will have an enhanced role in health:

– Health and Wellbeing Boards

– leading joint strategic needs assessments (JSNA)

– supporting local voice, and the exercise of patient choice

– leading on local health improvement and prevention activity

Public Health - Healthy Lives, Healthy People

– Directors of Public Health (DsPH) jointly appointed by Public

Health Service and Local Councils; employed by Councils;

– Councils, through DsPH, lead on health improvement with ring-

fenced budget;

– First allocations to Councils in April 2013;

– Outcomes framework for Public Health Service;

– Councils free to define contribution to national outcomes;

– Public Health Service will need to work closely with the NHS

• White Paper published November; consultation on outcomes and

scope

A vision for adult social care: Capable communities and active citizens

• Based on seven principles – • personalisation • prevention • plurality • productivity • partnership • protection • people

• Think Local, Act Personal

This vision demonstrates the Government’s values of freedom, fairness and responsibility, shifting power from central to local, from state to citizen, from provider to people who use services.

The case for change – challenges and opportunities

• The probability of needing care in later life is high• Many people can face very high costs• Average lifetime cost of care (including accommodation

costs in residential care for 65 year olds today - around £50,300

• Demand is set to increase by £1.7m by 2030• Office for Budgetary Responsibility suggests that by

2029/30 government will be spending 1.7% on long-term care, compared with 1.2% in 2009/10.

• Life expectancy is increasing; healthy life expectancy is increasing more slowly

• Expectations continue to increase

The case for change – challenges and opportunities

• People can face catastrophic costs • People with the same needs receive different levels of care

depending on where they live • Many people with high needs do not get help from the state towards

paying for their care and support• The different parts of the care and support system do not always

work together• The system as a whole is confusing• Funding for care and support does not provide value for money• You will hear from the Commission on Funding for Care and Support

this afternoon

Next Steps in Reform Journey

Government publishes Vision and Outcomes Consultation

Law Commission publishes its review of adult social care legislation

Commission on the Funding of Care and Support publishes its report

Government publishes Care and Support White Paper

Government publishes Social Care Reform Bill

Nov 2010 Spring 2011 Summer 2011 End 2011 Spring 2012

Health and Social Care Integration

• Health and Well-being Boards to drive the commissioning process at the local level

• Joint Strategic Needs Assessments & Joint Health and Well-being Strategies

• New legal duties to encourage and consider joint working arrangements

• Aligned outcomes frameworks for NHS, public health and social care

• Strengthening the role of the Care Quality Commission• Extending the remit of the National Institute for Health and

Clinical Excellence (NICE) to social care• Establishing HealthWatch to champion the voice of people using

services and carers across both health and social care• Financial resources: £1bn; £70m, £163m for reablement/joint work

Key activity

• Outcome framework• Evidence and efficiency and QIPP• Mental Health Strategy• Dementia• Carers• QIPP

Conclusion

Closer joint work will lead to better quality outcomes for people and better use of the public pound.