Paul Burstow – 2012 King’s Fund Speech

Below is the text of the 2012 King’s Fund speech made by Paul Burstow.

Thank you for the invitation to take part in your conference today.

Just seven days have passed since the publication of the Care and Support White Paper and draft Bill.  And of course the progress report on reform of how care is paid for.

I think social care can be described as Beveridge’s or perhaps Bevan’s orphan.  What was left after the birth of the NHS in 1946.

Social care has suffered ever since.  Hidden behind its favoured sibling: the NHS.

For most people social care is out of sight until life takes a turn that tips us into a crisis.

I call it an orphan because social care is not the product of Beveridge’s universalist vision or Bevan’s determination to deliver an NHS.

Social care looks back.  It looks back to older less egalitarian principles.  The mark of the Poor Law rests on the 1948 National Assistance Act.

Not universal.

A safety net for the needy.

Last week that began to change.

Although if you followed the media reporting you could be forgiven for thinking that it was all about who pays for care.

Drawing the line between personal responsibility for meeting our care costs and the State. Deciding where the boundary should fall.

Of course reform of how care is paid for in this country is important. It is something I care deeply about.

It is social care’s nasty little secret: it’s not free.

A secret that is beginning to be more widely understood.

But redrawing the boundary between personal responsibility and State support is not enough.  Not by a long way.

It scratches the surface of a broken system.

So let me say something about that broken system and what we plan to put in its place.

Let me start with a proposition.

I believe morbidity not mortality is the biggest challenge facing our health and care system. Failure to prevent or at least postpone the onset of morbidity, especially co-morbidity, is a huge driver of cost to the individual and to the taxpayer.

And failure to manage morbidity well can tip people into more costly crisis interventions.

So last week the White Paper and the Bill signalled a radical shift in policy and practice. Away from a system that stutters into life only once the crisis has arrived. To one focused on wellbeing, prevention and early intervention.

So the challenge is not just how we support people with co-morbidity.  It’s how we tackle the causes themselves.  Those wider determinants of health and wellbeing.

It is that convergence between public health, social work and health that is the really exciting opportunity.

A new paradigm that looks to the assets people and communities have – not just their deficits and gaps.

The talents, the networks of mutual support.

This asset based approach is at the heart of the White Paper and the Bill.

It is also part of the draft JSNA guidance that we are consulting on.

Let me illustrate what I mean.

I have talked a lot recently about loneliness.

I’ve called it a hidden killer.

There is mounting evidence of the impact on a person’s wellbeing and health of loneliness. The absence of connectedness.

Put simply, relationships matter. They are critical to personal resilience. They confer a health benefit.

Tackling those wider determinants of health and wellbeing are exactly why I successfully made the case for public health coming home to local government and for the establishment of Health and Wellbeing Boards.

And this central idea of wellbeing is at the heart of the Care and Support Bill.

The idea that the system is the servant of the individual. That decision-making should be centred on the person with needs: whether service user or carer.

And that idea of ‘no decision about me without me’ is crucial. The response should be co-produced and about meeting the personal goals of the individual.

And for the first time the draft Bill creates the framework for a universal social care offer from local authorities.

Information and advice so that people can plan and prepare.

Prevention

Sufficiency and quality of service to support choice

Integration and co-operation – going beyond the NHS and social care to include housing too.

And the Bill goes even further than that.

It clarifies the point at which the state will start to offer support by setting a national minimum eligibility threshold for the first time.

It does something no Government Bill has ever done before.  It recognises the role of family carers.  Establishing for the first time an entitlement to support for eligible needs.

A major milestone.

30 years ago the Carers National Association, now Carers UK, was denied charitable status because it was thought there was no such group of people.

The Bill also provides protection from disrupted care, either when moving from one part of the country to another or for young people as they transition to adult services.

And as I have already said the Bill enshrines the idea of person centeredness.  That idea is given further substance with the provisions for personal budgets.

Indeed since I first set the ambition of everyone eligible for a personal budget receiving one in 2010 I can report that the number of people receiving a personal budget has increased from 168,000 to 432,000.  Over half over people eligible for a budget.

So a Bill full of reform.

Let me return to reform of who pays for care.

Let me be clear.  The Government has made significant progress on funding reform. We have accepted the principles of the Dilnot Commission’s model and a number of the Commission’s other recommendations. Many of those recommendations are translated into the draft Bill.

That was an important milestone on this long road of funding reform.

Something else important happened in the past week.

Liberal Democrat, Conservative and Labour all endorsed the Dilnot model of a cap on life time care costs and an increase in the means test threshold to £100,000.

There is now a consensus about the principles of the reform.  We now must move from consensus to settlement.

There are design questions still to be considered.  Trade-offs to be weighed.

Would a higher cap offer similar benefits at lower cost?

Could a voluntary or opt-in scheme ensure that those who benefit most pay?

But with all public spending hemmed in by the economic situation it is right that final decisions will be made in the next Spending Review.

In the meantime we are pressing ahead with the introduction of a universal deferred payment scheme.  A scheme we will consult on.  A scheme we will fund.  A scheme that will come into operation in 2015.

That leads me to the question of funding.

Before the 2010 spending review the Dilnot Commission urged the Government to protect baseline funding for social care.

We did just that.

In October 2010 we confirmed an extra £7.2 billion of support for adult social care which together with a programme of efficiency was sufficient to protect access to support.

This included an unprecedented £3.8 billion of NHS resources to support social care to promote integration and service transformation.

So how are Councils coping?

It’s easy to simplify – to oversimplify.  To caricature even.

The truth is the picture is complex.

Are Councils struggling with a tough budget settlement.  Yes.

Are some Councils coping better than others.  Yes.

I want to acknowledge the difficulties.  I also want to applaud the ways some Councils have risen to the challenge and are protecting vulnerable people.

I won’t tar every Council with the same brush, as crude cutters of social care.

Different Councils are responding to the pressures in different ways.  Some are being smart, others are resorting to easy, short-sighted cuts.

The smart ones are working with service users, carers and providers to innovate and redesign services.  Using the investment in reablement.  Looking to integrate.  Sharing back office functions.

Such as in Greenwich where they have redesigned their care management system, creating integrated teams with the local NHS Community Health partners, care managers, occupational therapists, district nurses and others. They manage the care pathways around hospital admissions, reducing emergency admissions, and delivering better discharge planning into intermediate care and reablement. The service has not only created £800,000 of efficiency savings but has also won the HSJ Award for Staff Engagement for 2012.

Another is Wiltshire, who have transformed their provision of domiciliary care. They have managed to reduce delivery costs by 20-25% through tighter geographic organisation of provision, the integration of housing support, reablement and low level preventive services, and the introduction of automated billing. As part of the new contracts the council has introduced a payment by results system. The results must improve independence and quality of life, delay deterioration or prevent harm.

The examples of Greenwich and Wiltshire, and there are many more, show what is possible, and show how services can improve despite tough economic times.

The latest budget survey from the Association of Directors of Adult Social Services reveals Councils protecting frontline care.  In 2011 for every £1 saved 69 pence came through greater efficiency.  This year that rose to 77 pence.

Overall, the latest budget data from the Communities and Local Government Department point to a planned reduction in spending on adult social care of around 1 per cent this year.

At no point have we publicly or privately suggested that the Government would reopen the 2010 Spending Review or bring forward the next Spending Review.

So it should have come as no surprise to anyone, that a little over a year into the Spending Period the Government has not embarked on a mini spending review for social care.

Nonetheless, we have been able to secure £300 million more NHS support for integration and innovation in 2013/15.

This sum of money is more than sufficient to meet the costs of our reforms in their early years.

Before I draw my remarks to a close, I want to say a few words about integration.

The Health and Social Care Act creates a legal framework that promotes and enables integration.  Every part of the system has it hardwired into itsDNA.

The draft Bill gives Councils a matching duty.

The White Paper sets out our intention to measure people’s experience of integrated health and care; align incentives to support integration and focus on delivering person centred co-ordinated care for older people.

But just as our genes don’t determine everything we do.  We know leadership counts too.  Which is why the White Paper signals a major drive to support collaborative leadership.

There is still a huge amount that I have not covered today.

Action on quality:

Greater provider transparency.

Tackling care billed by the minute.

A new vision for care homes.

Doubling the number of care apprenticeships to 100,000.

The first ever national minimum training standards for care workers.

Action on safeguarding.

Action on end of life care.

Action on housing:

£200 million to support the growth of specialist housing.

New opportunities for home improvement agencies.

The White Paper contains a rich agenda of action and reform.

Taken together with the draft Bill, with or without funding reform it amounts to the most comprehensive overhaul of social care for 60 years.

Paul Burstow – 2012 Speech at Community Care Live

Below is the text of the speech made by Paul Burstow on 17th May 2013 at Community Care Live.

Thank you Penny [Thompson, GSCC CEO].

And thank you for the work you have done over these past two years.

For your leadership and determination to move the profession forward.

And it is the future of social work – particularly of adult social work – that I want to talk about today.

Social work at its best is extraordinary.

You enrich people’s lives, you solve problems and you make change happen.

But.

Let’s be honest, social work and social care are often in the news for all the wrong reasons.

When things go wrong.

The talk is of crisis management.

Of abuse and neglect.

While failures are splashed across the media your successes go uncelebrated and certainly unreported.

Shortly the Government will publish a White Paper setting out how we plan to reform care and support in England.

While I can’t talk in detail about the White Paper today I can tell you that social work will be critical to its success.

Why?

Because at its best social work can have such a huge and positive impact on people’s lives…

That is why we need to do everything we can to encourage and support the best people to become social workers and social care workers.

Everything we can to help them to be the best they can possibly be, every single day, and above all make sure that the person receiving care and support is at the centre of your practice.

That is what we will do and it is what, together, we are doing now.

Strengthening and supporting the workforce, driving up the quality of care and personalising care formed three key elements that were discussed during the course of the Autumn last year during our Caring for our future engagement and fed into our thinking around the White Paper.

And these principles will be echoed in the Bill that will follow shortly too.

I am sure you will all have noticed that last week, despite what many were predicting, the government confirmed its commitment to a Care and Support Bill in the Queen’s Speech last week and we’ll be publishing a draft Bill shortly.

But what does this mean in terms of the coalition’s vision for social care?

And how do you fit in?

Radical Social Work

The idea of social workers playing a greater role in ‘joining up the dots’ for people in acting to prevent and postpone the need for formal care and support is nothing new.

What is new, is a Government that truly embraces this idea, one that displays a desire to see this vision become a reality in more than just a few areas across the country.

Some people call it local area co-ordination, some call it connected care and others call it asset-based community development.

Simply put, it is a vision for social work that is no longer based on one that only reacts in a crisis.

Instead, we want social workers to look to people’s assets – whether that be a talent for gardening or a supportive friend – to build resilience through relationships, to foster those informal networks of family and community that give meaning and purpose to people’s lives.

This is not about buying and selling a service.

I am talking about starting with a different question.

Asking what a person’s goals are, what their gifts and talents are. What they can achieve and want to achieve themselves.

This is a system serious about prevention.

– which prevents people from becoming socially isolated,

– protects them from declining health,

– and helps them to be active members of society for as long as possible.

This is not about prescribing practice, it is about scaling up best practice.

There is great work being done, so in a very real sense the future of social work and social care already exists. Putting it all together is where the transformation comes.

From Darlington to Suffolk and Basildon, councils are tailoring this vision to local needs and demands.

These councils and many others are challenging the age-old concept of seeing care and support as merely a service to make people better.

And we won’t just build social capital by making a reality of this kind of vision.

There is emerging evidence that shows these approaches make economic sense too. Studies into Turning Point’s ‘Connected Care’ project, for example, have shown that savings of £2.50 can be made for every £1 invested in these sort of approaches.

In short, in preparing the White Paper and draft Bill we are strongly considering the crucial role that support networks and asset-based approaches can play in allowing people to lead the life they want to lead.

Workforce

Now, changing systems is one thing, but all the system change in the world won’t matter if we don’t get the culture right and that means supporting the people working within the system – supporting you.

You may by now have discerned that I think relationships matter.

And when it comes to formal care and support, the single most important relationship is the one between the social worker or the social care worker and the person who needs care, their carers and family.

If the relationship is strong and built on mutual respect then it can make the world of difference.

As professionals with great responsibilities, you need to have the right training and support throughout your careers. And there is a lot going on here.

The Social Work Reform Board has been hard at work looking at how we can improve the quality of the curriculum for social work – we’re currently consulting on the best way to use the Social Work Bursary to attract new top talent. If you haven’t already contributed to the consultation about the bursary, please do get involved.

And while we’re talking about the Reform Board, I’d very much like to thank Moira Gibb and the other members of the Board for the incredible work they have done, leading and transforming the profession.

And also to Maurice Bates and Corrine May-Chalal for leading the development of the new College of Social Work.

The College, working with ADASS, Skills for Care and others, is currently establishing an Adults Faculty, shining a new spotlight on social work with adults.

And, in the coming year there will be more done to strengthen the social work. This includes:

– implementing the assessed and supported year in employment in September to give students stronger practical grounding in their chosen career,

– putting in place a Professional Capabilities Framework that sets out the skills and knowledge you need at different points in your career,

– and strengthening the entry requirements for social work degrees from September 2013, thus emphasising the value of good quality social work.

And we haven’t forgotten social care workers. Skills for Care and Skills for Health are working together to develop a code of conduct and suggested training requirements for health support workers and care workers, which will not only help to improve the skills and competence of staff, but also improve the reputation of the profession, which is crucial for both its stability and sustainability.

Funding of care services

Of course, I know that one of the main concerns when it comes to social care is money.

But that doesn’t mean there aren’t ways to make the money that is in the system go further and deliver better results as well.

Last year when I spoke at this conference there was a healthy dose of scepticism about what I called an unprecedented transfer of money from the NHS to local authorities – £648m last year.

Some said it would never happen, the money would never arrive.

But it did.

Of course there are real pressures on local authority budgets, I won’t deny that.

But acting as a high dependency crisis service is unsustainable.

Quite simply the choice is this, it’s on a retrench or reform.

Radically changing the way we think about and deliver social care in a way that chimes with the asset rich approach I’ve just outlined.

I do not think this is pie in the sky. Last year, a report by Demos, ‘Coping with the Cuts’, showed how councils who take a radical and creative approach to social care can protect the frontline while delivering better quality care.

Leadership

The places that are daring to do things differently have one thing in common.

Effective leadership.

Leadership will be central to the future of social work and social care. It’s what we heard time and again during the Caring for our future engagement, and it’s what we believe will really make the difference.

And here I’m not only talking about leadership at the very top, but at all levels. While high-level leadership is vital – and Government is committed to the recruitment of a Chief Social Worker which will help to bring coherence and drive to the profession – the real job is to be done on the ground, at practice level.

When it comes to pushing the boundaries and exploring what’s possible with local leadership, the Social Work Practice Pilots are also leading the way. These social enterprises, led by social workers who are actively engaged in social work practice, will seek to improve the lives of and adults by empowering the front line and cutting bureaucracy.

So whether it’s working with hard to reach groups in Lambeth or people with disabilities in Birmingham, change and innovation is coming.

Conclusion

I have no doubt – certainly not from this government or in my mind – of the vital importance of social work.

Government can do many things.

It can legislate for a simpler system and we will.

It can provide national leadership on the issues that count and we will.

It can create an environment where quality is expected and demanded and where those who are entrusted with delivering it are held to account and we will.

But you are the ones who will make this work. You will be the ones to make the difference, and we want to support you to make this happen.

And I have faith that you will.

Thank you.