Secretary of State speech at the King's Fund
The Secretary of State delivered a speech at the King's Fund highlighting the work the government is doing to fix the NHS and make it fit for the future.
Thank you for inviting me to speak at your conference today.
It’s underscoring the themes of courage, honesty, and the future.
We started in government, thinking back to the time I was here around this time last year with the Prime Minister launching the Darzi investigation.
We started in government by being brutally honest about the state of the NHS, and the Darzi investigation concluding that it was in a critical condition. That left us with a stark but simple choice. Do nothing and leave it to die, or reform it to make it fit for the future.
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So, unsurprisingly, the party that founded the NHS in 1948 will be the party that rebuilds it and makes it fit for the future.
But Lord Darzi’s diagnosis wasn’t just a health check, it was also a reality check. We can’t just play the greatest hits from 1997. Times have changed, and we have to do things fundamentally differently to meet the rising demands of our ageing society and the higher burden of disease, to harness the promise of science and technology, and to replace today’s overly centralised top-down state bureaucracy with a service that empowers frontline leaders and staff to reshape the way they provide care.
Our 10 Year Plan sets out the radical transformation required to fix our broken NHS. Three big shifts in the provision of healthcare that you’ll be familiar with, from hospital to community, analogue to digital, sickness to prevention. And major reforms in how the NHS is run, removing unnecessary layers of bureaucracy, ending the culture of micromanagement and directing resources and responsibility down to the frontline.
All designed to ultimately put power in the hands of patients. The easiest part of any plan, of course, is drawing it up, even if by draft 3,042, it didn’t feel entirely like that.
But what really matters, though, as you’ve been discussing, is delivering it.
And one of the biggest obstacles facing this government is the same one that’s facing nearly every democracy around the world today. Cynicism.
It’s not surprising. By my account, in the last 20 years, there have been 10 major NHS plans, coming along almost as frequently as health secretaries.
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Those plans haven’t been delivered. Bureaucracy has become bloated. Costs have ballooned and services have gone backwards. So, I do get the scepticism. What I reject is the pessimism.
Nothing is more corrosive to our plan to turning around the NHS, and with it, our nation’s health, because it’s only by inspiring and mobilising broader coalitions, and harnessing the potential of a workforce of more than 1.5 million people that we stand any chance of rescuing the NHS from the biggest crisis in its history, and to meet the challenge of building the NHS we need for this century.
So, I want to have a go today at persuading all of you, not only is our agenda a bold vision for the future of health and healthcare, but that we’ve got a credible plan that the government and the system can deliver together.
And that starts with recognising that we’re already getting to work. On electives, we’ve delivered almost five million extra appointments, more than double we promised in our first year, waiting lists are down by a quarter of a million to their lowest level in two years, and they fell in the month of April for the first time in 17 years.
We’ve begun delivering the next shift with an extra £1 billion in funding to GP practices, with more than 2,000 extra GPs on the front line.
But of course, I’m conscious that whenever I talk about some of the data moving in the right direction, there’ll be someone raising their eyebrows somewhere saying I couldn’t get a GP appointment this morning or I’m still waiting for my hip operation. They’re right. It’s not yet good enough.
And of course, there is sometimes data that moves in the wrong direction or doesn’t move fast enough in the right direction.
That’s why earlier today we took the latest step in rebuilding people’s faith in the NHS by publishing a new set of league tables. I’ll always be transparent about the state of the NHS, where it’s improving and where it still falls short of the standards patients deserve, because honesty is the first step on the road to recovery.
And with these league tables comes actions to address the postcode lottery in care across the country. Good performance will be incentivised and rewarded. Top trusts who run services will be able to reinvest them in new kit and buildings, and they’ll be first in line for the new wave of Foundation Trusts from next year.
Those at the bottom will receive more support and interventions to help turn them around. I’ve approved high salaries to attract our best leaders to take on the most challenged trusts, and these new tables shine a light on where that focus is needed.
It’s not been universally popular. There will always be some NHS leaders who would rather I spared their blushes and brush their failures under the carpet.
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Nor is this an exercise in naming a shaming. In fact, I spent much of this morning on the television and radio, highlighting the appalling conditions that staff and patients endure.
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And I know that every day, in every part of the country, there are outstanding episodes of care being delivered by dedicated people, and many of them will be doing so in the most challenged trusts. Some of our hardest working leaders have gone to run those trusts because they’re motivated by public service.
So, I’m in the business of naming and proclaiming. Marking out the leaders on the frontline to inspire and incentivise improvement and ultimately deliver a better NHS for all of us. Our challenge now is to make the exceptional the every day by taking the best of the NHS to the rest of the NHS. The King’s Fund said league tables are not meaningful and over simplistic.
I’m sorry, but that just doesn’t wash for me. Your researchers trawl through the data, they know exactly which hospitals are doing well and which are falling behind the pack. So why shouldn’t the public?
The public pays for the NHS, they own it, they deserve to know how it’s performing. And I believe fundamentally in giving all patients information, choice, and voice.
That’s at the heart of the NHS’s founding values, of Britain’s values and of my values. So, as we rescue the NHS, we’re also getting on with building a truly modern health service.
And today I’m announcing the first places selected as part of the National Neighbourhood Implementation Programme. We actually had 141 applications, which speaks to a huge amount of work already done to design, develop and deploy neighbourhood health services.
From those, we are today naming our 43 wave one sites covering more than 12 million patients from Cornwall to Nottingham to Sunderland. They are the ones best placed to provide immediate improvements for patients where the need is greatest.
Starting in the most deprived parts of the country, vulnerable patients with multiple long-term conditions will get more joined up services, closer to home, and avoid the frustration caused by a maze of referrals.
In time, the sites will expand this approach to other patient groups. And with GPs as the cornerstone, they will act as test beds for the new financial flows and primary care contracts we described in the 10 Year Plan.
In the spirit of honesty, let’s be clear that this is a big departure from what’s gone before, and not every area will succeed immediately. Dare I say it, we will make some mistakes along the way. This is people from different organisations, behaving as one team, and those organisations behaving as one system. This is an entirely new way of operating for the NHS.
This is the Neighbourhood Health Service, and this is another example of us getting on with the job to build a healthier nation and reduce the health inequalities that shame our society.
That’s what the government is doing, and it’s matched, outstripped even, by innovative and entrepreneurial approaches we’re seeing on the frontline that are giving us a glimpse of the future.
The can-do attitude of NHS stars on the ground in Whitstable means that patients can see their GP and specialist consultants in the same building, often on the same day, no longer needing to schlepp across Kent to busy hospitals.
On the Isle of Wight, drones will get chemotherapy drugs to cancer patients in just 30 minutes instead of them waiting four hours. And AI is shaving an hour off triage time for stroke patients in Dudley, potentially making the difference between someone walking out of the hospital or leaving in a wheelchair, because we all know that time is brain.
These examples are just the beginning, but they inspire us because they show what’s possible when providers can care more about their patients than about ticking boxes on whiteboard checklists.
Empowering and motivating the frontline is how we will move our health service. I want to give people freedom to innovate, try new reformed ways of working, and then judge people on outcomes.
That’s why our 10 Year Plan is a break from the past. We’ve actually halved the targets in this year’s Planning Guidance and done the same with the GP contract.
Our reform agenda is about greater accountability, but less top down diktat. I understand the disquiet about abolishing, merging or slimming down bodies like NHS England, Healthwatch, and Integrated Care Boards.
We’re not looking for scapegoats. We simply have a duty to patients and taxpayers to get the biggest bang for their buck. And I don’t think there is anyone here who thinks that we can’t put money wasted on duplication and needless bureaucracy to better use.
Our 10 Year Plan isn’t just a plan for the NHS. It’s a plan to improve the health of our nation too. In the weeks since the launch of the 10 Year Plan, we’re banning the sale of high caffeine energy drinks to under 16s. We’ve brought in healthier food standards to give babies the best start in life, and we’ve launched a campaign with Joe Wicks to get kids more active.
The King’s Fund and Health Foundation have highlighted the excessive influence that the food, alcohol, and tobacco lobby has had on popular health policy.
We know we’ve got some great allies in our food and drinks industry, including some of the biggest supermarkets, brands, and suppliers who really do care about our nation’s health. But we also know in those industries, particularly in tobacco, there are powerful vested interests who too often have got away with calling the shots.
I will continue taking on these vested interests, where they work against the health of our people and the interests of our nation. And I will need your support to do it.
So I actually welcome the scrutiny I’m getting from the King’s Fund and the other Think Tanks, and the challenges the wider health sector is putting in front of me and that is exactly why I am here today.
I think it speaks to how deep our shared commitment is to the mission of creating a healthier, fairer Britain.
So let me end by just saying this. When the Spending Review announced my department would receive an extra £29 billion a year, some pointed out that the 3% uplift for the NHS didn’t match the increases…
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So, yes, it’s true. If you focus on the 3% and ask whether that 3% alone can clear the backlog, and improve A&E and ambulance response times, make it easier to see a GP or dentist, and meet all the rising pressures on the health service as well as every reasonable and worthy demand people place on me and my department, the task in front of us looks daunting.
But that misses the point. Look instead at the 100% of the budget the NHS will receive next year, £205 billion and ask, what if we spend it where it makes the biggest difference for patients? Then think about that same question acquired over a decade, and the opportunities before us.
To go back to the themes of your conference, we’ve been honest about the state the NHS is in, and that it will take time to turn it around. We’ve also had the courage to say no to extra targets, vested interests, to abolish influential bodies and to pursue reforms that give power to those on the ground instead of pretending that change is made by pulling a lever in Whitehall.
And we set out a radical vision for the future of healthcare, one that is rooted in the values upon which the NHS was founded, and most importantly one that is within our grasp. But we will only deliver it if every part of the NHS and the wider health sector pull in the same direction with us.
We now have the plan to deliver an NHS fit for the future. We have the means and the will to do it, and I’m absolutely determined to pull it off, which is why I’m delighted the Prime Minister asked me to continue in this task and why I’m delighted you invited me here today to share that ambition and determination with all of you.