National Care Forum Annual Conference

Tuesday 20 April

Stephen Ladyman MP, Parliamentary Under Secretary of State for Community

Thank you for giving me the opportunity of addressing your first Annual Conference.

I have a mission. That mission is to drive up the standard of social care in this country and give people more choice in how they receive that care.

In that mission, I have no greater ally than the not for profit sector and so I would like to begin by paying tribute to the enormously important contribution that you already make to the provision of social care.  And I want to nail my colours to the mast – I am very keen to see the so called ‘third sector’ taking on more of the delivery of social care.

I had the pleasure of speaking at your launch, last October, and I am delighted that you now have more than 20 member organisations who deliver care, day in day out, across the full range of care services.

Of course, the voluntary sector faces particular challenges.  For example, I know that achieving a stable funding stream is not always easy.  The smaller size of many of your organisations sometimes makes it difficult to cope with bureaucracy.  I suspect many of you here today may have felt that in respect of our National Minimum Standards for care homes. 

I am also aware that your organisations will need to develop greater leadership and management competencies if they are to respond effectively to the Government’s desire to see the sector play a stronger role.

The theme of your conference today is “Delivering Quality”.  I am impressed by the emphasis that the National Care Forum places on quality.  Quality is a subject we do not pay sufficient attention to – and frankly there are some organisations representing the care industry that seldom seem to refer to it at all.

This Government has put into place the fundamental building blocks needed to drive up the quality and standards of care services.

We established the Social Care Institute for Excellence, which is developing best practice guidelines to drive up the standards of effective social work practice.

We’ve made a huge investment in training for the social care workforce.

We established the General Social Care Council with the introduction of a formal registration scheme for professional social care staff.

We developed National Minimum Standards for both care homes and home care services. And, as you all know, this month has seen the launch of the new Commission for Social Care Inspection which for the first time will give us a comprehensive picture of the quality of social care services and the performance of councils in meeting social care needs of local people.

We published Building Capacity and Partnership in Care which encouraged a whole systems approach to the commissioning of care services; and recognised that to improve the quality of services; people using services should be involved in the planning and design of services throughout the commissioning process.

I could go on, ad nauseam, listing the steps we have taken and our achievements. But I recognise that, despite these steps, we are only at the start of the long journey to deliver the quality services people now want.  But, as the Chinese proverb has it, “A journey of a thousand miles must begin with a single step”.

I find that exciting.  A challenge. I hope you share my enthusiasm for the challenge that faces us all.  Every working day, I want all of you to be thinking what else could I do to improve the quality of the services I provide?  What more can I do to extend the range of services I provide?

So, how do I see the delivery of quality care services in the future?  Some of what I am going to say may be seen as controversial and, I hope, challenging. I make no apology for that.  All of us working for, or associated with, the care sector must understand the challenges ahead and how we can all share in a vision that has, as its core objective, a transformation in the quality of life of people using services.

I am told in some quarters that the solution to delivering quality services in the future is to be found in the past. I’m told that the types of care that have been traditionally available are all we need for the future and if I just give everyone a lot more money and leave them alone to do what they’ve always done then everything will be fine.

I don’t accept that.  I believe delivering quality services in the future will require new models for delivering care.

Models that put the consumer at the heart of the process.  We must discard the dependency models of the past.  People want to be able to choose from a range of care services – they don’t want my will, or yours, imposed on theirs.

What are people telling us about the kinds of services they want? They want services that treat them as people, as consumers, not passive recipients of services prescribed by professionals.

They want services that promote independence, that are person centred, tailored to each individual’s needs. Services that promote retention of life skills, that allow people to pursue their hobbies, their interests, and in some cases, their ability to work.

Services designed to help people regain lost skills. Services that recognise the importance of human contact, of friends and family. Services that respect each of us as an individual.

How do you succeed in reshaping services to achieve this? Why don’t you start by fundamentally re-evaluating how you deliver your services?  A powerful test you might use is: “would I be satisfied if I received that service?”

I face daily criticism from some in the care home sector. They say that my vision is about the end of care homes. 

The truth is different. It is true that I do not believe that long-term care is synomous with care provided in care homes. I make no bones about it.

But it is also true that I do see a role for residential care in the future, however, it is a different role from the past.

It is true I have no patience for those care homes where good management practice and the need to improve standards are seen as burdens and needless regulation. Or with care homes that consider their residents as a commodity. But it’s equally true that I am quick to praise those homes that treat their residents as people and put their needs first.

The challenge for the care home sector is to radically remodel their services, to provide homes that promote independence, that provide high quality person centred care. I know that some care home owners do run these types of homes, and I pay tribute to them, but frankly I remain to be persuaded that the majority of care home owners see things that way.

The recent NCSC report told us that only about 50% of care homes for older people are fully meeting the standards for complaints and protection; and in 2002/3 less than half fully met the standards for administering and handling medication. These are the sorts of things that worry me and lead me to believe I have a duty to challenge the sector to improve.

Challenging care home attitudes is one way we can change things and ensure quality services in the future.  Providing new housing options is another.

I believe that extra care housing will, over the coming decades, become a real alternative to residential care homes, both in the public sector and in the private sector. There are real benefits for people in having their own self contained living space behind their front door. I would invite anyone who has any doubts about this to visit one of the many new schemes being developed.

We are now at the time of year when many of you are planning and booking your summer holidays. How many of you here would book your family holiday in a hotel in rooms without en suite facilities? Or if you booked an apartment, would you be willing to share the kitchen and living room with strangers?

Not even as a child did I have to share a living room, bathroom or kitchen with strangers. I don’t wish to do so when I am on holiday and I certainly don’t wish to do so in my old age. That’s why I, and I believe most other people will prefer extra care housing to a care home if and when the time comes.

A further way we are responding to the challenge of delivering quality care is through direct payments. Take a look at the recent report ‘It pays dividends’: direct payments and older people.  The report looked at the way older people use direct payments in two councils, how older people make them work to transform their lives and the role council care managers and direct payments support services play in making direct payments a real option for older people.

The report found that older people receiving direct payments reported feeling happier, more motivated and had a significantly improved quality of life than before. One couple told the authors that direct payments had “revolutionised” their lives, another older person said he could now watch a football match on television without being put to bed before the end of the game, while yet another said “its like a magic door opening. It’s meant that, well, I’m living a life now”. 

That’s why I find direct payments such an exciting development for older people.

You may be asking whether my vision for the future is just a personal one – is this really what people want for the future? Yes, it is. For those of you who are still unsure, read the recent report published by the new Commission for Social Care Inspection – When I Get Older. The report was based on a national survey of over 1,000 people aged 16 and above which asked what they want from the social care services they may have to use when they get older.

Nearly three quarters of people want to choose their social care and be given a direct payment by the state to pay for it. People were also asked to give their preferences for receiving social care. Most want to live as independently as possible and receive care in their own home rather than move into a care home. Options such as sheltered and extra care housing are preferred to care homes. People were also asked to give their quality of life priorities if they need care. The top five preferences were:

“my own room”

“being allowed the independence to come and go as I please”

“friendship and company”

“having visitors whenever I like”

and “my own shower, bath and toilet”. 

What is so striking about these preferences is that these are things most of us take for granted in our private life.  Why should it be different just because we receive care services?

The survey found that people strongly value independence and choice. And they want services that suit their own individual needs and that respect their rights.

And I find it very telling that no one receiving services has ever claimed my vision is wrong.  The people who say I am an idealist, that the vision is unachievable, are restricted to those who provide care services.

So here is a challenge for you: “How is your organisation changing to reflect this new consumer power?” And which of you can see the opportunities in the world I’m describing as well as the challenges?

I suggest that any care provider who does not now take on board these preferences will simply not be in business in the future. Nor should they be.

So how do we achieve this vision?

First we must design service structures in which people are involved, recognised as consumers of services and encouraged to contribute. Whether a person is in an ordinary home, extra care housing or a care home they have a right to be involved and we have a duty to make it possible. This will keep people active and motivated, probably the two most important aspects in retaining independence. 

Secondly we have to involve people in their own care. We must get away from the sort of care planning where everyone around you is making assumptions about what they think you can’t do.

Thirdly I want people to experience real choice. That means a full spectrum of care options have to be available in their own community. That might mean care in the home you already live in or an extra care scheme.  I want to stress that it might also mean a care home – but one that understands the services and facilities that must be provided are more than just a bedroom and full board.

Fourthly, when designing a care package for a person we need to take a more realistic view of risk. The entire focus must be on quality of life; it is not good enough to subjugate this to an agenda of protection. We shouldn’t try to wrap people in cotton wool at the first sign of frailty or even dementia if that takes them away from the environment or activities that bring them satisfaction. Of course, risk needs to be assessed and managed but people like you and me take some risks every day of our lives.  Why should risk-taking be solely the province of those who are fit and well?

Fifth, it means every council adopting best practice commissioning and starting to plan innovative services and encourage a local market place in which good providers thrive and bad ones disappear. In that market place, providers will bid for services at a price that reflects their costs and local circumstances, but councils will be able to demand cost effective high quality services in return.

That’s how I see quality services in the future, services that will transform the quality of people’s lives not constrain them.  And the not for profit sector can rise to my challenge. You can be my key allies in the battles ahead.

We may not see eye-to-eye on everything you have heard me say.  Whatever our disagreements on particular issues, the partnership between us – the Government and the not-for-profit sector - is essential and I intend to ensure it remains positive and firm. 

There is a large agenda here and we all need to work together to achieve it for the greater good of those who need care services.

You can help me. I can help you. Together we can deliver the care the public is demanding.

Thank you for listening to me.