Tapping the hidden assets: Address to the Social Service Conference 2004

I would like to start by thanking ADSS and the LGA for inviting me to take part in your conference here this year. It really is very good to be here in Newcastle.

I have been attending your conference on and off now for the last seven years. Social care is never boring. There are always plenty of challenges facing practitioners and local politicians.

Some of those challenges are an ever present feature of the social care landscape. Budget pressures, staff shortages, making sense of the legislation the Government churns out.

Some challenges come and go. New targets, new Ministers, Ministers in search of new visions.

Challenges aplenty. So lets start with those budget pressures.

I remember standing in the wings listening to Alan Milburn addressing this conference just two years ago. He had welcome news.

He said:

"In the lead up to the Budget I fought for those extra resources. The Budget secured them. From April 2003, for the next three years, real growth in social services investment will double compared to the last three years. Whereas just six years ago real terms spending on social services was rising by just 0.1% a year it is now set to rise by 6% a year."

That was great news. Social care was no longer to be the poor relation to the NHS. After years of famine social care was going to see some real terms growth. At long last a Secretary of State for Health had acknowledgement that the NHS and social care were two sides of the same coin.

Three years of growth.

Three years of growth.

But lets not get carried away. Just three years of growth. Just three years to fix and put right decades of underinvestment.

Under John Reid social care seems to be back to square one. The poor relation of the NHS. When it comes to sustained investment the NHS and social care share two things in common. They share two numbers. The number Two and the number Seven. It's all a matter of which way round you read them. For the NHS the seven comes first. A 7.2 per cent real terms increase in NHS spending up to 2008. For social care the two comes first. A 2.7 per cent real terms increase in social care spending up to 2008.

After three years of growth where are we today? According to the LGA last year there was a £1 billion shortfall in social care budgets up and down the land. This year budgets for both children and adults are overspent. Making up the shortfall is getting harder and harder. With the ring fencing of education budgets getting tighter and tighter social care budgets are under intense pressure. The budget is balanced by more rationing, more charges, and more service cuts.

I agree with Dame Denise Platt. Budget pressures there may be but they cannot be an excuse for not delivering the very best support, help and care to all who need it. But just because it is not an excuse does not mean it is not a problem. A problem to get angry about.

Social care needs sustained investment not boom and bust budgeting. Social care needs to be treated as an equal to the NHS.

When it came to delivering a sustained increase in resources to the NHS Labour's first term was marred by false starts. First they stuck to Tory spending plans for two years. Then they over claimed for their increased spending for the next two years. And at the 2001 General Election they were unwilling to tell the truth and make the case for a tax increase to pay for a better NHS.

I am proud to be a member of a Party that had the courage to argue that case during the General Election. Charles Kennedy put it in simple terms: you don't get something for nothing.

Only after polling day did Chancellor Brown find the justification the tax increased necessary to pay for a massive and sustained increase in NHS funding. He found it in Derek Wanless's report Securing Our Future Health. It made a powerful case for increased investment. But Wanless was only asked to look at healthcare spending. Reading his report it is clear that he soon realised just how interconnected health and social care are. The report is full of references to social care and the need for a similar examination. Sadly no such exercise has been commissioned.

I believe that social care needs sustained investment. But I am not willing to sign a blank cheque. As part of our first comprehensive review of spending a Liberal Democrat Government will commission a Wanless type review of social care spending.

While more money is necessary to oil the wheels. More money is not itself a sufficient answer. There must be more integrated commissioning and more integrated delivery of services. To get the most out of every pound the taxpayer invests in health and social care. Decisions about the what, where, who, how and why of commissioning should be made locally. Those who make the decisions should be answerable locally for their decisions.

That is why in Government Liberal Democrats would legislate to give local authorities the job of commissioning healthcare as well as social care. And to get things moving quickly we would use existing powers under the 1999 Health Act to pilot local authority led commissioning.

As Health Secretary I would call for volunteers to work with the Department of Health as pathfinder authorities ahead of enabling legislation. And having welcomed the piloting of Children's Trusts we would want to learn the lessons from those Trusts who have taken on the commissioning of health and care for children.

I would want the new pathfinders to experiment. For example, it should be possible for local authority commissioners to direct health resources to develop social services. That is not just my view. It is the view of the Department of Health's Primary Care Tsar Dr David Colin-Thome. He recently told a conference on long term medical conditions that some health service money has to go in the direction of social care rather than just being spent on clinical work. This is not about robbing Peter to pay Paul. It is about delivering the right service at the right time in the right place.

A theme I will return to later.

If funding is an ever present challenge so too is the never-ending task of implementing the legislation Government pushes through Parliament - no matter how half-baked it might be. And there is plenty of it.

I want to mention three Bills that are currently before Parliament which will impact on you.

The Children Bill.

The Mental Capacity Bill.

And the Draft Mental Health Bill.

Let's start with the Children Bill. A Bill with a good purpose. But a Bill that needs improvement. The Bill proposes a Children's Commissioner for England. At last catching up with Wales, Scotland and Northern Ireland. In the Lords Liberal Democrat Peers won both the argument and the vote to amend the Bill to give a rights-based focus to the work of the Commissioner. I very much regret that Margaret Hodge thinks such a rights based approach is too narrow. She wants to focus on outcomes and of course outcomes matter. But how can you be sure the outcomes are the right ones if you are not clear what a child's rights are?

What is the point of signing up to the UN convention on the rights of the child if there is not to be a powerful champion for those rights?

When Lord Laming published his report into the death of Victoria Climbie he drew attention to the problems her housing. It will be a missed opportunity if the Bill does not build links between registered social landlords and children's services authorities. Those links are vital to child welfare and protection.

One of the most contentious issues in the Children Bill concerns information held on databases. Getting the Government to be clear about what information the database would hold or how it would be held has been like drawing teeth. The Bill still states that the database may contain information about the existence of any cause for concern in relation a child. Any cause for concern. This is simply too vague. It will be open to very wide interpretation even misinterpretation. MPs and Peers on the Parliamentary Human Rights Committee agree. We are trying hard to get the Government to think again.

Perhaps the most controversial issue that the Commons will debate is the common law defence of reasonable chastisement. The Children Bill was amended on this in the Lords with good intent. In effect the Bill now offers a legal definition of the ways in which a child can be assaulted. I think that sends the wrong message. It says that violence towards children is OK. The evidence is compelling. Children who witness or who are themselves victims of violence learn and repeat that behaviour.

My Party is clear in its view that the judgement of a 19th century court should not stand as the basis for a 21st century children protection Act. Nor should a well intentioned but flawed half-way house passed in the House of Lords be the standard Parliament sets. The defence of reasonable chastisement must go. The law should be clear. Children should have the same protection from assault as adults.

But it is not just Children's rights that Liberal Democrats are championing. We also champion the rights of those in our society who lack the capacity to make decisions for them self.

After 15 years of reports, Green Papers, consultations and draft Bills at last Parliament is debating the Mental Capacity Bill. I support the Bill. But even after 15 years there is still room for improvement.

The Bill lacks a commitment to advocacy support for people when making decisions. The Bill lacks a commitment to provide the resources to meet any and every communication requirement. The Bill lacks a commitment to non-discrimination.

Putting in place effective advocacy services is the key to making a day to day reality of the legal presumption of capacity that the Bill will make law. I want to see local authorities commissioning more advocacy services. The approach being taken in Scotland with a national advocacy strategy and local action to build-up advocacy capacity offers a way forward.

I have already successfully argued that the Bill must make the provision and communication of information in appropriate formats a legal requirement.

I also strongly believe that making non-discrimination a core principle of the Bill would send a clear message. A clear message to professionals and everyone involved in proxy decision making. A clear message to set aside prejudices and preconceived ideas. A clear message to treat the person in front of them no less favourably than someone with capacity. The Minister has yet to be persuaded to amend the Bill. But he has put on record that the best interest test should be taken to include the proposition that it is in no ones best interest to be discriminated against. An important statement.

It really is time the law recognised the rights of people who lack capacity to be able to exercise the maximum possible control over their own lives. The Mental Capacity Bill will give all those lacking capacity, new rights to maximise their own preferences on how they want to lead their day-to-day lives. I think that the Bill has the potential to radically redefine the way in which incapacity is treated in law and in society.

And autonomy and control are sadly missing from the last Bill I wanted to talk about today. The draft Mental Health Bill. Like the law it will replace, the current draft Mental Health Act, contains unique powers to curtail the freedom of people believed to need treatment for mental ill health and mental disorder.

I am concerned that the Bill has a very wide definition of "treatment". There are no conditions limiting the use of compulsory powers. As the Bill stands compulsion can be used even if the treatment offers no health or therapeutic benefit to the patient.

Currently the majority of people who genuinely wish to be treated voluntarily cannot be detained in hospital or receive compulsory treatment. The Bill makes it possible to detain a person who appears to pose a risk to the health and safety of another person without having to show that they are refusing care and treatment on a voluntary basis.

I think it is wrong to include such a wide range of people and such a wide definition of "treatment" within a Bill that provides for compulsory treatment and loss of liberty. It still feels like a Home Office Bill masquerading as a Health Bill.

Certainly Liberal Democrat Peers and MPs will do all we can to improve the Bill. Without improvement it should not pass.

While resource pressures and new legislation are constant features of the social care landscape the same cannot be said for Ministers. Ministers come and Ministers go. That brings me to Stephen Ladyman.

In April Stephen Ladyman announced he was in search of a vision for social care. Stephen had lost his vision and was in search of a new one. The Minister embarked on a nationwide search for the missing vision. Notices were posted on websites. Appeals were made asking for sightings of the missing vision. No stone was to be left unturned in the Ministers quest. Then abruptly the search was called off.

In a statement the Minister said he was disappointed. Disappointed with the responses he had received. The search for the new vision would be postponed. The Minister complained that the search had got bogged down in process - the means rather than ends. He wanted to ask other Minister if they had seen the vision and if they would share it with him.

At least that's how it seemed to me when I read Stephen Ladyman's Ministerial Foreword to the responses to his consultation. A word comes to mind when I read the Minister's words. Patronising.

Things will get worse if social care stands still he says. You're too focused on means rather than ends he says.

It really is a bit rich for a Minister in this target obsessed,

tick box driven, top down Government to lecture social services about concentrating on process.

Just how many targets are there for social services? What exactly are bed blocking fines? Does social care need a new vision?

Or does social care need a new Government?

As the Social Care Commission report yesterday demonstrated using fines to speed up hospital discharge can have unfortunate outcomes. With a price on their head thousands of older people find themselves consigned to care homes before their time. In some parts of the country more than one in three people are discharged to a care home. In some parts of the country, half of the people surveyed had to go back into hospital again within three months. But the Government target is hit. The fines are avoided. The box gets a tick. But a life is wasted.

I say wasted because although there is a need for a choice of care settings and there are some very good care homes that earn their fees and deserve our praise the quality of care can be poor. Research into residential care has found in a six hour daytime period half of the time was spent asleep, socially withdrawn or not actively engaged in any form of basic or constructive activity. Only 50 minutes was spent talking or communicating in other ways with staff or other residents and less than 12 minutes were spent engaging in everyday constructive activities. Less than 12 minutes spent in everyday constructive activities. What a life. Perhaps I should say what life!

That's what happens when means become more important than ends. That's not my vision of social care. It's not your vision of social care. I don't think the vision is broke. I don't think you need a new one. I think the vision is clear.

A vision of social care that starts with the idea that independence is best achieved in a community of interdependent people.

A vision of social care that promotes personal autonomy and well-being through community involvement and prevention.

A vision of social care where service users manage their health and care needs around their life rather than fit their life around the service provider.

A vision of social care that is more than just the discovery and rescue of social casualties.

That is the vision. The question is how we make it a reality. Because for many it is not a reality. Crisis management is the name of the day. The Baywatch approach to social care. For ever diving in and pulling out half-drowned people. Never the time to take breath and find out why they are getting into difficulties in the first place. Never the time to offer the support and encouragement so that people can learn to swim for themselves.

Because of cash constraints.

Because of staff shortages.

Because of Government targets.

Social care is bogged down with managing dependency rather than acting to prevent and postpone that dependency. Let me give an example of what I mean. Home care. There are 100,000 fewer people receiving homecare today than when this Government came to office. Those left are receiving homecare for more hours. There has been a shift towards high dependency intensive homecare packages.

What has happened to those 100,000 people and many more like them? I think the answer came in the 2001 census. It showed a marked increase in the number of family carers. There are 5.9 million carers. Saving the taxpayer £5.7 billion a year. More carers providing more hours of care. Shouldering a growing burden. According to the census, 9,000 of them are children aged five to 15 providing 50 hours of care a week. 18,000 provide 20 hours or more a week. There are 382,000 people aged 65 and over who provide care for more than 50 hours a week. That includes a staggering 44,000 people over 85-I could not believe that figure-providing 50 hours or more of care a week.

What view would the Government take if 9,000 children aged five to 15 worked outside their homes for 50 hours a week or more? Education Ministers would rightly protest about the effect on their education, and others would rightly campaign about their welfare.

Surely, that is an unacceptable burden to place on children. Whether it is children who are carers, children who are disabled, children in need. It is vital that they are at the centre of the way in which children's services are planned, commissioned and delivered.

Listening to children and their families. Learning from them. Keeping in mind that all children want something very basic. They want to have fun.

Whether it is the young or the over-65s who are working as carers, if they were in paid employment, they would be breaching the European working time directive. There should be an outcry about the numbers who are shouldering that heavy burden of more than 50 hours of care a week.

Just where is the choice for these carers?

Choice is this Government's big idea. Choice is the Conservative's big idea too. My choice is bigger than your choice seemed to sum up the row between Tony Blair and Michael Howard. Choice of 5 hospitals under Labour or a choice of going private if you can afford it under the Tories.

There's nothing wrong with choice. It must be one of those means that Stephen Ladyman had in mind when he chastised you all for being too focused on process. But if choice is the means, just what are the ends?

If the choice agenda just turns us all into consumers in search of the best stats or the fastest service it is doomed to fail. That would be health and social care without relationships. Without a human friendly face. Without roots. Without community.

Doomed to fail because those human aspects are the hidden assets that actually heal and help people. There are two great assets which in the debate about choice are ignored yet are the potential resource that will get us the sustainable health and social care we need. One is the front line staff, with their knowledge and individual experience. The other is service users and their neighbours.

Whitehall targets are all designed to keep these at bay, but they are the forces I believe social services must champion.

Real relationships, in fact. Not targets, not professionals, not Ministerial micro-management. Let me give an example of what I mean.

Earlier this year I visited the Rushey Green Clinic in Lewisham. They have been pioneering the practice of timebanks providing a basic infrastructure whereby patients and service users can support each other. Check up if they have food in the house when they come out of hospital, change a light bulb so an older person doesn't have to sit in the dark, give lifts, keep in touch by phone. And let me tell you what the research says: the health benefits go both ways - and I don't just mean medical health. People get healthier when they help even more than when they're helped. Why? Because feeling useful - a feeling we deny most people over retirement age and many below it - is actually a basic human need. And it can change lives.

Isolation makes people sick, but relationships can heal. Active communities keep people well. And really this is good news, because it means we have massive untapped resources in this country to bring to bear - if we dare.

The time, experience and ability to care of patients, service users and their neighbours.

We just need to take practical steps that can inspire and use it. Which measures, and reward, and recognises people's efforts. Time banks, self-care, direct payments, support groups - that's the future for health and social care. Providing services that professionals could never provide even if we had the money.

Liberal Democrat health and social care policy is one that looks beyond the current stand-off, the exhausted and over-stretched professionals, the disempowered patients and service users for whom time hangs heavy - and sees where the assets lie that can make us healthy again and keep us well.

The time and willingness of patients and service users. Their need to make a useful contribution. And the knowledge and experience of frontline staff, set free from targets and liberated from Ministerial meddling.

That's my parties agenda for social care. I hope its an agenda we can work on together.