Check against delivery
We are now in the final stages of the Government’s listening exercise on proposals to reform the NHS.
An unusual thing for government to do: pausing legislation because we didn’t get all of the substance right. Accepting that we now need to make changes - in some cases, significant ones. But a process that is proving immensely helpful in producing the best set of reforms we can.
I know that many people following the debate about the NHS are asking themselves: what happens now? What does all this mean for me, my family, my area?
So I’m here today to reassure people: yes, there will be reform of the NHS. There must be reform of the NHS. But not change for change’s sake.
The right reform, making the best of everything that is great in our health service but, equally, taking on the big challenges it faces: making sure the NHS is world-class.
Ensuring you get the care you need.
First, I’ll set out why the NHS can’t stand still. Why it must, of course, evolve to keep up with the world around it.
But then I want to describe what the right kind of reform looks like.
The detail will have to wait. We’ll be setting out the changes to the Bill more fully once the listening exercise is complete.
However I can tell you that the right kind of reform starts from the patients’ point of view.
Not bureaucrats, not unions, not Ministers, not political parties - patients.
So I want to sketch out what patients have told me they want, and how that will influence the steps this Government takes.
First: why reform the NHS?
The fact is: our health services need to be updated, modernised.
Many of the treatments we rely on today are different to those from before.
Previously fatal illnesses are now more often longer-term conditions, placing extra demands on services.
Our population isn’t the same. People in Britain are living longer than ever. There are now more pensioners in this country than under 16 year olds, and the number is rising.
That’s more older men and women needing care; more families looking after older relatives needing support.
And our finances aren’t the same either.
The health budget has been increased by billions over the last decade.
And that investment was necessary. But we need a health service that can survive in lean times as well as plentiful ones. That can cope with the rising costs of healthcare.
The Coalition is protecting NHS funding but, even with that protection, our health services face huge financial and demographic pressures in the future.
And unless we change the way we do things now, to get the most out of every pound we spend, we are setting the NHS up for a fall.
So the world is changing, and the NHS needs to change with it.
There’s nothing wrong with saying that there are areas where we can improve.
Nothing wrong with patients being demanding about what they expect for their taxes, or admitting that sometimes people have bad experiences as well as good.
How often have you heard about an older patient stuck in hospital for weeks because there’s nowhere else for them to convalesce?
Or someone who’s had to trek to hospital for a minor treatment like getting a hearing aid fitted - something they could have done on the high street?
Or asthmatic and diabetic patients not getting the right support to manage their condition ending up in A&E before being put on the ward to recover?
We have too many patients, spending too long in hospital, taking too long to get better.
Everyone knows our healthcare professionals are some of the most passionate, dedicated and talented in the world.
The need to reform isn’t a reflection on them; it isn’t a criticism of the NHS.
It’s a response to changing circumstances: longer life expectancy, developments in medicine and technology, unprecedented pressure on the public purse.
And those professionals will be the first to tell you: together, we can do better.
What mustn’t change, however, are the principles on which our NHS is founded.
When Beveridge first proposed a nationalised health service in 1942, he didn’t prescribe exactly how it should work.
He called for a comprehensive service to ensure every citizen can get “whatever medical treatment he requires in whatever form he requires it.”
Care, free at the point of use, based on need and not ability to pay.
No government worth its salt - certainly, no government of which I am a part - will ever jeopardise that.
And staying true to the original vision of the NHS means ensuring that any reform begins and ends with patients.
Because, when everything else is said and done, what’s left are the private, often painful, experiences of individuals and their families.
Look at the NHS constitution and you’ll see the first words: what is the NHS for?
The answer: ‘it touches our lives at times of basic human need, when care and compassion are what matter most’.
So what do people want from their NHS?
From everything I’ve heard over recent weeks, I would say three big things: peace of mind, the best care, and a say in the decisions that affect them and their families.
Those are the tests by which every element of the Government’s package will now be judged.
First: peace of mind.
The comfort of knowing that the NHS will always be there for you.
If you’re in an accident, if you get ill, if your family need treatment.
And it will always be free. No bills, no credit cards, no worries about money when you’re worrying about your health.
That’s why I have been absolutely clear: there will be no privatisation of the NHS.
The NHS has always benefited from a mix of providers, from the private sector, charities and social enterprises, and that should continue.
People want choice: over their GP, where to give birth, which hospital to use.
But providing that choice isn’t the same as allowing private companies to cherry-pick NHS services.
It’s not the same as turning this treasured public service into a competition-driven, dog-eat-dog market where the NHS is flogged off to the highest bidder.
Competition can help drive up standards but it is not an end in itself.
That’s why, as Andrew Lansley confirmed earlier this week, the main duty of Monitor, the health regulator, will not be to push competition above all else.
Especially not at the expense of integrated services and collaborative practices like clinical networks.
Monitor’s main duty will be to protect and promote the needs of patients instead using collaboration and competition as means to that end.
Two: patients want to know that they’ll get the best care available.
Good advice, swift referrals, effective treatments, access to some of the best doctors and nurses in the world.
With all the different parts of the system working together so your experience is as comfortable and successful as possible.
I hear time and time again how frustrated people get when it feels like the different bits of the NHS aren’t talking to each other.
Different appointments, with different people, in different places, all about the same condition, while no one seems to have a grip on the whole thing.
And I’ve heard the, understandable, concerns, that the Government’s reforms will make that worse, not better. More fragmentation, not less.
That will not be the case.
We are striving to create services that are much better integrated.
What that means for patients is your physiotherapist talking to your surgeon…
So, after an injury, you’re put on the best course of rehabilitation.
Your GP and community nurse in touch with experts at the hospital, to get the latest information and advice.
Social care services knowing when you’re discharged from hospital so they can send someone round to look after you.
So we’re getting GPs and other healthcare professionals to take more responsibility for the overall picture.
That’s the point of clinician-led commissioning.
But, crucially, they will also have to work closely with social care services, with hospital specialist services, with children’s services - joining up your care.
And we want to see how we can bring budgets together at the community or personal level.
Getting different parts of the machine working together for you.
Three: patients want to know their voice will be heard.
A say in how, when and where you’re treated, guided by the experts.
A say in the big decisions about the healthcare in your neighbourhood.
And the guarantee that someone in the hospital, at the council, and in government is accountable to you.
You cannot overestimate the difference this can make.
We know that when people get involved in their care they get better results, and they manage long-term conditions more successfully too.
And we know that plenty of people only have kind words for the doctors and nurses who treat them.
Yet still feel powerless over health services in their area: having to stand by while changes and closures take place, with no explanation and no way to intervene.
Having to deal with the same old problems, which no one ever seems to take responsibility to solve.
No mental health professionals nearby, physiotherapy services that aren’t wheelchair friendly, hard to get hold of out-of-hours services.
So we’re looking at how patients can be properly represented at every level.
From your own care, to decisions taken in your area, as well as at the national level.
I’ve heard people suggest that our reforms could lead to politicians washing their hands of our health services, because of the way the Bill is phrased.
So we need to be clearer - the Secretary of State will continue to be accountable for your health services.
This is your NHS; funded by your taxes and you have a right to know there is someone at the very top, answerable to you. With a public duty to ensure a comprehensive health service, accessible to all.
Finally, we’re making sure that our reforms protect your rights, as set out in the NHS constitution. Like the right to treatment within a specified waiting time.
The right to drugs and treatments recommended by NICE for use in the NHS, if your doctor says they are appropriate for you. And the right to be given information about your treatment.
Peace of mind, the best care, a proper say in decisions. That’s what patients have told me they want and any reform that doesn’t pass those tests isn’t going to be passed.
As we move forward, improving and then implementing our reforms, we’re going to
take our time to make sure we get this right.
The challenges facing the NHS are complex.
Change won’t happen overnight and arbitrary deadlines are no good to any one.
So, yes, family doctors should be more involved in the way the NHS works. But they should only take on that responsibility when they are ready and willing, working with other medical professionals too.
We aren’t going to just sweep away tiers of NHS management overnight. NHS managers will carry on doing the commissioning in areas where GPs aren’t yet ready.
And there’ll be no sudden, top-down opening up of all NHS services to any qualified provider.
We should be opening up services that patients and communities want to be opened up. Services where competition will genuinely drive up quality, and we should do it in a planned, phased way.
So we’re going to tread carefully.
But we’re not going to shrink from doing what needs to be done.
We will reform our health services, creating an NHS that lives within its means but still provides the best care possible.
Where you aren’t pushed endlessly from pillar to post.
Where you have someone to turn to if things go wrong.
Where your doctor is not just responsible for your welfare when you’re in the GP’s surgery, but also following what happens to you when you’re on the hospital ward, and when you’re back at home after.
Where no decision is made about you, without you.
That’s the right kind of reform.
Reform that puts you, the patients, first.