Speech: 15 November 2011, Andrew Lansley, NHS Employers

Andrew Lansley speaks to NHS Employers.

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

The Rt Hon Andrew Lansley CBE


Thank you Jenni [Murray, Radio 4].

As leaders in your organisations, you are at the forefront of change in the NHS.

As a Coalition Government, we have demonstrated our commitment to the NHS in rising real terms increases. [£3.5bn more this year than last]; and in a commitment to support the modernisation of the NHS.

The NHS cannot stand still - demand is increasing; the population is ageing; technology and practice is advancing; and people have rightly grown to expect a higher standard of care.

The challenge of modernisation is leading to a fundamental re-think of how care is commissioned and delivered throughout the country.

But the inflexibilities in the system we inherited mean there is only so much that SHAs, PCTs and NHS Trusts can do to meet this challenge.

That’s why we are bringing new thinking throughout the NHS.  To give you the tools and the flexibility to exploit every opportunity to improve patient care.  To do things better and to do more with what you’ve got.

What all of this means is a shift of power - from me, to you.

From the politicians and Whitehall civil servants, to the clinicians and managers on the front line of NHS care.


With you, NHS Employers, given more freedom than ever before.

Freedom to commission.  Clinical Commissioning Groups able to respond directly to local needs.  Joining forces with their colleagues in social care and with local authorities better to meet the needs of their local communities.

Freedom to provide.  With Foundation Trusts free to innovate, to experiment and to organise themselves as they see fit.  Free to develop new and changing services for the benefit of NHS patients.  Free to focus on the things they do best.

For your organisations, freedom to be rewarded.  So that if you give patients what they want - in terms of a better experience and better outcomes - then your organisation will benefit from it.

Money following the patient through the growing system of tariffs, and more choice for patients as people increasingly seek out the very best care for themselves and their loved ones.

In your day-to-day work and in the demands placed upon you, you will all be more free from central interference and political micro-management.

And once we are through this period of transition, once we are fully settled into the new, patient- and clinician- led system, we are committed to maintaining a stable structure for your organisations.

Change and renewal will always be with us.  But it will not be dictated then by me and my successors.  It will be led by you and your successors.


With greater freedom comes greater responsibility.

Before all others, a responsibility to patients - for their safety and their dignity.

For maintaining and improving the standards of care in your organisations.

From this, others flow…

Responsibility for ensuring an open, blame-free culture when it comes to admitting and rectifying errors or poor quality care.

And a responsibility for the highest standards of training and development of your staff.
The government has a responsibility too.

To ensure that the right systems are in place so that you receive the support you need to fulfil your responsibilities.

And to ensure that you and your staff are properly rewarded.
I would like to talk about all of these things today.

Nursing Standards and HCAs

First, standards.  In particular, nursing standards.

There are an immense number of excellent nurses and Healthcare Assistants in the NHS, providing their patients with exemplary care on a daily basis.  Often providing that service in difficult and trying circumstances.

But, we must admit, this is not the whole story.

We have seen a light being shone into the darker corners of the NHS.  Exposing issues long left unresolved. How too many hospitals, or wards within hospitals, are letting their patients down.  Even when it comes to the most basic standards of care.

The CQC’s report on the 100 unannounced nurse-led inspections I asked earlier this year, shows how the quality of care for older people can fall far short of what we would want.

And that it is a problem more widespread than we would have hoped and expected.

  • Around half of the hospitals visited gave cause for concern.
  • Twenty hospitals were not delivering care that met the essential standards the law says people should expect.
  • And separately, I was alarmed to see that, in fourteen hospital trusts in response to the NHS Staff Survey, fewer than half of staff say that they would be happy to see a friend or relative treated there - in their own hospital!

This was reinforced only last week by a similar report by the Patients Association.

It told of patients denied pain relief, left to sit in their own faeces and going without food and drink.

This is utterly unacceptable.

And only serves to undermine people’s faith in our National Health Service.

I have asked the CQC to continue with these unannounced inspections.  There will be a further 700 between now and next summer, covering facilities for people with learning difficulties, in care homes and in hospitals.

Health care assistants are a big part of modern NHS care.  Both nurses and patients really value the hard work that hundreds of thousands of them do every single day.

I know that some see the compulsory regulation of Health Care Assistants, or even all healthcare support workers and adult social care workers, as part of the solution.

But I don’t believe the case is strong enough to extend statutory regulation to a further 1.2 million relatively low-paid workers - requiring them by law to pay registration fees in order to pursue their livelihoods

Regulation needs to be proportionate, targeted and effective.

There are already existing tiers of regulatory safeguards to protect patients and service users.  Like the Vetting and Barring Scheme.
But most importantly, it is the role of employers to ensure safe, high quality care.

It is your responsibility to employ the right people and to train and develop them in the right way.

It is your responsibility to enforce high standards of care amongst healthcare support workers and all of your staff.

But to support you to do this, through the Bill, we are enabling a new system of assured voluntary registration through which we will define clear standards for healthcare support workers.

So, I can announce today that I have asked Skills for Health and Skills for Care - in partnership with unions, employers, regulators, educators and others - to develop a code of conduct and minimum training standards for healthcare support workers and adult social care workers.

Amongst other things, it will help nurses know which tasks they can delegate and which they shouldn’t.  And it will bring clarity to the training that assistants need where they deliver more advanced tasks.

They will present their recommendations by September next year.

Having your name on a register in London does not automatically make you a good HCA.  Nor does it make you a good nurse or a good doctor.

Strong leadership, strong management and a commitment to quality.  That is what leads to high standards.  That is where we will focus.


Another thing that supports high standards is a culture of openness.  Of facing up to and learning from your mistakes.

In every organisation that delivers or commissions NHS care, staff must feel able to voice their concerns without fear of recrimination.

Harnessing front line staff as the prime early warning system is essential if we are to root out poor performance across the NHS.

I want to support whistle blowers, but we need to understand that if it takes someone to blow the whistle, then it may already be too late.

We can’t wait until things get so bad that people feel the only way they can get something done is to by-pass internal procedures.

Doctors, nurses, managers.  We’re all human beings and human beings make mistakes.

The best thing to do when things go wrong is not to sweep it under the carpet, but to look at it square in the eye.

To learn from mistakes and to improve things for the next time.

But this does not always happen.

The NHS staff survey showed that:

  • almost a fifth of staff [18%] did not feel encouraged to report errors, near misses and incidents.
  • One in ten [11%] feared that such reporting would lead to punishment or blame.
  • 40% felt that incident reporting was not handled confidentially,
  • and almost half - 45% - felt that insufficient action was taken to prevent similar errors happening in the future.

The figures just are not good enough.

The experiences of staff matter and we must listen to what they tell us.
There is strong evidence now that if staff feel positive about where they work, that translates directly into better patient experience, improved patient outcomes and reduced mortality.

We need to do more.  Both in government and in individual NHS organisations.

Since we came into office last year, we have:

  • issued the “Speak up for a Healthy NHS” guidance with the Social Partnership Forum,
  • We’ve amended staff contracts to include both the right and the duty to raise concerns,
  • and we’ve issued unequivocal guidance to NHS employers that their contracts of employment must cover whistleblowing rights.

And only last month, I announced that we would update the NHS Constitution.

In the NHS Constitution, there will now be…

  • an expectation that staff should raise concerns at the earliest opportunity,
  • a pledge that NHS organisations should support staff when raising concerns,
  • and clarity around the existing legal right for staff to raise concerns about safety, malpractice or other wrong doing without fear of reprisal.

And we will not stop there.  I will do anything within my power to bring a culture of openness and transparency to the NHS.  To end the blame culture and create a wide-spread learning culture.

But, government can only do so much. Once again, the real responsibility for leadership lies in your hands.

Education and Training

The third area that leads to high standards is a first class system education and training.

As more power to shape local services is devolved, it makes sense that this is accompanied by a new approach to staff development.

The NHS Future Forum agreed that there are significant benefits in moving to a system that is more sensitive to the needs of local services and employers.  One that is professionally informed and underpinned by strong academic links.

And for the first time in the legislation, we are introducing a duty on the Secretary of State to maintain a system of education and training within the NHS.

But this doesn’t grant the Secretary of State new powers to intervene.

Health Education England will provide national leadership and oversight with real power delegated to you.  To the employer.  To the people best placed to understand the needs of your own workforce; and the workforce requirements for future services.

To ensure the effectiveness of this new approach, it is underpinned by a set of principles, as we set out in Developing the Healthcare Workforce.

Things like:

  • ensuring fairness and transparency in decision making,
  • taking an integrated, multi-professional approach to workforce planning
  • aspiring to excellence in training and supporting NHS values to provide patient-centred care,
  • limiting national level action, enabling the maximum opportunity for local innovation and flexibility,
  • ensuring strong partnerships with universities,
  • and making sure that processes and structures are simple, cost-effective and efficient.

With these and other principles at its core and with powers delegated to those who can best respond to the changing needs of local communities, I know that we can ensure that patients are cared for by highly trained, professionals who have the right skills and behaviours.


All of you have a huge responsibility to your employees and to the patients you care for.

Government has a responsibility to you and the people who deliver NHS services.

And one large part of that responsibility is to ensure that NHS staff continue to have the best possible pension.
I am personally committed to reaching an agreement that is both fair to staff and fair to taxpayers.

We all know that the circumstances have changed.  We are living for longer, so we are drawing our pensions for longer.

The old calculations are out of date.

While I wish it were not so, we cannot deny the fact that without change, the current pension scheme is unsustainable.

To compensate, people will need to work a bit longer and they will need to pay a bit more.

At the end of this month, some unions in the public sector will go on strike in protest at the changes we are proposing.

Like NHS Employers, I believe this is premature.

Discussions are still ongoing and a new, unprecedented offer has been placed on the table.

An offer:

  • that protects the pension rights that people have earned to date,
  • that ensures that those on low and middle incomes working a full career will receive pension benefits at least as good, if not better, than they get now, when they come to retire at the new pension age,
  • and that those with less than 10 years to retirement will see no change in their pension.

This offer significantly exceeds Lord Hutton’s minimum recommendation.  To get the same on the private market, a public service worker would need to contribute around a third of their salary, every year.  It is also conditional on reaching agreement with the unions.

I think it is a very positive basis for reaching such an agreement.  Let me give you an example to illustrate just how good the proposed NHS pension is.

If a nurse or midwife joins the NHS at 23 and retires at 68 on about £34,000, she will have made personal contributions to her pension of about £85,000.

That would give her a pension worth around £20,000 a year.
If she wanted a private pension of similar value, she would need to have invested in a fund over half a million pounds.

The NHS pension is and will remain an excellent deal for NHS staff and I would urge the unions to consider the offer, and their actions, very carefully indeed so that we can conclude discussion on reform by the end of the year.

I know that many managers and staff side representatives are working hard locally to mitigate the impact of strike action.  And I thank you for it.  We need to maintain services wherever possible and ensure patient safety at all times.

I also want to support you as you explain the proposals to your employees.

  • To help, we’ve a new section of the Department of Health website to help answer your, and their, questions.
  • We’ve published a fact sheet for all staff to update them of the implications of the changes.
  • And we’ve sent you all a presentation to use in local staff road-shows and the like, to keep your staff informed.


So, more freedom.  But also greater responsibility.

The freedom to run your organisations as you see fit.

To commission or provide services to meet the needs of your communities.

To be innovative.

Delivering for patients.

But freedom with responsibility.

The responsibility to maintain and improve standards.

To create and maintain a culture of openness and continual improvement.

To give your staff the best possible education and training.

To ensure your staff have a positive experience working for the NHS,

And the responsibility, above all things and at all times, to ensure patient safety.

This, if you like, is the price of that freedom.

This level of freedom, coupled with this degree of responsibility, needs one thing above all else.


Leadership at every level.

To steer your organisation, or department or ward forward.

Leadership to drive up standards.  To meet the needs of your communities.  To demand the best from your teams.

Improving the quality of careers your employees can enjoy.

And improving the quality of care you give patients.
What the NHS needs most is not greater regulation, or tighter control.

It needs greater transparency and more freedom to act.
It needs leadership.

Over 8 years, I have visited hundreds of hospitals, surgeries and clinics.

And I know from my 8 years of experience in this job, that the NHS can absolutely lead the world in providing access to healthcare, and it can, when free to do so, lead the world in providing excellent care.

My mission is to support and enable you to do exactly that: providing the best health outcomes anywhere.

Thank you.

Published 15 November 2011