CHECK AGAINST DELIVERY
Labour's Shadow Health Secretary John Healey MP, speaking to the National Children and Adult Services Conference today said:
Thank you for inviting to me to this important conference so early in my new job as Shadow Secretary of State for Health
If you think it’s been an early start from Rotherham and I haven’t shaved properly, you’re right. I’m growing a sponsored moustache during November – raising funds and awareness for the Prostate Cancer Charity. They tell me that 50,000 other men in the country doing it, but I haven’t met one yet!
Andy Burnham, having done this job before me, could have delivered my speech and then his own. I’m very pleased I follow Andy as Shadow Health Secretary, who did a great deal while Labour were in Government.
Less than a month into this new job, and I am here to listen as much to as to speak. And I am looking forward to talking and working with you closely in the months to come. It’s what I – and my great Shadow team including shadow minister for social care Emily Thornberry – will do.
And listening is no bad thing for a Labour shadow ministers to do for now.
Labour lost the election. And for the moment there is a general good will towards the Government. They see two parties putting their differences behind then and trying to work for the good of the country. But the public have not yet seen or felt the affect of the cuts and the changes to come.
If they don’t yet see what is to come, you do. You are professional services experts and leading local politicians with unparalleled expertise in social care. I am very interested in your views.
It’s fair to say that we’re adjusting to opposition. As Minister for Housing and Planning I had nearly two and a half thousand people working for me. Since May I’ve been doing my own diary, and ordering the replacement cartridges for the printer. Although, three weeks ago I appointed one adviser to help me.
But Conservatives and Liberal Democrats are still adjusting to Government. They are making decisions now, not us. They are the ones with responsibility for current and future care of elderly and disabled people. They are the ones entrusted with the future of our National Health Service.
Now it matters so much less what Labour planned, and so much more what the Tories and Lib Dems plan.
The debate is now no longer between what the Government is doing and what we would have done if we were in Government.
And the serious questions are about what they plan and what they do; and in particular the gap between what they are saying and what they are doing, what they promise and what they deliver.
It’s early days but the early signs suggest serious grounds for concern for the future of social care and the National Health Service.
Let me quote a vision and a commitment:
“People should receive health and social care support, which promotes their recovery, independence, inclusion, health and wellbeing… People needing care deserve to be treated with dignity and respect. We understand the urgency of reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face… Establish a commission on long term care… break down between health and social care funding… extend the greater roll out of personal budgets… use direct payments to carers and better community-based provision to improve access to respite care… reform Access to Work.”
Andy Burnham could have said that as Secretary of State, but it comes from the Coalition Agreement.
They are setting the right aims, but are they taking the right actions?
I see serious flaws that risk serious failure in three main areas:
And my underlying concern for the essential services that you provide and commission – to which we are all committed – is that the national Government is setting up local government to fail on social care and health.
We’re all familiar with the figures on public spending in adult social care:
• £14.4bn a year spent on adult social services, with a 4% pressure built into the system by the changing age profile of the population
• Local authorities facing a grant reduction of over 25% - and many councils in the poorest areas face much more. Savings on the scale needed, even with 3% efficiency gains, an increase in charges, and some changes in the eligibility criteria “will be impossible to achieve within the current legal framework.”
This is your analysis; your warning to the Government in the submission made by the Association of Directors of Adult Social Services and the Local Government Association to the spending review.
There is some extra money being put into personal social services – though I suspect that’s more a tribute to David Behan than Andrew Lansley. This is welcome. It is of course funding for adult social care, but there is no guarantee that the money will be spent on social care because there is no longer any ringfence.
We’ve seen already this year important care funding streams consolidated in the area based grant, but non-ringfenced, being eroded in budget decisions across councils.
And Government claims that social care funding streams are being “protected” in May’s £1.1b billion in-year council cuts weren’t worth the paper the press release was printed on.
It simply isn’t sufficient to meet the pressure of need.
Figures from Age UK this week claim:
• Over 250,000 over 65s are set to lose home care; and
• there will be 7% real terms average cuts to council social care spending.
I will be more measured, and offer two objections on funding, both of which give us a glimpse of the emerging character of this new Government.
First, it’s fair enough for Andrew Lansley and Paul Burstow to make a lot of the extra £2 billion for social care – both did in the House of Commons this week at Health Questions.
But both must know that it won’t be enough to avoid severe funding strains.
And both must realise that it’s deeply unconvincing when they read out word for word the Departmental lines to take – as both also did in the House of Commons this week:
“On this basis there is no need for local authorities to have to reduce eligibility to social care.”
We know from experience in Government that if you adopt a policy, set a position, and become too rigid repeating it people will start to see you as out of touch, not listening and unwilling to take advice.
Second, by all means point, as ministers do, to the extra money for social care. But don't double count the credit and don't double count the funding. Because when £1 billion switched from the NHS to social care is taken into account, the Government has not protected the NHS as it promised. It's not the real terms increase of 0.4 percent they claimed. It's a real terms cut of 0.5 percent."
The Government set out an important role for local authorities in the Coalition Agreement and in the White Paper in “joining up the commissioning of local NHS services, social care and health improvement,” by promoting integration and partnerships, and by leading joint strategic needs assessments.
We’ve some experience of how easy this is to say and how hard this is to do: in planning, housing, the local economy and of course in health and social care.
My fear is that local authorities will get responsibility without the resources or powers to do the jobs the Government says it wants councils and councillors to do. This will be a recipe for frustration and failure in local government.
The public health white paper will be a big test for the Government, and my two principal tests of the Government’s plan when it’s published will be whether local government is given the necessary resources and powers to take on responsibility for public health.
This is the right aim but it requires the right action to achieve it.
Anyone believing the new Government’s commitment to localism meant a commitment to local government will already be deeply disappointed.
On schools, on housing and on police, central Government is reducing and removing, not reinforcing, local government’s role.
And councils were first in line for more than £1 billion cuts in May and in the frontline of cuts in the Spending Review.
I don’t see a consistent Government belief, as I have, in:
• Councils as the first among equals of local agencies
• Public accountability through elected representatives
• The public service ethos as an essential element of the services many of us and our families rely on.
I don’t see a consistent government commitment to the public service reforms I want:
• Greater personalisation of services
• Greater area not agency funding streams and more pooled budgets
• Greater integration of social care with health – on planning, funding, commissioning and delivering
• Greater improvements in Cinderella services like mental health and learning disabilities.
And I don’t see a consistent government will to make the hard decisions about long term reform.
I welcome Andrew Dilnot’s work on heading the Government’s commission – as Andy Burnham did when it was set up in the summer.
But so much of the ground has been so well covered before, not least by Labour in our Green Paper and White Paper.
And Andy Burnham got close to a consensus but we got too close to the General Election. Then short term political gain became too tempting for the Conservatives.
I’m glad they’ve allowed the Commission to look at all the funding options and I had hoped we could see the work Andrew Dilnot is doing speeded up.
But when there is no provision in the spending review to implement any recommendation the Commission might make, I think it’s reasonable to doubt the Government’s determination to do the long term reforms that are needed.
Now is not the time or the place for a detailed discussion of the Government’s NHS reforms and White Paper, but these are so interlinked with social care, and in my view ought to be more integrated.
My overriding concern is that the NHS will go backwards under the Government’s plans:
• GPs and the National Commissioning Board will take health services further away from, not closer to local authorities
• More GP consortia than PCTs with weaker statutory duties will lead to greater fragmentation not, integration
• Light legal reporting and accountability requirements for GP consortia will mean a more secretive, not a more open NHS.
• Any willing provider, and maximum, not set tariffs, will result in the economics of the private market driving the NHS, not the ethics of public service
• Providers commissioned by local GPs will lead to less patient choice and personalisation, not more
I fear we will lose the ‘N’ in the NHS and see “commercial in confidence” stamped over many of the most important decisions taken.
And let us not forget that this has been described as the biggest reorganisation since the NHS was set up over 60 years ago.
It’s not what NHS patients, staff or the public expected when David Cameron promised before the election and the Coalition Agreement pledged after the election, “no more top down reorganisations in the NHS”.
This reorganisation is untested and unnecessary. It is high cost and high risk.
At this time when finances are tight, all efforts should be bent to making sound efficiencies and improve patient care.
NHS experts, professional bodies and patient groups say “slow down”, because this big reorganisation is a big risk for the NHS.
But Andrew Lansley is not listening.
And on the NHS reorganisation, like on funding, on the moratorium on service closures, on improving waiting times for patients – in six short months the new Government is falling short of the promises it has made on the NHS.
We know from experience in Britain that if people see a Government breaking the promises they made to the public, locked into decisions they’ve taken come-what-may and failing to listen to advice, concern will rise and confidence will fall that these are the right actions to fulfil the aims of civil service reform.