Andrew Lansley speaks to the NHS Confederation.
Hello Sarah [Montague], and hello everybody. It’s great to be with you again and I am delighted I can just about see you with these lights, but, it is a great pleasure to be with you.
Thank you once again for the opportunity to be here with the NHS Confederation. I know it has been a busy year. A lot has been done. A lot has been achieved over the last year.
Let us just remind ourselves of some of them. Over the past 12 months:
- We have seen breast and bowel cancer screening increasing faster than scheduled.
- We have seen MRSA blood stream infections down by 17 percent.
- C.diff down by 15 percent.
- 19 out of every 20 women now seen by a midwife in their first trimester during pregnancy. That is up by 8 percent.
- Almost three quarters of a million more people accessing NHS dentistry.
- Waiting times in the NHS, referral to treatment average waiting times, lower than it was at the time of the General Election.
- The numbers of people being put in to mixed sex accommodation when they should not, down by 83 percent.
Now, all of this in a year which also saw the severe winter; the impact of flu again; significant increases in demand; over half-a-million more people treated in hospital; over 100 thousand more diagnostic tests.
And all of that achieved with spending in the year just finished, 2010-11, 2.2 percent higher than in the previous year. And delivered with a strong financial performance - a surplus from Strategic Health Authorities and Primary Care Trusts in total of over £1.3 billion.
So, it is a time of change, I know that. A time of great challenges, not least in continuously improving the service that we provide to patients.
But the people of the NHS have yet again proved how, through commitment, dedication and skill, they can continuously improve that care for patients.
So I just want to say firstly, for all that has been achieved over this year, thank you.
Last year has been busy for other reasons too.
- A time of change in terms of how the vision and purpose of the National Health Service is to be established.
- A White Paper last July.
- A statutory consultation through to the autumn.
- A response at the end of the year.
- and the Bill published in the New Year.
But of course while we were pressing ahead there grew an increasing perception amongst some people, perhaps too many people, that the Bill could pave the way for things that they did not want.
At the same time, I think we all know that a big gap opened up between what was actually happening on the ground and what was perceived to be happening in the Health Service by the commentariat at Westminster.
So, we needed a way to re-connect. To re-assure those with genuine concerns, to learn from those already implementing the changes locally about how to make the Bill… the policies… the implementation of modernisation - meet their needs in the future.
So, in April we did take an unusual step of pausing the progress of the Bill.
The NHS Future Forum under Steve Field’s leadership enabled us to look again at how the Bill was constructed and indeed how it was to be implemented and some of the issues related to it.
Issues not only that were already in the Bill, but some like education and training, which people felt rightly needed to be considered right alongside it. It gave us an opportunity to address head on concerns people had.
Some people were genuinely concerned about the impact of competition on the NHS that it would be promoted as an end in itself and not in the interests of patients. We will not do that.
Competition will only ever be used as a means of improving care for patients. What matters is that we create a level playing field that allows the best health care providers to flourish.
Some groups of clinicians, like the Royal College of Nursing, were concerned that the make up of local commissioning was too narrow.
The pause allowed us to ensure, rightly, that commissioning is about clinical leadership. And that is across and beyond the general practice, it is even actually beyond health care. It is health and social care. Bringing people together to design better services.
And we knew from the many letters we received from members of the public that people feared, perhaps were told they should fear, that the Bill would undermine the values of the NHS.
I would never let that happen. But we have now, I hope, re-assured people of our commitment to the fundamental values of the NHS.
Something here with the NHS Confederation conference I have done year after year after year, and indeed, some of you will remember we have done that here with David Cameron with the NHS Confederation in years past.
A commitment to an NHS available to all, based on need, free at the point of delivery. And strengthening the NHS Constitution as the basis for what we do.
The pause gave us the opportunity to build then a greater sense of ownership. Essential for proper implementation. And it enables me to assure you that the Coalition Government is fully committed both to the NHS and to its modernisation.
Now, the Future Forum did a great job and I would like to thank all of them, and include all of the managers who worked so hard to develop its recommendations.
They recommended that the pause should end. It has. But that does not mean that we have stopped listening.
On Monday, I will discuss directly with members of the Future Forum what implementation challenges they might help us with next. That process of listening, engagement, and co-production of implementation of modernisation will be a continuing feature of how we do our business.
While there have been substantial changes, the guiding principals remain.
I said to you last year that patients must be at the heart of everything that we do, not just as beneficiaries of care, but as participants in its design. Making the principal of no decision about me without me one that is imbued in the practice of the National Health Service.
That still stands.
Last year, I said we need a rigorous focus on outcomes with the ambition of securing results on health care services in this country that are amongst the best in the world.
That is still true.
Last year I said we must set professionals free to use their clinical judgment to do their jobs to the best of their ability, and on the basis of the evidence.
That vision also remains. And, our determination to put clinical leadership and decision making close to patients in order to deliver the best service for patients.
And last year I underlined the central importance of emphasising a Public Health Service that worked on a both more integrated basis, and impacted on the wider determinants of health.
That we are pursuing.
And I said we were committed to the modernisation of social care and to its reform.
And that, too, we are pursuing.
But my main message to you today is that after the pause it is now time to move forwards and to get on with improving services for patients.
Listening to General Practitioners at Pathfinder events or at the National Association for Primary Care, I know that while our plans were in flux some became less keen to commit to long-term changes. Some of them, some of you, I am sure, will have felt unsure about how to proceed.
Well it is now time to re-gain the momentum, to get back on the front-foot, to focus again on the challenges that we all face.
And to underline that return of momentum, I am glad to announce today the fifth wave of Pathfinders for Clinical Commissioning Groups. 35 new pathfinder groups, bringing the total to 257, covering almost 50 million people, 97 percent of the population in England.
Some Primary Care Trusts have already delegated budgets and commissioning responsibilities to Pathfinders, and I hope to see the great majority do so by next April.
If 2012-13 is generally to be a year of preparation, it needs to include a substantial delegation of responsibility in the course of the coming year.
By October next year, the NHS Commissioning Board will begin the process of authorisation of Clinical Commissioning Groups, delegating budgets to them directly, and by April 2013, Commissioning Groups will start to take statutory responsibility in their own right.
You will hear more about this tomorrow from David Nicholson, but it will be the mission of the NHS Commissioning Board to support local clinical commissioning groups to get up and running as quickly as is practical to do so.
Only when commissioning is both clinically led and locally led can it bring about the transformation so critical to meeting the challenges of the years ahead.
Now, those challenges are great. As I see it there are four major challenges facing the NHS and facing you as managers in the service.
- To increase productivity.
- To improve patient care.
- To re-shape how that care is delivered.
- And to integrate care around the needs of patients.
First then, dramatically increasing productivity year-on-year. By treating more people closer to home; by focusing on prevention as much as on cure; by eliminating errors and avoidable harm; and by integrating care around the needs of patients.
Making big savings and increasing productivity must be about delivering more productive care, more integrated care, more preventative care, more accessible care. It can not be about crude cuts to services. Not when it can be about making them better.
Second challenge I will suggest: To improve the quality of patient care.
I know that people are satisfied, many very satisfied with the National Health Service. But, we cannot turn that level of satisfaction on the part of the public in to an excuse for complacency on our part about the service that we can deliver in the future.
We know, not least because for example of what we have seen in the atlas of variation published in December, we know that there is still too great a variation in the quality of care in different places across the service.
Look just last week, for example, at the report produced by Tom Hughes-Hallett and the variations he was able to demonstrate in access to palliative care and the quality of end of life care.
We must make excellence standard. The NHS can do better. We all know that, it is not to criticise what has been achieved in the past because so much has been achieved, but we all know that there is variation and unacceptably poor standards in some places just as there is excellence in others. We must make excellence the norm.
We need to measure more.
We need to publish more.
We need to incentivise more.
And in coming years we will give England the most transparent health care system in the world. The Prime Minister said this morning that transparency is a central tenet of this Government’s approach to improving all public services.
Up to now, this approach has been demonstrated in relation to aspects of access to care in the NHS like waiting times.
But in the coming years, we must also publish far more data on clinical outcomes for the public and for professionals to see. Data like hospital mortality rates for bowel cancer, published for the first time in April this year, which showed mortality rates that varied from 1.7 percent to 15.6 percent.
Every doctor and every nurse and every manager and every health care provider wants to be as good as they possibly can be. And in a more transparent National Health Service everyone will see just how good they are.
And then professional pride, patient choice, and indeed, proper incentives, will drive outcomes up.
The third challenge is to re-shape NHS care.
More community based care. Like I saw for myself in Whitstable where no longer do people have to go to hospital for endoscopy; they can have one at their local GP surgery.
Equally more specialist care taking place in centres of excellence. Like the new centre that I was able to join in launching at the Queen Elizabeth hospital in Birmingham. The Centre for Surgery Re-Construction and Microbiology. Bringing together trauma surgeons and research scientists from the military and as well as the NHS; pushing the boundaries of what we can achieve in major trauma care.
Now, every provider, especially hospitals, needs to take a deep look at the services they provide and how they provide them.
The best hospitals already no longer think of themselves as a physical place, bricks and mortar, but as a service provider of excellent health care. Not so much a hospital trust, or a mental health trust, but a health care trust.
Like in Croydon: Croydon Health Services providing both hospital and community services through a range of community and specialist clinics right through their area. This flexibility makes adapting creatively to changes and needs far easier.
But change, even when it is clearly clinically justified, is not easy. People often form a strong emotional bond to the places where their life may have been saved or that of a loved one. So, it is incumbent on us to make the argument for pressing forward.
Change must be - and seen to be - clinically, not politically led.
Of course, the NHS will always be political to an extent. Government sets the overall budget, we have amended the Bill, we have re-affirmed Ministers are accountable over all with a duty to promote a comprehensive Health Service.
But for the future, we need much less political interference in the day-to-day running of the National Health Service.
There may be a lot of guidance and direction at the moment through transition, but, the objective is then to liberate the NHS.
NHS accountable to patients and accountable for the results that are being achieved. Because we know where decisions are clinically led based on the latest evidence and where patients and the public have been properly involved in their planning and design, services will improve.
Our fourth challenge is to cut bureaucracy and to integrate services around the needs of patients using more resources at the front line.
Last November, my father died. His care was good. With the support of the NHS community services where he lived and indeed Marie Curie cancer care services, he was able to have, I think, a good death.
It was not an experience of health care without its problems. The people in the NHS who looked after him were very good but the service, especially in the early stages, was fragmented and uncoordinated.
I remember at one stage I could not work out who was in charge actually: his GP, oncologist, palliative care consultant or the hospice?
There are too many hoops for patients to jump through. Too many administrative obstacles for clinicians and managers to negotiate. All getting in the way of the integration of services built around patients.
Now, you all know I have been a critic of excess bureaucracy, of red tape, of an over-administered National Health Service.
But I also know from long experience of talking to many of you and your colleagues around the NHS that you are vocal opponents of excessive bureaucracy.
Some of people who have been most vociferous to me about how they could deliver services more effectively if only the bureaucracy would led them get on with it, have been the Chief Executives of Foundation Trusts, who believed they were being given greater freedoms.
So what we have to do is we have to stop the bureaucracy that gets in the way. We have to stop it if it stifles innovation. If it gets in the way of providing patient centred care.
But that is not to say that management is not important.
Management is vital.
Without high quality management, we can not hope to meet the challenges we face.
Without good managers, we cannot achieve the efficiency and effectiveness gained so vital in the Health Service.
Without good managers, we cannot take the leaps forward in the patient care.
Without good managers, we cannot re-shape NHS services.
Without good managers, we can not achieve integration of services.
The modernisation we know we need is as much about managers leading modernisation as it is about clinicians. But, the essence of it is providing that leadership together.
As I have said to you before, and I will keep saying, where we have in the National Health Service doctors and nurses and health professionals who treat managers as “them”, the service is bound to fail.
Where we have the health professionals who provide care who see managers and management as “us”, then we are going to succeed.
Because management is integral to the process of delivering best practice.
And, leadership in the National Health Service will come from clinicians, and it will come from managers. But, it must not be seen as something that occurs separately. It must be something achieved together.
Now, the challenges that I have been talking about, the changes I have been talking about, they are going to have an impact on each and every one of us.
There is a huge amount to do, a huge amount to get to grips with, and I know that it can be a tough time. It is a tough time across the public services.
Just a fortnight ago, I was with the Local Government Association and there are many in Local Government who are grappling with very serious levels of demand, and doing so with fewer resources.
I understand the difficulty the position some of you find yourselves in as a consequence of changes. But, not to change is not an option.
Change needs champions. So, patients need you to be those champions. To do what is necessary to make the transition to a modernised National Health Service one that is smooth and effective. To realise the opportunities that change brings, using your knowledge of the service.
So it is time now to look those challenges in the eye, to do what is necessary to meet them, to regain the momentum.
And I do ask you to return to all of your organisations right across the National Health Service with one simple message:
The pause is over. It is now time to act.
Thank you all very much.