Alan Milburn’s speech to the National Social Services Conference

Alan Milburn’s speech to the
2002 Annual Social Services Conference, Cardiff

Reforming Social
Services

16 October 2002

This is the fourth year I have addressed your conference as
Secretary of State for health and social services. Each year
I have been able to report on real progress in the delivery of
social care. I am pleased to say that this year is no exception.
You have delivered more intensive support to help more older people
live independently at home. Your co-operation with the health
service has reduced delayed discharges from hospital. You have
helped 10% more looked after children to be adopted.

Social services – local authorities, voluntary organisations,
private sector providers – make a difference – every single
day.

You make a difference when the foster parent, the teacher and
the social worker help a child who has been in care all their lives
get through school and then on to college.

You make a difference when the therapist and the advocate help a
young man with a learning disability get training and then a
job.

You make a difference when the home help and the social worker
help an old lady return home after hospital to regain her
confidence, her dignity and then her independence.

So, I want to thank you for what you have done and for the vital
role you play in delivering care and offering hope to millions of
people in our country. Good social services – and social workers
– are valued. They do not deserve to be vilified.

Yet, today I believe social services are at a crossroads.

You are under scrutiny as never before. For all the millions of
successes, it is the lapses in social services that still corrode
public confidence. All of us here know that if social services
fail, the consequences fall on the most vulnerable people in our
society.

It would be comforting to believe the problems confronting
social services stem purely from a hostile media. I do not believe
they do. They stem in my view from a much deeper failure – a
failure, which we all share, that has allowed the way we deliver
social services to get out of step with the society we serve.

In the half century since the Welfare State was founded, and in
particular, in the thirty years since Seebohm formulated the modern
concept of social services, British society has undergone profound
changes.

Fifty years ago, if you got a job, it was for life. Today, while
the new global economy has brought more opportunities for
prosperity than ever before, there is more insecurity and
uncertainty. While unemployment has fallen sharply in recent years
social exclusion has found new expression. Prosperity has widened
but poverty has become more entrenched. Joblessness has become more
concentrated in certain communities and amongst certain families.
New social problems – particularly the link between drugs and
crime – have emerged.

Family structure has undergone profound change. Family breakdown
is more common. Teenage pregnancies are still too high. For the
first time older people outnumber children in our society.

Public expectations have changed too. Thirty years ago the one
size fits all approach of the 1940s was still in the ascendant.
Public services were monolithic. The public were supposed to be
truly grateful for what they were about to receive. People had
little say and precious little choice.

Today we live in a quite different world. We live in a consumer
age. People demand services tailor made to their individual needs.
Ours is the informed and inquiring society. People expect choice
and demand quality.

These changes challenge all our public services. For some, these
changes call into question the very values on which health and
social services are based. They say, public services must
inevitably fail because they always put the needs of the
institution above the needs of the individual. For them the only
solution is a free market solution.

Nothing could be more mistaken. Think about it. A privatised
health care system based on ability to pay not the depth of need
would leave those needing health care most able to afford it least.
Delivering up youngsters in care to the whim of the free market
would only mean more lives paid for in drugs, delinquency and
despair. We have lived through the decades when there was
apparently “no such thing as society”. Society was poorer as a
result. We all ended up paying the price. I believe that we must
not pay that price again.

The values that underpin our social services – the
recognition that we do achieve more together than we ever can alone
– are more relevant today than they have ever been. The
problems society faces today call for modern active social
services.

It is the means of delivery – not the values of social
services – that need to change.

Delivery requires investment. It is a fact that for too long
social services have been the poor relation in the public services.
Investment in social care has failed to keep pace with
today’s challenges. You can see the impact of decades of
neglect in high staff vacancy rates and staff who work under real
pressure. I believe that we now have the opportunity to put that
right.

A year ago I said at your conference that social services needed
more resources. 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.

The extra resources will help get the extra staff we need. A
year into the national social work recruitment campaign which I
launched at last year’s conference we have already reversed
the trend in falling applications. Over the next three years we can
look forward to 50,000 more social care staff.

New challenges call for new skills. I think you all know the
complexity of modern social problems requires more specialised
skills not just the traditional general mix of social work skills.
So I am today, asking the General Social Care Council, training
organisations and local government to work with us to develop new
types of social care professional.

People who can work in the community, combining the skills of
the therapist and the home help to provide rehabilitation alongside
home care. Family care workers combining the skills of the health
visitor and the social worker to provide family support in times of
trouble.

The extra resources give us the opportunity to make these
reforms.

Of course, extra resources can not solve every problem but
having made the case for extra investment in social services local
government now has to spend those resources on social services.

Here I think that there is a tension: different communities have
quite different needs – and that calls for a greater local
say. And yet it must be right that an older person in one part of
the country is able to enjoy similar standards of care to an older
person in another part of the country – and that calls for
proper national standards. Better services are not a choice between
national standards and local control. Raising standards requires
both. Getting the right balance holds the key to securing these
improvements.

There was a time when there were no national standards. When
care was a local lottery. I do not believe anyone who is serious
about ensuring fairness in social care wants to go back to those
days. Equally with national standards, tough inspections and
performance ratings all now in place I believe the time is now
right to shift the balance of power – to greater local
autonomy. So I can tell this conference whilst there will be more
resources for social services, there will be less earmarking of
those resources for local government by central government. Today
17% of social services spending is ring-fenced. That will now fall
to 15% next year, 11% the year after and 9% the year after
that.

The Local Government White Paper sets out the basis for a new
partnership between Whitehall and the town hall as a means of
rejuvenating local democracy. Where councils have greater financial
freedoms. Where inspection is more proportionate. Where local
councils have powers to scrutinise local health services and ensure
the well-being of local communities.

And we can go further. The new governance arrangements we will
shortly bring forward for the first generation of NHS Foundation
Hospitals will mean local government can represent the local
community in the running of the local health service too.

We are moving into a whole new ball game with brand new rules:
where flexibility and freedom come in return for delivery and
reform. As performance improves – as I am confident it will
– greater autonomy for social services and local councils
will be earned. Those that are doing best will get more freedom.
Those that are doing less well will get more help. Where there are
persistent problems central government will step in. Where there is
progress we will step back.

Those councils that enjoy the highest star ratings will get
significant freedoms: reduced inspection; the right to carry over
resources between one financial year and the next; the freedom to
spend social services grant on any aspect of social care free from
ring-fencing altogether. And I can tell this conference that,
together with the Deputy Prime Minister John Prescott, I am
examining further freedoms still for the best performers.

The better you do the more you get. That is a discipline that
needs to apply just as much in the public sector as in the private
sector. Both to provide a reward for those already the best –
and to provide an incentive for those who can to do better.

At the other end of the spectrum there are a small minority of
councils where social services are persistently in trouble and,
frankly, failing to deliver. Here a different approach is needed.
Here, central government can not stand idly by. We have a duty to
act to uphold standards in care. And when we do it works.

Of the 21 councils put on special measures in the last few
years, 18 have improved their performance. Since August, where
there have been more entrenched problems still Performance Action
Teams – put together by the private sector but involving the
best of the public sector – have gone in to social services
departments to strengthen management structures and improve service
delivery.

And in extremis where there is endemic failure and
where this form of external support also fails, I will use powers
under the Local Government Act to appoint a nominee to take over
the running of the local service. The nominee will be able to make
radical recommendations about how the service is delivered and
crucially how more effective local partnerships can be
developed.

Today over half of all councils have broken away from the old
monolithic, single social services departmental structures towards
greater specialisation and more integration with other service
providers. I want to set out now how I believe we can help you take
this process further.

The old style, public service monoliths can not meet modern
challenges. They need to be broken up. In their place we can forge
new local partnerships that specialise in tackling the particular
problems local communities face.

Combating social exclusion, breaking the link between drugs and
crime, securing for elderly people dignity in old age is beyond the
remit of any one organisation.

Dealing with these new challenges demands new forms of
organisation: that enlist support in the community as well as of
statutory agencies; that harness the expertise of the private and
voluntary sectors alongside the public sector; that recognise that
in the modern world people will no longer tolerate inflexible
services from competing systems but demand instead flexible
services from a single care system.

In recent years social services who have led the effort to break
down boundaries and build up new partnerships. Two thirds of social
services today are provided by the private and voluntary sectors.
The 600,000 social care staff who work in those sectors provide the
majority of home care and residential care. Most looked after
children rely on foster carers. The voluntary sector today is the
mainstay of learning disability services. New initiatives like Sure
Start have put community and charitable organisations centre stage
in delivering what are mainstream public services.

I believe that the voluntary and community sector has an even
greater role to play. If we are to activate local communities to
help deal with the problems they face – rather than simply
complain about them – now is the time to bring those
organisations in from the cold.

So I can tell the Conference I have asked the Strategic
Commissioning Group – chaired by my colleague Jacqui Smith
– to report to me on how local voluntary and community
organisations could play a bigger part still in the delivery of
social services.

Government, central or local, no longer needs to provide every
public service. Gone are the days when Whitehall or indeed the town
hall always knew best. What counts today is the quality of the
service, not the origin of the provider. And today the sheer
complexity of the social problems facing us call for services that
are less homogenous and more specialist.

The job of providing services to children in need is a very
different job from services to the elderly person. The one size
fits all approach embodied in the traditional social services
department may have been OK in the 1970s, but as more and more
councils are recognising, it does not belong to today.

Let’s take children’s services. Every child deserves
the best start in life. They need services that lift them up and
keep them from harm. Mostly that is what social services deliver.
Sadly, sometimes they do not.

Two years ago Victoria Climbie died in the most appalling
circumstances. No one who has heard the evidence to the independent
inquiry I established under Lord Laming could fail to be shocked by
what occurred. Quite simply services which should have protected a
vulnerable child failed that child.

When Lord Laming delivers his report it will consider what
changes are needed to the whole system of child protection in our
country – and we will consider his findings carefully.

We will also be considering the conclusions of this week’s
report from the SSI and other Inspectors into safeguards for
children. And later this year we will publish the first strand of
the new children’s national service framework which will set
out for the first time clear standards for all of our
children’s services.

There is much that remains to be done despite the achievements
of Quality Protects. Our goal surely has to be to give the children
in care the same opportunities as every other child: to be part of
a family; to do well at school; to get a job; to have a home; to
live a life free from drugs and crime. But progress towards this
goal is still too slow.

Today I can outline extra resources to help us do better. To
reduce the number of children in care. To bring about improvements
in life prospects when children leave care. Growing up in a stable
family provides the best environment for children to develop. So
over the next three years over £180 million will be made
available to expand and strengthen fostering services and to
provide extra support for adoption so that more children get the
chance of growing up as part of stable and loving families.

Some children of course need further help still. Around one in
ten aged between 5-15 years old have a mental health disorder.
Tackling poor educational achievement, dealing with youth offending
and other behavioural problems calls for a major expansion in child
and adolescent mental health services. So I can announce today
increased investment of £140 million over the next three
years, to build capacity, improve access and, together with new NHS
investment, to help deliver for the first time a comprehensive
CAMHS service in each and every area.

To get the best from these resources, there will need to be
reforms. All too often traditional service boundaries get in the
way of good care for children. The local education service can be
pulling in one direction with health going in the other and social
services going another way still. That brings failures of
communication as well as organisation. Children and parents get
passed around the system. Confusion means that services intervene
later when they should be involved sooner.

Fragmented decision-making is not delivering the best for
anyone. I believe it is now time to develop more specialised local
organisations which pool the knowledge, skills and resources that
exist in our education, health and social services to provide a
more seamless service for children.

So I intend to create specialist Children’s Trusts to
jointly plan, commission, finance and – where it makes sense
– deliver children’s services. Children’s Trusts
which commission services will be based firmly in local councils
with the power for the first time to commission health as well as
social care. And for those Children’s Trusts that want to
specialise in providing services we will want to explore a range of
models in different parts of the country. These could potentially
include local, not for profit, public interest companies that could
enlist the involvement of the community, voluntary and private
sectors alongside the public sector.

We want to pilot this new approach so in December this year my
department alongside Estelle Morris’ will ask for expressions
of interest from local organisations keen to test how
Children’s Trusts could improve local services.

Children’s Trusts can help you dramatically reshape how
social services are organised and delivered. Many of you have
already taken advantage of the NHS Act flexibilities we introduced
two years ago . They have allowed health and social services to
work more closely together through at least 160 local partnerships
delivering services now worth £2 billion a year. These
services are breaking down barriers between services so that people
who are elderly or have a mental health problem do not have to deal
with two different – sometimes competing– systems. You
know as well as I do that health and social care sink or swim
together. They both need each other. The older person needs
both.

Care Trusts provide another means to this end. Some are already
in place. More will follow next year. Later this month we will
launch a new national Integrated Care Network to provide more
support and encourage wider take up. In the next two years I expect
to see health and social services in every part of the country
pooling resources and skills to deliver a seamless service for
older people – either through a Care Trust or through use of the
existing Health Act flexibilities. In time this should become the
norm for how elderly care services are provided and
commissioned.

In the meantime we intend to legislate to ensure that conflict
between health and social services does not get in the way of older
people receiving the care they need. I am continually struck when I
visit health and social care around the country by the power of
partnership when it works. But when it does not, it is the older
person who suffers.

Delayed discharge from hospital is a particular problem
affecting 5,000 older people at any one time. Thanks to your help
and the resources we have made available, delayed discharges from
hospitals have fallen but this has been achieved only through a
short term fix of ringfenced money, top down targets and intensive
monitoring. I do not believe this approach is sensible or
sustainable for the long term.

In any partnership people have to know who is accountable and
who is responsible for making things happen. So where people are
needlessly waiting in hospital for social services to become
available, we will shortly legislate so that councils reimburse the
hospital for the cost of the bed the person occupies. This will
provide an incentive – which does not currently exist – to end the
misery of what is sometimes pejoratively called bed-blocking but is
in fact thousands of older people needlessly trapped in hospital
when they are well enough to be cared for in the community.

Councils that enjoy positive partnerships with the NHS – and
those that are prepared to invest extra resources to build up
capacity – have nothing to fear from this policy. Indeed the policy
should help social services get the money spent on social services.
It is not about punishing councils, still less about forcing them
to fund people who wait for services that are not their
responsibility. The policy will guarantee more seamless services
for older people. I hope what ever your reservations might be, you
will now work with us to deliver this reform.

It is all about putting the users of services centre stage. You
can already teach the health service a thing or two about that. But
today I want you to go further. If social services are going to
genuinely put users first then those users have got to have more
power. And that means more choice.

Choice is not just a question of consulting users or promising
to take their views into account. Nor is it just about making
advocacy services more widely available. It is all these things
– and I believe that it is more.

Choice means opening up a broader span of services so that care
can be tailored to fit the needs of the individual rather than
assuming the individual will simply fit the off-the peg
service.

In elderly care for example local councils will want to use some
of the extra £1 billion we will provide over the next three
years to stabilise the care home market and to buy extra care home
places. But different forms of care are needed for older people
too, in order to widen choice and promote independence. More
intermediate care and better rehabilitation services through
partnership with the health service. More extra-care housing in
partnership with housing associations. More intensive home-based
support. Free community equipment for the first time. And greater
backing for our country’s carers. So more older people get
what they say they want – help to live more independently for
more of the time at home.

It is right that the generation which created our great public
services should have more direct choice over those services. So I
can confirm today that I will shortly be laying regulations in
Parliament to ensure that all older people assessed as being in
need of care – whether for rehab after a hip operation or for a bit
of help with household chores – have, as of right, for the
first time, the choice of receiving a direct service or instead
receiving a direct cash payment to purchase care that better suits
their individual needs. Direct payments will give older people
direct choices over the services they receive.

And to ensure these are informed choices, I can also announce
today that we will make available £9 million to help older
people’s and other voluntary organisations make a reality of
direct payments not just for tens of thousands of older people but
for thousands of adults and the parents and carers of disabled
children too.

It is local government that has called for devolution and
decentralisation: to make services more responsive; to make social
services more effective. Today, devolution and decentralisation are
at the heart of the Government’s programme of investment and
reform in public services.

But devolution does not start in the corridors of Whitehall and
end at the doors of the Town Hall.

True devolution sees power flow from central government, through
regional government and into local government and then out into
communities and neighbourhoods. True decentralisation empowers the
individual at the expense of the institution.

And social services are nothing if they are not about empowering
the powerless: giving older people the power to stay in their own
home; giving young people in care the chance of a stable family
life; protecting the most vulnerable children from abuse and
neglect; promoting independence and self-reliance; bringing hope to
families where hope has almost gone.

Our task – together – is to reform social services so they are
better able to empower the individual; better resourced to support
the vulnerable; better structured in the interests of the user.

Having had the courage to invest in social services. Now is the
time to make these big reforms. I look forward to working with the
LGA, ADSS, private sector, voluntary sector and councils in making
these changes happen.