皇冠体育app

Thank you - I鈥檓 pleased to be able to join you here tonight.

Just the thing a Secretary of State needs, an evening with friends, in a brewery, to liven up what might otherwise be a dull week

I鈥檇 like to begin with a few thank yous - particularly to Macmillian Cancer Support.聽 Macmillian do an immense amount of work, and I am privileged to be able to see their work day, day out. Its difficult to measure just how much they have improved the outcomes for cancer patients across the length and breath of the country over its 100 plus years.

I鈥檇 like to thank and pay tribute to the effort and the expertise that leaders in local government have put into the health and care reforms.聽 You鈥檝e all been truly outstanding.

A few of you here tonight will feel you spend more time in Richmond House than in your own.

We鈥檝e asked a huge amount of you - and I鈥檇 like to thank all of you for the time, energy and commitment you鈥檝e put in helping get these reforms right.

If you were following our reforms in the media, you鈥檇 be forgiven for thinking it was all about the NHS and GPs. But I鈥檓 sure, you like me, would be happy to put the media right on a variety of subjects.

But in my view, the truly radical bit in the health and care reforms is not the responsibility we鈥檙e giving to GPs and clinicans, that builds on past experience. It鈥檚 not that we are expanding patient choice. It鈥檚 not even the focus on quality in the NHS, vitally important as those things are.

皇冠体育app radical bit is actually about local government.

It鈥檚 about allowing local councils to do what they are best placed to do - to shape and improve the well being of their community.

And it鈥檚 about a new kind of collaborative leadership - across the NHS, local government and communities - through the new Health and Wellbeing Boards.

Genuine local ability to improve the lives of local people.聽 It鈥檚 a very simple idea and one that鈥檚 been too readily forgotten over the past few decades.

Its what I care about. I believe local government can deliver the very best.

But delve back into history and look at some of the greatest and most influential developments in public health.聽 皇冠体育appy鈥檝e come from local leadership.

Some history鈥�

If you were just a mile or two west of where we are tonight, you have Broadwick Street in Soho.聽 This is where, in 1854, John Snow, in the face of derision from fellow doctors, ended the cholera epidemic with the simplest of interventions. He took the handle off the water pump.

He took the view that cholera wasn鈥檛 spread through the air - the culprit was dirty water.

He was a local. He lived round the corner on Frith street. He lived and breathed the problem in a way that no lofty, so-called expert, geographically isolated and emotionally detached from the problem ever could.

Because he lived there鈥� because he could see the cesspits leaking into the water supply鈥β� Because he saw what was happening to people鈥檚 health鈥β� He was able to join the dots and take what was to be a great leap forward for public health.

About a decade earlier and a mile or two to the east, Victoria Park became the first public park in the world.

Why a royal park slap bang in the middle of the East End?

Because people in power started to realise that where we live is important.

At the time, the Registrar General said, 鈥溾��a Park in the East End of London would probably diminish the annual deaths by several thousands鈥�. and add several years to the lives of the entire population鈥�

Public Health

But those ideas would never have been anything more than tinkering around the edges had the idea not been embraced by local government.

It was only when cities embarked on programmes to light and pave their streets; when they chose to supply all their homes with plentiful and pure running water, and to connect working-class homes to mains sewer systems that Britain as a society began to really evolve and advance.

It was the improvements in our homes, our streets and our schools, led by local government, that really began to extend life, to cut disease , to beautify our towns and cities and to civilise our environment for all of us.

皇冠体育app air we breathe, the water we drink, having somewhere safe for our children to play - these things are important.

皇冠体育appse things matter then and they remain every bit as important today.

Public health - it鈥檚 about how people live and breathe. And If you want to improve people鈥檚 health and wellbeing, you have to live and breathe their problems. You can鈥檛 do that from Whitehall, you can only do that from on the ground.

That鈥檚 why, in more recent times, it was councils like Liverpool and others who pushed smokefree workplaces on to the radar of national government. 皇冠体育appy could see the difference it would make to local people - they were the visionaries.

You might have heard some of this before. I鈥檓 definitely not the first politician to stand before you and tell you that local government has an vital role in improving people鈥檚 health.

皇冠体育appre鈥檚 been a lot of talk about this over the last few years, but to little action.

You can ask every area to do a Joint Strategic Needs Assessment, but if it just sits on someone鈥檚 shelf gathering dust, it鈥檚 not worth the paper it鈥檚 written on, however many optimistic meetings you might have had with the primary care trust.

You can talk all you like about the need for a more profound connection between health and other local services, but if all the powers are against change, then not much will change.

But as Einstein said, a form of insanity is to keep doing the same thing and expecting a different result.

So we are now doing change. You are doing change. Change to devolve power; change to foster new clinical and professional leadership; change to empower local democratic accountability in a new partnership between local government and the NHS.

Health and Wellbeing boards

Health and Wellbeing boards will be genuine leaders - in the design of local services, on devising the strategy that will deliver the most for local people and in carrying it out with local partners.

皇冠体育app Boards will be the ones with the complete picture - from seeing and preventing the causes of poor health, to how we can best care for people who live with long term illness or disability.

皇冠体育app Boards will lead the drive to join up services, making integration the name of the game, and to tackle health inequalities.

And their success will depend on how local leaders work together, on developing relationships, creating the right culture and changing behaviour.

This wont be easy. But by bringing together councils and councillors, with clinicians and patient representatives, we can bring to bear the sort of insight and creativity that John Snow and the founders of Victoria Park showed so long ago.

It will be tough. Physical environments are easy to change. Culture is the hardest thing to change.聽聽 Community shapes, not places.

Some of you have spoken of the new positive connection you鈥檝e seen when GPs and councillors come together for the first time鈥�

鈥� Two sets of people who have roots in their local community with a shared passion for doing the very best for their local communities鈥�

鈥� for making sure that strategies, rather than gathering dust on a shelf, are translated into action on the ground.

I hope this shared sense of purpose and understanding can and must lead to powerful Health and Wellbeing Boards that work with communities to drive better services and improve their health and wellbeing.

Healthwatch

And, of course, they will be doing all of this hand in hand with the local Healthwatch.聽 A powerful advocate for local people on the Health and Wellbeing Board it will be critical in making sure the Boards tackle the issues that matter most to patients and care users.

Every Health and Wellbeing Board will rely on committed and knowledgeable local volunteers to play a full role in improving local services.

And it is crucial that the Healthwatch representative on Board is provided with good, strong, open-hearted support.
This includes supporting them to challenge as well as to collaborate.

Healthwatch is a champion for local people.聽 If those services aren鈥檛 up to scratch Healthwatch will be your critical friend - highlighting the problems and working with you to find the solutions.

皇冠体育appy鈥檒l need sufficient resources to do this.聽 Arrangements will vary.聽 What I am enabling local government to do is to ensure that Healthwatch has a solid platform on which to operate and to be the strong independent voice that patients and care users want.

Public Health Outcomes Framework

Across public services, we are for getting results. That, means focussing on outcomes. Not just inequatlities or process.

When it comes to the indicators on the public health outcomes framework we鈥檝e focused on the things that you鈥檝e known for many years will tackle the causes of poor health and health inequalities.

Some are obvious, like levels of obesity in children, and reducing the number of people who smoke.

Others are more complex, such as school attendance, school readiness, homelessness and air pollution.
We鈥檝e chosen these indicators because they accurately reflect the outcomes which have the greatest impact on people鈥檚 health - in particular, the health of the poorest.

But as we know with any major change, when it comes to implementation, the devil is often in the detail.

Governments before have talked a good game on local freedom, but the result has always been the same - more bureaucracy and industrial scale form filling, divorced from what you were actually trying to deliver.
We won鈥檛 do that on public health. We鈥檙e not telling you how to reach these indicators, or your priorities - that鈥檒l be up to you.

But you will be publicly accountable for the money you spend and what you deliver. We won鈥檛 replicate the heavy-handed performance management culture of the past, but we will expect to see something back from you.

This is an opportunity to think differently about how we 鈥渄o鈥� public health, and that鈥檚 the culture that you as leaders need to generate in your teams, wherever they come from.

I will also support you to shape public health in ways that add value and that engage with the voluntary sector and your local communities.

Public health should not just be about analysing the problem, it is about delivering solutions. You will look for those who can lead in doing that; and I will back you.

Money

And then there鈥檚 the money to support your public health change.

I have published baseline estimates
鈥⒙犅� 聽拢5.2 billion for public health

鈥⒙犅� 聽拢2.2 billion baseline for local government responsibilities.

It鈥檚 a first step, and I hope it will go some way to helping you with planning for the responsibilities you鈥檒l take on formally in 15 months.

Again, I share your frustration - it鈥檚 taken us a long time to get to this point because the system didn鈥檛 know how much was being spent on public health, and the figures might not be what you were all expecting.

What I do want to emphasise is that these numbers are estimates not predictions.

While no one will get less than what we鈥檝e estimated, there will be some details we need to iron out.

So if you think we鈥檝e got it wrong, please keep working with your primary care trust, and with us, so we can get it right. If you think our methodology can be improved, we鈥檙e happy to hear from you.

We鈥檒l be finalising allocations between now and the end of the year, so we have time to get this right. At the very least, they should be a good basis for planning.

Like any major change, there will be bumps along the road, and adjustments we have to make as we go along. But it doesn鈥檛 mean it鈥檚 not the right thing to do, or that we should give up.

Take a look at the local authorities who鈥檝e led the way on issues like integration. Local authorities like Knowlsey where they don鈥檛 talk about money for the NHS and money for social care - they talk about the Knowlsey pound, because it鈥檚 the same people of Knowlsey that they all work for.

Whether it鈥檚 the logo of the NHS or the local council on their office is neither here nor there.

Or look to Torbay, where they focused their vision for integrated care on a fictional older lady called 鈥淢rs Smith,鈥� with multiple health and care needs. So health and social care staff asked at every stage: 鈥淲hat would this mean for Mrs Smith?鈥�

Social Care White Paper

Social care reform too.

I know there are sceptics who think we鈥檙e not going to bite the bullet on reform. Although I鈥檓 surprised if any of you think that I wont swallow every bullet fired at me. Who suspect we鈥檙e going to consign issues to the 鈥渢oo difficult鈥� box.

I understand why people are sceptical. You鈥檝e had government after government, report after report, consultations and debates. All promising the answer, but few coming up with the goods.

It is difficult. Its because its difficult, that people haven鈥檛 done it before. But all the more reason for us to make it happen.

皇冠体育appre is much we know will make a postive difference

• more preventative, more personalised care.
• Portability of assessments
• Better information, advice and support
• Integrated services
• strong Safeguarding
• effective regulation

But I am not going to pretend that funding鈥檚 not the also a key issue - how we support growing numbers of older and disabled people is the problem faced by almost every major nation.

And as Andrew Dilnot said, how to enable people to prepare and plan must be a partnership between families and the state.

Its not just about how much money,. As you鈥檒l know all too well, these days, spending more money in one place means spending less or moving money from somewhere else.

In the financially challenged world we are in we have to know where the money comes from and the value it delivers.

So It鈥檚 about thinking in a different way about how we support older people, disabled people and carers.

皇冠体育app Caring for the Future discussions we had at the end of last year gave us the time and the space to do some serious thinking on these kind of issues, and it鈥檚 been all the richer for your support.

Over 300 engagement events took place with the care and support community.

We鈥檝e had 640 separate pieces of correspondence, in the form of letters, reports, feedback forms and website comments. And thousands of people visited the Caring for the Future website.

When I publish the White Paper in the spring, I hope you will recognise much of its content, because much of it is what you and your communities, told us was important.

Conclusion

No one underestimates the size of the challenge you鈥檙e facing鈥�
-聽聽 聽in continuing business as usual while building for the future,
-聽聽 聽in planning for transition, as future leaders in the health and care system.
-聽聽 聽Modernising, reforming , changing.

Not something we can鈥檛 do because of financial and demographic pressures. Something we have to do to deliver improving quality of care in the face of those challenges.

We are addressing some of the biggest challenges of our generation, and you are on the front line.

But I have confidence in the exceptional local leadership I know is here in this room today to drive and shape this agenda, and improve the health and wellbeing of the people in your communities.

Thank you.