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Modernisation of the NHS: article by David Cameron

Prime Minister David Cameron has written an article for The Times on modernisation of the NHS.

This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

Prime Minister David Cameron has written an article for The Times on modernisation of the NHS.

Read the article

Two weeks ago I set out the government’s plans to modernise the NHS. Since then there’s been a whole flurry of debate - with The Times among those leading the way. It goes to show just how much people care about our NHS. Well, let me tell you: I care too. A lot. I have huge respect and admiration for our doctors and nurses and I am more determined than ever to deliver a world-class health service for all. The debate today is about the best way to achieve that. But as ever with debates like this, some myths have crept in about the changes we plan. And here, I want to take them head on.

The first myth is that we don’t need change. This simply isn’t the case. Just look at what’s coming down the line. The number of people with three or more long-term health conditions is set to rise by 30% in just 8 years. The cost of drugs has been growing by £600 million a year and medical technologies are continuously advancing. Now ask yourself: do you think the NHS will be able to cope with all this if we just put in a little money and carry on business as usual? The answer’s no. Fail to modernise, and the NHS is heading for crisis. Already our health outcomes lag behind the best in Europe. Without modernisation, the principle we all hold dear - that the NHS is free to all who need it, when they need it - will become unaffordable. That’s just not acceptable. We simply can not stand by and let that happen. But we will only prevent it if we change the way we do things so we really promote excellence and get value for money too.

The second myth is that we plan a revolution at the heart of the NHS. This is not revolution. It’s evolution. GP-led commissioning, patient choice, payment-by-results and Foundation Trusts have all existed in one form or another over the past fifteen years. And the NHS has always worked with a range of social enterprises, charities and private companies. The difference is that we plan to make these changes effective right across our NHS. Under the last Government, it was all far too piecemeal - and far too half-hearted. We understand that all parts of the NHS are connected, and they all need to be developed together in a clear and consistent way.

The third myth is that doctors are being forced to do something they don’t want to do. These are not like the changes of recent years, with politicians and bureaucrats bossing, controlling and re-organising from on-high. Our plans take ministers and management out of decision-making, and give doctors much more freedom. We propose commissioning by consortia, not individual practices, and it will be up to the GPs involved to decide how active a part they want to play. What we’re finding though, is that when you put that decision in their hands - they want to do this. Already 141 GP-led consortia have come forward, covering half the country. That, in anyone’s book, is an extraordinary response.

The fourth myth is that this is privatisation by the back door. That, somehow, GP consortia will be ‘forced’ to use the private sector to help them commission services. Again, not true. We have set no quotas and made no demands. This is about the freedom for GPs to choose whatever is best for their patients. That’s not privatisation - it’s progress. We simply can’t allow prejudices about the public, private or voluntary sectors to get in the way of what is best for patients.

The fifth and final myth is the most important: the suggestion that patient care will suffer. The opposite is true. Our changes draw on some simple logic - that professionals, not managers or politicians, are best placed to understand the needs of patients. And when you couple that professional freedom for doctors and nurses with choice and transparency for the patient, you get a mix that will expose poor performance and drive standards up.

GPs have been telling me about the new possibilities open to them. One said that instead of his patients waiting two weeks for an ultrasound scan, he wanted to commission one for the same day he saw them. Another described how in Bexley, one of the first areas where GPs have taken on commissioning responsibilities, dozens of patients with suspected heart conditions have already been able to get specialist CT scans at a private clinic in Harley Street, free on the NHS.

Nurses too will continue to play a vital role. GP consortia will have a statutory duty to work with nurses and other healthcare professionals, ensuring they have a real voice in shaping better care for patients. Many nurses are already taking advantage of greater freedoms to improve care for their patients by striking out and forming their own staff-run social enterprises.

These sorts of changes are only possible with the modernisation we plan. Only by modernising can we achieve the world class care that we all want to see. That is why this matters so much and it’s why I’m so determined this coalition government will see it through.

Published 31 January 2011