Speech: Thursday 26 January 2012: Andrew Lansley, NHS modernisation and the launch of the Children and Young People’s Outcomes Strategy
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
Andrew Lansley speaks at the launch of the Children and Young People’s Outcomes Strategy.
CHECK AGAINST DELIVERY
Thank you Ian [Lewis, Medical Director at Alder Hey Hospital] for your introduction and for your personal commitment to improving outcomes for children and young people.
This morning, here to mark the development of a new strategy for helping children and young people…
I think back to my own upbringing.
Because my commitment to the NHS is a personal one.
And it’s one my family has shared from the very start.
On the 5th of July 1948…
….that remarkable day in our history when the NHS came into being…
…my father went to work with pride as an NHS scientist.
Then, for over 30 years he ran the pathology lab at East Ham Memorial Hospital.
He was chairman of the Institute of Biomedical Sciences.
He was a professional, dedicated to serving the public in the best healthcare system in the world.
And he passed that dedication on to me.
As I grew up the NHS wasn’t some remote organisation.
It was what we knew, what we cared about and what we wanted to make work.
And that is every bit as true today.
As a son, as a father and as a patient, I know what it is to have the NHS at your side.
To see dedicated, skilled, caring professionals work to save lives.
And alongside that experience the anxiety, sometimes even the loneliness…
…of feeling that you are just a unit in a system that can seem so big, so complex, that the process can appear to overwhelm the patient.
And if that is true for adults…
…then imagine how frightening the experience can be for a child.
And that is what we need to put right and what I want to talk about today
Not interfere with the values of the NHS…
…which are as rock solid today as they were six decades ago.
But improve the way things are done so that young people, as much as adults, who use health services are always treated as individuals.
Almost nine years ago, in opposition, I was proud to become shadow secretary of state for health.
I’ve held the post in opposition and now in office ever since.
Indeed, since the NHS’s foundation no other frontbench politician has served in this post for so long.
Or had the time and enthusiasm to talk to NHS staff at all levels, observe the system, get to know the many things that go right and the ones that also go wrong.
I’m not an outsider.
The NHS is my passion, my mission…
…and I would never do anything to harm it.
I’m backing the reshaping of the way the NHS works not because I dreamed up modernisation on some remote ministerial whiteboard.
But because time after time, over 7 years as a shadow Secretary of State, patients, GPs and nurses told me what needed to change.
That the NHS is led too much by bureaucracy and too little by patients and that’s got to change. Dominated by targets and not by evidence. Obsessed by inputs not by outcomes.
So let me say this at the start…
…I know the NHS is a precious asset.
…I know that any change will worry people.
…but I also know that without change the NHS cannot suceed.
In this room today there are people from far beyond the NHS.
From children’s services, children’s charities and from local government.
But all of us share one ambition: to give people the best possible health care.
To listen to their needs.
To allow the professionals to do their job.
And that applies to children’s services just as much as to everything else.
In his review of NHS services for children, Sir Ian Kennedy expressed his concerns when he said: “Pockets of excellent practice exist [but] they are just that… islands in a sea of mediocrity, or worse.”
In essence, that the system itself was getting in the way of doctors, nurses and others from giving children and young people the kind of care they wanted to.
Outcomes for children vary immensely across the country.
Young people under 16 not included in the patient survey asking about what’s happening to them, or what they think of the experience.
Services not linked together.
Professionals lacking power.
And that’s what drives this government’s reforms - in care for children just as much as elsewhere across the NHS.
CHILD HEALTH STRATEGY
That is why I’ve asked you to come together today.
We recognise that children are not just small adults.
That they require not just the right facilities, but the right structure of services.
The principles of:
- listening to patients and their families;
- empowering professionals;
- focussing on outcomes.
All apply to children’s services. We need to integrate services around patients, not just pathways, not institutions.
Outcomes depend on integration across services. Opportunity of NHS/public health/and local authorities together. Like they do in Sheffield.
This will be the first opportunity in new system to demonstrate how we can bring together services.
Not structural integration but integration around familes and children.
Marmot (universal proportionalism) - early intervention.
Strengthening GP practice expertise and delivery of children’s services.
Bring expertise out of hospitals into design and delivery of community paediatric services.
Clinical commissioning groups and health and well-being boards able to see Outcomes Strategy for a template of how they can shape children’s services across England in a way which brings services together better than ever before. And the Forum challenging us, the Board, local government, Public Health England in how we can ensure the right leadership, outcomes and support.
I see this as an exciting opportunity. Not to ditch anything which works but to do the things we always dreamed of.
The reason it is right to do this now is because clinical commissioning groups and health and well-being boards have been established all across England.
They are shaping new relationships and new opportunities.
The outcomes structure for children prepared now will enable those new relationships to focus on children and young people.
It will enable us to link commissioning across children’s services - local authorities, public health and the NHS - to realise the opportunity of delivering the more integrated services for children and young people that we are all looking for.
Now as things stand - let’s not hide from the fact - several health organisations oppose aspects of the reforms I believe are essential.
I wish it was otherwise.
I don’t seek out a fight.
I’m not the sort of politician who delights in the sound of gun fire.
I’ve paused. I’ve listened. I’ve worked with the independent Future Forum.
I’ve reshaped the plans where my critics have a case.
And after we did that, they came out and supported much of what we had done.
And now I want these organisations to continue to come in, talk and help us make it work.
And I know - because their leaders have been working with me from the start, always welcome in my office - I know that they want the same.
Because this isn’t - at its core - a debate about principles. Principles are shared.
Clinicians do want to lead in commissioning services for patients.
We all want to see shared decision-making with patients. We all know that it is right to focus on outcomes and not process targets.
Hospital doctors and nurses agree.
They don’t want to be dictated to by ministers or managers. And our plans will give them that freedom.
Perhaps those eight years in the health job have left me a little too immersed in NHS-speak.
Pressing on with the implementation has allowed the debate to be about what we’re accused of doing, not about what we are doing. As they say, “a lie is halfway around the world before the truth has got its boots on”.
Of course, every important reform to the NHS, under whatever government, has had its well-meaning critics from within the system.
Look back to 1948 when the British Medical Association denounced Aneurin Bevan as “a would-be Fuhrer” for wanting them to join a National Health Service.
And Bevan himself described the BMA as “politically poisoned people”.
A survey at the time showed only 10% of doctors backed the plans…
…but where we would be today if my predecessors had caved in.
Sometimes change is hard. Sometimes, you can’t expect unanimity. Sometimes the right thing to do is keep listening, keep making your case, keep calm.
So today I want to set out three key points in simple language.
First, the case for reform.
Second, what are reforms actually involve - rather than what people have been told to fear.
And third, how I believe we can move forward together to put our differences behind us and build the modern NHS in which all of us believe.
CASE FOR REFORM
The fact is that the NHS needs to change.
It needs to change to make it work better today.
We should celebrate our successes and excellence but it’s not disloyal to say there are problems. It’s honest.
I’ve spoken to literally hundreds of doctors and nurses who tell me about what they want to happen.
There is still way too much bureaucracy getting in the way of their work.
And there’s also still way too much waste - because the funding system we’ve been left with is hardwired to subsidise wasteful spending.
This government knows healthcare costs will rise and we are committed to keep spending rising in real terms to meet them.
But when cuts are happening in other services it is my duty to ensure that precious money is not wasted.
Yet in the year before the general election, the management of Primary Care Trusts alone rose by 23%.
If a hospital doesn’t balance its books, then it is bailed out by the surpluses taken from other hospitals which have kept within their budget.
As a result, money that could go on operations, new drugs, new training - is wasted.
This is what I’ve heard from doctors and nurses.
And patients, too, want things to change.
Overall they’re glad and grateful for the treatment they get on the NHS.
But there are also concerns:
“If my mum’s in hospital, will someone keep checking she’s had enough to eat and drink?”
“When I go home after treatment will I get the therapy I need?”
“Will I get the best drugs that are out there for the illness I’ve got?”
These concerns do exist, and we should address them.
If we were as good in Britain at treating cancer as the top European countries, then we’d save 10,000 lives a year.
So we should be really ambitious about how we want the NHS to work today.
And we should be very realistic about what’s coming up for the NHS tomorrow.
Dramatic new pressures on its budget.
An ageing population. More long-term conditions to treat.
Great new treatments and diagnostics coming in - but each meaning new costs.
Everyone is agreed that rising health demand is a major challenge we’ve got to meet.
We can’t hide from this.
The cost of providing treatments is rising by hundreds of millions of pounds a year.
So to make sure the NHS is well-equipped and funded for tomorrow, and to make sure it works as best as it can today, we have got to reform.
The case for modernisation is not one of ideology - but necessity.
POWER TO PATIENTS
I know there’s much confusion about our plans.
Many scare stories.
And a series of valid suggestions for improvement which we are taking on board.
The reality is very simple.
We’re making changes to help patients.
Not to make the lives of doctors easier, or win applause from nurses, or boost those mysterious creatures that NHS experts like to describe purchasers and providers.
This is about people.
So step one on our road to a modern NHS is to keep the things that work.
Guaranteed free care. Your local general practice. Accessible local hospitals. High-calibre specialist care.
Help anywhere, anytime that doesn’t depend on who you are or what you can pay, but what you need.
Now putting people first might sound an obvious principle for any good health system.
But it isn’t how the NHS is structured at the moment.
It’s ossified around institutions and bureaucracies when it should be focussing on the individuals and families it is there to serve.
We’ve ended up with targets and top-down orders that didn’t recognise what humans actually need.
Those old targets didn’t even include a mention of children and young people.
They were just lumped in with everyone else.
Or look at the example of Mid-Staffs, at Stafford General Hospital.
They hit the target. They made sure that patients were discharged from A&E within four hours.
But patients suffered - and when people tried to voice their concerns they found the system was so self-satisfied there was nothing they could do.
I know. I’ve been there many times to talk to patients in person.
So we will put doctors and nurses in charge of designing the services their patients need. Clinical commissioners and clinical networks, including for children and young people
The doctor you know and trust can order the treatment he or she knows you need - and not run up against some manager in a distant building whose computer says no.
We will give patients choice - about how and where they are treated.
But of course not everyone wants to choose, all of the time.
What they really want is the right to be heard.
The right to be involved to what happens to them.
The right to an NHS that is personal to them.
And in our modernisation plans, that is what we are providing.
Making for patients a reality of ‘no decision about me without me”.
POWER TO PROFESSIONALS
The second step in our plan is about strengthening the power of health professionals to shape the service that they provide.
You know, it’s a funny thing that in 1948 doctors complained the government was taking independence away from doctors…
…and now some complain that we want to give it back.
At the top of the NHS, we will give independence from politicians…
…so the organisation is run in the interests of patients and professionals not what suits the government at the time.
The BMA asked for autonomy for the NHS, and in the commissioning board, led by NHS chief executive David Nicholson, the NHS will have that opportunity for leadership.
Then, in local areas, new commissioning organisations that will include GPs, hospital doctors and nurses, so they can shape services in the way that work locally.
It’s a simple reform…
…fewer managers, more professionals.
And it is both necessary and right.
I know some people ask: “ok, I get your plans for change but do we really need legislation?”
Just pull the levers you’ve got, they urge. It’s what the last government did.
And it failed.
Without legislation, GPs won’t trust government to give them the power; and local authorities won’t get the responsibilities they need.
So I’m proud that we are taking this reform through parliament, where opinions can be heard.
It’s been an…interesting…process.
But soon it will be over.
We will have a law…
…and we can end the squabbling about structures
…and get on with what we all want, which is creating a better NHS.
Because I’m doing this job to make a difference.
I want my inheritance to be a stronger NHS.
And it will be.
I’m a parent of five children.
I know what it’s like.
The very thought of one of them being taken seriously ill, of having to go into hospital or needing long-term treatment and care… it’s the worst thing for a parent.
That’s why we have to do everything we can to get the right care, at the right time, in the right place.
Not because I don’t think professionals care. Of course they do.
But because at times the NHS forgets that people come first.
Well, our reforms will change that.
For children, for adults…
…if we use our resources well and listen to people then we can deliver the best.
And that is our intention and the task ahead: outcomes for children amongst the best anywhere in the world.