Speech: 14 September 2011, Andrew Lansley, NAPC/ NHS Alliance conference

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

Andrew Lansley speaks at the NAPC/ NHS Alliance conference.

[Check against delivery]

Thanks to you all for inviting me to speak with you at this conference. As ever, it’s a pleasure to be in the company of the people who are leading the way in commissioning reform.

When you look back through the history of medicine and healthcare, from Hippocrates defining medicine as a profession, to Thomas Linacre establishing the Royal College of Physicians to Nye Bevan and the NHS, it is obvious that the plaudits go to the innovators. The modernisers. The ones who see that that the status quo is always there to be improved upon, not supinely accepted.

Take John Snow, whose work with the Broad Street pump, just a short walk away from here, completely changed the way the Victorians thought about public health.

Until Snow got involved, miasma was blamed for much public ill-health.

But through his rejection of the orthodox consensus, John Snow changed that. He proved for the first time that cholera was waterborne, not caused by miasma or anything else. And the rest is history.

Although the original pump around which he built his study is long gone, a replica is still there. You can still go and look at it. And in perhaps the most potent recognition that this country can bestow, right next door to the place where the pump used to be, there’s a pub named after him!

It’s a testament to his boldness, his burning desire to change things and not be constrained by old habits.

In other words, he showed leadership.

Not arrogance, or ideological posing, but a genuine desire to change things, to prove they can be done better.

That’s still an important quality. When you are able to embrace change, and improve lives, people will follow you.

That’s what you, the clinical commissioning group leaders and your staff, are doing.

You are at the heart of the means by which the NHS will modernise, improve and succeed for the future.  My task is to support you.

A changing NHS

So, firstly, let me reiterate that we are 100% committed to providing free healthcare for all, based on need, not ability to pay. The Prime Minister has said it, the Deputy Prime Minister has said it, I’ve said it. And you have my word that we will carry on delivering year-on-year funding increases to support it.

Secondly, we will enable you to work together and to influence the whole of healthcare policy, and that is why I very much welcome today’s announcement about the formation of the Coalition.

We’ve made these decisions because, quite simply, the NHS is part of our national identity. We all unite behind it as a symbol of fairness, decency and good healthcare for everyone.

But it’s because it’s such a big part of our national identity that changes have to be made.

I know I’ve spoken about this before, but it’s really important - in some significant areas, NHS survival rates are considerably worse than those of the best international healthcare systems. Rates for some cancers are particularly bad, amongst the worst in the world.

Productivity’s down, too. 4% down over the last decade. And when you think of the demographic timebomb we face, where there are already more pensioners than children, that becomes a big, big problem.

Yes, a study in the Royal Society of Medicine journal said that the NHS is cost-efficient . But efficiency should be a means to achieve equity and excellence, not and end in itself.

These dramatic improvements require bold action. From us in Whitehall, but most of all, from you.

Empowered clinicians

Our reforms are all designed to give you and your colleagues freedom. To decide how to use NHS resources, so they deliver better quality, better integrated services, better patient experience.

That starts with those working in general practices.

People in the UK make about 300 million visits to their GP practices every year.

Practice staff know better than anyone else about the public’s health. You already play a central role in coordinating patient care advocating patients’ best interests.

So under our plans, you will be able to take ownership of NHS resources and decisions. You’ll be able to challenge wasteful contracts, get rid of unnecessary bureaucracy, and spend money where it needs to be spend. All in a way that reflects the needs of local people.

It really will be a different way of working.. At the moment, I delegate responsibility to PCTs. That means ministers can interfere and tell them what to do.

But we aren’t the ones who treat patients and care for families - you are.

So the Health and Social Care Bill creates Clinical Commissioning Groups as statutory bodies, in their own right.  And if you meet your statutory duties then you will so much more freedom to take decisions that help your patients.

When that happens, we see real benefits. In fact, we are already seeing them.

GPs and hospital doctors in Liverpool have been working together to reduce unnecessary trips to A&E. That has saved over £100,000, but more importantly it has meant patients being treated in community settings, without the stress of going to hospital. And it has freed up time in the accident and emergency departments, so the patients can be seen quicker.

And GP practices in Northamptonshire have worked together to review referrals to hospitals, so patients always get the most suitable treatment. That has shortened patients’ stays in hospital, it has reduced duplication of care, and it has meant fewer patients being passed around departments like they were on the phone to a call centre.

Those are signs of a modern NHS.

And they show how good quality, innovative care often goes hand-in-hand with substantial savings. It makes sense - avoiding unnecessary treatment and duplication will always be reflected in reduced costs. That’s why it’s important for practitioners everywhere to start up similar schemes that suit their individual communities.

Clinical Commissioning

Of course, it’s impossible to talk about greater clinical independence without also talking about commissioning.

The system at the moment is restrictive, and it is irrational. In many cases, it removes patients from the entire commissioning process.

Recently there have been a number of stories suggesting PCTs are ordering the arbitrary rationing of services. In some places, that included cancer diagnostic tests.

I’m sure you read them with the same concern as I did.  We have always been clear with commissioners that decisions on access to treatment must be sensitive to individual circumstances and clinical needs.  They cannot be based on blanket restrictions.

Clinical commissioning groups will help make sure that future commissioning decisions are based on clinical considerations - and what is right for individual patients.

That is one of the benefits of moving decision-making closer to patients.  Both patients and GPs will be able to know that decisions are being made for the right reasons. Clinical reasons.

There are already 253 pathfinder CCGs covering 97% of England. I think that’s a strong indication of how much you want to make good, quick progress, and start passing on the benefits to your patients.

Next, I want Clinical Commissioning Groups to cover the whole of England and I want them to be fully authorised.

I know some of you are concerned that authorisation is a way for the NHS Commissioning Board to have constant control, that you will never be able to be fully autonomous.

But I can tell you that authorisation is a one-off process. A single test. And when you pass, that’s it done. You will have all the freedom of a statutory body..

I’m confident that you will thrive on that freedom, that responsibility to commissioning healthcare safely. There’s no-one better placed to take control of most of the NHS budget with a clear clinical focus and added clinical value.

Full authorisation across the country will mean we have moved from the current position of a vibrant network of pathfinders, to a position of comprehensive coverage by established clinical commissioning groups.

I know that many, if not all, of you in emerging CCGs have already begun your development journey or are already well down the development path.  I am going to support you on that journey, to really exploit the potential for clinical leadership and clinical commissioning.

Taking on more responsibility from PCTs is a key step towards full authorisation.  Gaining experience and building up your track record of performance will be key for authorisation, and for the commissioning responsibilities you will take on.

I was in the Wirral recently, where the pathfinder group was telling me they have been devolved 60% of the PCT budget.  So, already, CCGs are assuming control and improving services.

Now, I am sure you will all have seen the draft authorisation framework.

It’s important that you comment on it. If you like some parts, or if you hate some parts, let your SHA know.

One important principle set out in that document at the moment recognises that, as ‘start up’ bodies, CCGs will be building a track record of performance.

Authorisation will focus on that track record, drawing on your ability to, for example, improve care for patients with long term conditions, but also on your track record of assuming responsibilities delegated from PCTs.

PCT clusters will support you to take on those responsibilities, themselves taking a step back where appropriate, depending on how well-equipped you are to take on the work. But it will be very important that you show that you demonstrate your ability to lead key elements of work, such as work on the QIPP agenda or building relationships with local authorities and patient groups.

All being equal, and subject to parliamentary approval, the NHS Commissioning Board will be able to start authorising clinical commissioning groups from the summer of next year.

Before then, it’s vital that you begin to put in place robust arrangements that allow you to commission effectively.

Increased clinical inclusion and leadership is at the heart of our reforms. But for it to be successful, the non-clinical aspects of commissioning - also need to be developed efficiently and effectively.

Commissioning support will become the ‘invisible stitching’ that will allow you to go the extra mile and really focus on improving outcomes for your patients.

I want to make sure that you have as much flexibility as possible to decide how to carry out your functions and where to get your commissioning support.

To help you make these decisions, we’re launching a new tool, the Ready Reckoner, to help you explore the costs of different commissioning support arrangements.

We’ve said Clinical Commissioning Groups will get £25-£35 per head of population in their area. So by entering information about your staffing structure and the size of the population you serve, it will let you work out how much you have left for external support.

In practice, it will mean you’re able to see how to get the best value for money. Whether it’s by sharing functions with other groups, or getting them from commissioning support organisations. And of course, the better value you get on your commissioning support, the more you’ll have to spend on the clinical and quality design aspects of commissioning.

It is right that some of your support may come from the independent sector, where some specific and specialist skills are concentrated

But the vast majority will grow from the extraordinary knowledge and capability that already exists within the NHS.

And whoever you choose, they will be working for you.  You will be in charge. Not me, not the Department of Health, or anyone else.  And if you’re not getting the support you need, if it’s not value for money, you can decide to change it.

That will create an environment where the best joint ventures between commissioning support suppliers will thrive, driving innovation and value for money. Helping you do the best for your patients.

To get there we need to work with you and other NHS staff to get the basics right. Later this month we will be setting out in more detail how we will support you in ensuring you have access to the commissioning support you want and need.

Future Forum

Even before that though, you can carry on interacting with the NHS Future Forum.  They are drawn from among you and other professionals, so we get front-line first approach to policy production.

And it demonstrates our commitment to listening to what you have to say.

I went around the country with all the health ministers. We listened and we learnt from you, from your colleagues and from everyone else who spoke up.

It was clear that a great many people had issues to raise about our proposals.

So we did something about it. We accepted every single one of the Future Forum’s core recommendations, on issues from competition to local commissioning, and made sure the Bill and its implementation responded positively, providing reassurance, clarity and changes.

I’m delighted that the Future Forum, still under the leadership of Steve Field, will continue to build on the work it’s done already. I will continue to listen to what they have to say on information, education, training, integration and making sure healthcare remains the number one priority for the NHS.


There’s been a lot of work getting us to where we are today. In the Future Forum, in the Department of Health, but most importantly in the practices in which you work.

I want to thank you for that.

But I also want to tell you that there is more to be done.

Together, we’ve created real momentum. Things are changing; outdated ways of thinking are being revised; complacency is on the way out.

We need to use that momentum to push on. So emerging clinical commissioning groups have the skills, capacity and motivation they need to get fully authorised.

I’ve already said that I’m here to support you, but I want to reiterate it, because I mean it.

I’m not under any misapprehension that it’ll be quick or easy.

But I am firm in the belief that it’s the right thing to do.

That the reforms will improve the health of patients, and also the wider public.

Giving everyone greater choice, more information and higher standards.

We can all agree that those aims are worth the effort they will undeniably take.

I’ve seen how ready you are to embrace these new challenges and new opportunities. So much closing message to you is - don’t stop now! We are on the cusp of a transformation of how healthcare is provided in this country.

I look forward to working with you to travel further down that road.

Thank you.