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<p>Check against delivery</p> <p>Good afternoon everyone. At the risk of seeming contrary on what’s traditionally the first day of spring, may I start by harking back to mid-winter.</p> <p>Because I want to begin by paying tribute to the vital and life-saving work that many of you did in delivering the specialist ECMO care during the Swine Flu outbreak.</p> <p>It is a striking achievement that, under such tremendous pressure, you managed to achieve survival rates that were as good as the very best specialised centres in the United States.</p> <p>I’d particularly like to mention Richard Firmin, who led the process from Leicester.</p> <p>The successful mobilisation of limited resources through cooperation and collaboration demonstrates what I want to talk about today.</p> <p>That is – the power that’s unleashed by professional groups working together as a community.</p> <p>By sharing information, combining resources, harvesting collective know-how and expertise to support patients.</p> <p>It’s something this Society has been demonstrating for many years now.</p> <p>Whether it’s in respect of survival rates in cardiac surgery or resection rates in lung cancer, the Society’s work follows a simple logic.</p> <p>Be open – and you improve safety.</p> <p>Communicate – and you reassure.</p> <p>Share knowledge – and you improve performance.</p> <p><strong>The value of information</strong></p> <p>A couple of centuries ago, the Duke of Wellington famously said ‘Publish and be damned’.</p> <p>Well, in recent years, you’ve proved the opposite: ‘Publish and be praised’.</p> <p>It is a motto I’ve held to throughout the seven years I’ve spent covering the health brief – and it’s now a clear motif in our modernisation plans.</p> <p>The conviction that through better information, stronger clinical auditing and a greater willingness to self-assess on the outcomes achieved, we can unlock higher clinical standards.</p> <p>A belief, frankly, that an open NHS is a safer NHS – and also, by definition, a more trusted NHS and a more empowering NHS.</p> <p>Because by putting information into the public domain, we give patients more control and more meaningful choice over how they’re treated.</p> <p>That’s why one of the first speeches I gave after getting this job was on the subject of outcomes and the information revolution.</p> <p>I want to make this a top order issue for the NHS, because I believe clinical auditing is such a powerful driver for clinical excellence.</p> <p>It does invite people to look at and compare their performance based on clinical parameters not tickbox rules and regulations.</p> <p>And it’s vital for improving accountability and public trust, which is something your report today quite rightly points out.</p> <p><strong>Cardiothoracic successes</strong></p> <p>Over the last five years, cardio-thoracic surgeons have broken new ground in using outcome measurements to drive up clinical standards in the UK.</p> <p>You’ve shown that opening up your data and demonstrating variation in standards isn’t an admission of weakness, but a sign of strength.</p> <p>And the result is the steep improvements seen in cardiac care.</p> <p>Of uniformly high standards in mortality rates across all specialist cardiac centres in England.</p> <p>Of better survival rates than ever for older people undergoing heart surgery.</p> <p>Of quality improvements achieving real savings in bed days for procedures.</p> <p>According to today’s report, £5 million was saved on bed days for coronary artery bypass operations alone, set against an outlay of £1.5 million for clinical audits.</p> <p>Good quality information is also identifying the gaps – the areas for improvement across the system.</p> <p>We know there’s significant variation in waiting times for non-elective cardiac surgery.</p> <p>This is unacceptable for emergency cases, where delay can make a huge difference to a patient’s experience of care and the cost of the service.</p> <p>It gives the NHS a clear warning sign that this needs to be addressed.</p> <p>Thoracic surgery too is heading in the same direction.</p> <p>Some important work has been done to develop the risk models necessary for full clinical outcome reporting.</p> <p>From the data we do have, we know there is still significant variation in resection rates for lung cancer patients.</p> <p>It varies from under 5 per cent in some areas, to more than 25 per cent in others.</p> <p>It also varies by age. The proportion of patients who undergo surgery for lung cancer drops off after the age of 50 and virtually flat-lines once you reach 80.</p> <p>There may be good clinical grounds for this – but this information gives us cause to ask questions and find answers.</p> <p>And proper analysis based on outcomes will give us either the confidence that the right decisions are being made – or cause for action and redress if they’re not.</p> <p><strong>An 'open source' NHS</strong></p> <p>That’s why my message today is quite simple: where you lead, the rest of the NHS must follow.</p> <p>In the past, and in too many areas today, we still have a ‘closed circuit’ NHS, where clinicians hold information close to their chest.</p> <p>And yet you only have to look at how the world is changing around us to question that logic.</p> <p>Look at the huge potential opened up by new technology.</p> <p>Look at the exponential rise of the internet as an influence over people’s lives.</p> <p>And look at how open source standards and protocols have pushed the boundaries in IT and mobile telecommunications.</p> <p>They’ve pushed boundaries precisely because they’ve allowed experts to develop and improve a product together, through a free exchange of ideas.</p> <p>We need to apply the lessons of openness and transparency in health.</p> <p>If you like, we need an “open source” NHS as far as information is concerned.</p> <p>A health service that’s more transparent, more digitally adept and more willing to share knowledge across professional groups and with the public.</p> <p>That’s what I really mean by an information revolution: a free exchange of ideas, information and data to drive improvement and expand choice for the patient.</p> <p>Cardio-thoracic surgeons are pioneering it.</p> <p>Clinical audits must be at the heart of it.</p> <p><strong>Funding for clinical audits</strong></p> <p>That’s why in July’s White Paper, we said that we would extend national audits to more conditions and a wider range of interventions.</p> <p>Over the next year, we’ll make another £1.2 million available for up to four new national clinical audits.</p> <p>The National Clinical Audit Advisory Group, chaired by Professor Nick Black, will lead on advising us on which areas these audits will focus on.</p> <p>But we want topics that align well with the Outcomes Framework and have NICE Quality Standards in place.</p> <p>Because in essence, the clinical audit provides the missing piece in the jigsaw.</p> <p>The Outcomes Framework show us what we’re looking to achieve …</p> <p>The Quality Standard shows how we do it – what a high quality service looks like …</p> <p>And the Clinical Audit gives us the detail and the benchmarking necessary to achieve it …</p> <p><strong>Information for the public</strong></p> <p>This is vital for continuous professional improvement on the one hand.</p> <p>And, of course, it can also help us to give the public the information they need about their treatment.</p> <p>So we need to make this data accessible to the public. To make it something they can use to assess and shape decisions about their care</p> <p>I think the public portal that the Society has set up is excellent in this regard – a true pioneer of the kind of patient-friendly information I want to see across the NHS.</p> <p>I know there is still work to do on the long term funding of the portal – discussions about where it’s hosted, how it can form part of a more unified access point and so on. </p> <p>But that should not detract from the achievements so far – and neither should they prevent the cardiothoracic community pushing further ahead.</p> <p><strong>Building for the future</strong></p> <p>I think you have some firm foundations to build on.</p> <p>Funding for the Adult Cardiac Surgical Database is guaranteed for the next three years, and we are continuing to support national clinical leads who will help with the collection and analysis of audit data.</p> <p>Longer term, funding for clinical audits will be up to the NHS Commissioning Board to determine, but the path of our reforms means it’s likely to be a clear priority for commissioners.</p> <p>For instance, the data from the audits are vital for delivering outcomes in the Operating Framework, and I also expect audits will be used to revalidate consultants.</p> <p>So it’s no flight of fancy to suggest that all providers in the future will be required to have robust clinical audit systems in place as a condition of contracting for NHS services.</p> <p>Quite simply, without them, how else could a commissioner be certain they’re targeting their resources effectively?</p> <p>How can they be sure that taxpayer’s money is being used to achieve the very best outcomes for patients?</p> <p>It won’t happen overnight, but over time I want the whole NHS waking up to what you and others have already recognised – that good information and good analysis isn’t an add-on, but an essential component of a high quality service.</p> <p>Outcomes are one of these key purposes of reform. </p> <p>A focus on patients, with shared decision-making is another.</p> <p>The third purpose is empowered professionals.</p> <p>So, for me, the leadership which you have given and continue to provide is instrumental to the achievement of continuously improving healthcare in a modernised NHS.</p> <p><strong>Conclusion</strong></p> <p>In concluding let me say this.</p> <p>I know it’s uncomfortable to be the vanguard. I know the progress you’ve made is hard-fought. I know it occasionally ruffles feathers.</p> <p>But don’t let internal resistance put you off.</p> <p>I’m giving you a very clear green light as far as this Government is concerned: we absolutely want to see these sort of approaches applied and expanded across the NHS.</p> <p>Since I started off with the Iron Duke, let me end with the Iron Lady.</p> <p>Margaret Thatcher once said: “You may have to fight a battle more than once to win it.”</p> <p>As far as opening up the NHS, extending information and applying greater scrutiny to clinical outcomes goes, this is a battle worth fighting.</p> <p>And based on what I see coming out of this Society and its membership, it’s a battle you’re winning and I hope will continue to win.<br /></p> 2011-04-17T21:20:47.222368 Andrew Lansley CBE MP speech to the Society for Cardiothoracic Surgery Department of Health 2011-03-21 speech to the Society for Cardiothoracic Surgery
<p>Check against delivery</p> <p>It’s great to be here today. My first chance to talk publicly about health and criminal justice – to explain why this issue matters to me and to the Government; and to explore the possibilities and priorities for the future.</p> <p>It’s now two years since Keith Bradley’s landmark report laid bare the flaws between our health and criminal justice systems.</p> <p>A real wake-up call, and a catalyst for some major improvements.</p> <p>It’s always invidious to pick out specific achievements, but let me mention one major landmark we’re about to celebrate.</p> <p>From this spring, every prison in England will be linked up to a single national clinical IT system for prison health.</p> <p>An excellent achievement that will allow medical records to follow offenders as they move between prisons.</p> <p>It gives those caring for them timely access to high quality clinical information.</p> <p>It provides a foundation for the kind of connected system we need to take offender health forward in a digital age.</p> <p>It’s a symbol, really, of the advances we’ve seen in recent years.</p> <p>To put offender health on the agenda and stop prison services being the ‘poor relation’.</p> <p>We should be heartened by the progress.</p> <p>But also emboldened.</p> <p>There is now a level of political consensus that we’ve never seen before.</p> <p>All three parties now publicly agree the tough talking, rhetoric of the past is neither sustainable nor effective.</p> <p>The catalogue of statistics tells us why.</p> <p>Nine in ten prisoners have at least one mental health or drug problem.</p> <p>A quarter have a longstanding physical disorder or disability.</p> <p>Nearly two-thirds of male prisoners admit to heavy drinking, and a similar proportion have taken drugs before going inside.</p> <p>In many cases, the criminal justice system is our big opportunity to help offenders with health problems.</p> <p>Really, we have a clear and stark choice, as a society.</p> <p>If we do nothing, fail to reach out and help people then we all suffer. Reoffending remains high. More lives ruined. More human potential lost. More cost to public services. More damage to communities.</p> <p>If we’re proactive – if we reach out, provide better support for those with illness, addiction or disability, then everyone benefits. Lives are rescued, futures are restored, money is saved.</p> <p><strong>Financial challenge</strong></p> <p>The big question is how we do it.</p> <p>How do we continue to improve standards in offender health, given the huge financial pressures facing the public sector.</p> <p>Well, let me answer that in a second.</p> <p>First, let me say this. I do realise that many of you are deeply and personally affected by the need to reduce public spending.</p> <p>Frankly, as politicians, we don’t say enough about the huge professionalism and commitment those working within, or in support of, the public sector are showing in these difficult times.</p> <p>I want to say that I do, and I’m extremely appreciative of the work you’re doing in this area.</p> <p><strong>Commissioning</strong></p> <p>But tough times don’t mean slamming on the brakes.</p> <p>They don’t mean that reform stops dead.</p> <p>In fact, they make change all the more urgent.</p> <p>Improving offender health isn’t just about spending more, it’s about spending better.</p> <p>That starts with the “internal wiring”, if you like.</p> <p>Getting the right processes, structures and relationships in place to bring the system together around the individual.</p> <p>Starting with commissioning.</p> <p>I agree with Keith Bradley.</p> <p>The alphabet soup of protocols and practices must go.</p> <p>We need a much more stable, consistent and effective approach.</p> <p>Since 2006, the NHS has held the ring in terms of commissioning health services in prisons.</p> <p>And some really important steps were taken in building links between health and the National Offender Management Service.</p> <p>In the future, the NHS responsibility for prison health will remain, but it will be a national NHS commissioning board, rather than Primary Care Trusts, taking the lead.</p> <p>Let’s be clear about what it does and doesn’t mean.</p> <p>It does mean a more consistent, national approach.</p> <p>Clearer expectations around what services should be available.</p> <p>Stronger national leadership to set standards and draw links across other health policies.</p> <p>What it doesn’t mean is turning our backs on the strong local relationships built up since 2006.</p> <p>The title of this conference is quite right: success does mean ‘thinking local’ – and ‘acting local’ too.</p> <p>So we expect the Commissioning Board to work closely with GP Consortia to understand and respond to local and regional pressures.</p> <p>Local Authorities have a key role as shapers of community health. They can help us bring together the broad range of agencies and organisations involved in delivering offender care.</p> <p>The Health and Wellbeing Boards, coupled with strengthened Joint Strategic Needs Assessment, will be a platform for understanding and assessing local needs in a shared way.</p> <p>Directors of Public Health will play a key role, working with the new Police and Crime Commissioners, for example, to draw agencies together.</p> <p>In particular, it will be important to have criminal justice representation at the Health &amp;amp; Well Being Boards.</p> <p>And through appropriate indicators in the NHS Outcomes Framework, all health agencies will have a clear picture of what they’re aiming for – a strong, collective purpose.</p> <p>This brings me to another of Bradley’s recommendations – that the NHS should commission healthcare in police custody suites as well as in prisons.</p> <p>Throughout the country, we find examples of the NHS partnering up with their local police force to join up healthcare provision across the criminal justice pathway in this way. </p> <p>The benefits are multifold – the detainee has better health and life outcomes, the NHS can spend money more effectively and the police have more time to spend on what they do best –preventing and detecting crime.</p> <p>We are currently working with the Home Office to consider how we can best support and encourage such partnerships over the coming year. I am thankful to the Association of Chief Police Officers for their firm support on this.</p> <p><strong>Diversion and liaison</strong></p> <p>Now at the heart of Keith Bradley’s report was his suggestion of a national diversion and liaison scheme.</p> <p>You’ll hear later from Danny, who can tell you much more powerfully than I can why this support is important – and why we need more of it in the future.</p> <p>Today I’m laying out some specific next steps to help us deliver better community-based support.</p> <p>Firstly, from next month, the Department of Health will take the lead on funding all drugs services for offenders, with the exception of youth offending teams.</p> <p>This is significant because it will simplify systems and help us to make the transition between community and prison-based support more seamless.</p> <p>A joint approach to commissioning, involving both the prison and health services, will bring the two systems together.</p> <p>And prison drug treatment commissioned against an outcomes framework for the first time – offering clear accountability and a clear incentive to raise quality and improve outcomes.</p> <p>Second, over the course of this year, we will invest up to £3m in around 40 adult diversion sites of which 20 will be diversion pathfinders. </p> <p>These pathfinders will take the best practice and local learning from existing diversion services to help build the financial and social business model needed to make these services available nationwide by 2014.</p> <p>They will also test new ideas and practices across the criminal and youth justice systems alongside various other high profile questions that we will be testing at the same time.</p> <p>What treatment based alternatives to custody could be provided for drug-users or people with mental health problems.</p> <p>Whether dedicated recovery wings in prison can help those with drug problems.</p> <p>And how can we use payment-by-result schemes involving voluntary providers to treat people with drug problems?</p> <p>Thirdly, we are putting an extra focus on diversion and support for children and young people.</p> <p>We know that most young people entering the youth justice system have a range of complex needs.</p> <p>Half of those in custody, for instance, have difficulties with speech, language and communication.</p> <p>Over the last two years, six pilots exploring different approaches to liaison and diversion for young people have been set up.</p> <p>Over the course of the next financial year, we’re putting £2 million towards up to 60 youth sites and extending the pilots to other areas of the country.</p> <p>As a result, last month, we also invited NHS and criminal justice partnerships to become specific ‘point of arrest pathfinders’ for children and young people.</p> <p>These pathfinders will look at how we can improve the way children are screened when they first come into contact with the police.</p> <p>To make sure we’re getting the full picture of their lives, and putting them in touch with the right services earlier.</p> <p>Finally, based on the lessons we learn from all of these pathfinders, we will introduce a national programme of diversion services by 2014, as the Justice Green Paper says.</p> <p>So the intentions are very clear.</p> <p>By building up the evidence base and proving these interventions work, we will make diversion services a staple of the health and criminal justice system.</p> <p>We will extend them to cover all age groups, and a wide range of needs.</p> <p>And we will open up opportunities for every court and custody suite to choose these alternatives to prison as and when it’s appropriate to do so.</p> <p>We will of course take this new diversion initiative forward alongside our third sector partners, including Revolving Doors and NACRO and in collaboration with the NHS Confederation and the Royal Colleges, among others. </p> <p>The National Clinical Director for health and criminal justice, Louis Appleby, will be convening further discussions on this important programme with our key partners in this sector.</p> <p><strong>Conclusion</strong></p> <p>Offender health has never been the most popular of issues. Charities and campaign groups have spent years battling against a tide of public and political antipathy.</p> <p>I think with a Coalition Government, we have the chance to break down the old orthodoxies around law and order.</p> <p>It’s time for a new approach. Diversion is key to it. And with your help, I’m sure we can deliver real improvement in the years ahead.<br /></p> None Paul Burstow MP speech to the Revolving Doors conference on offender health Department of Health 2011-03-16 speech to Revolving Doors conference on offender health
<p>Check against delivery</p> <p>It was at the start of the last century that Alois Alzheimer first described the mystery of the disease now bearing his name.</p> <p>In this century, as more and more people develop dementia, everyone wants answers. Can we prevent it? Can we cure it? How can we improve care and support?</p> <p>This means turning our minds increasingly to research, to discovery and exploration, to the work many of you are leading to improve our knowledge and open up new possibilities for treatment and cure.</p> <p>It’s hard to overplay the seriousness.</p> <p>Before the election, before I got this job, I wrote a foreword for the Dementia 2010 report for the Alzheimer’s Research Trust.</p> <p>It struck me that this report started to answer a simple and dramatic question.</p> <p>How do you put a price on life?</p> <p>And how do you demonstrate the cost of doing nothing?</p> <p>From the economists working on that study, we got our answer.</p> <p>£23 billion in care costs and lost productivity.</p> <p>There are many more statistics out there.</p> <p>- £8.2 billion spent caring for the three-quarters of a million people with dementia each year.<br />- A quarter of all patients in NHS hospitals have dementia.<br />- Fifty per cent of people in care homes have a form of dementia.<br />- 40 per cent of the work community matrons do is with people who have dementia.</p> <p>All of these figures dramatise the effect dementia has on society and public services.</p> <p>With experts predicting an explosion in numbers – a doubling by 2030 – the pressure will only intensify.</p> <p>Now we can improve services through the Dementia Strategy.</p> <p>But the only sustainable, long term answer to dementia is to tackle demand. The inexorable rise in demand for care.</p> <p>And for me, that means investing in human ingenuity and discovery.</p> <p>For years, people have said the amount going into dementia research doesn’t come close to matching the scale of the problem.</p> <p>And me among them. I said it for years in opposition. I argued for a commitment in my party’s election manifesto. And I was delighted we agreed to prioritise dementia research in the Coalition Programme.</p> <p>So a clear commitment. But one that’s a two-way deal, involving an increase in the quality and the quantity of research bids.</p> <p>Now this is about infrastructure and capacity.</p> <p>It’s about improving the appeal of dementia research, in particular by tackling stigma.</p> <p>It’s about developing a clearer and better career structure for dementia research.</p> <p>And, yes, it’s about investing in the right places at the right times, to maximise impact.</p> <p>And I’m clear the Government’s got a big role to play. To stimulate interest. To steer progress – which we’re doing through the Ministerial Advisory Group I chair.</p> <p>But it’s also fundamentally up to you to rise to the challenge and to answer this call.</p> <p>And today’s event is really about bringing all of us together to think about how we do it.</p> <p>We’ve got a clear strategy, a clear plan of action led by the Ministerial group.</p> <p>Focused, as you’re seeing today, around five priority areas.</p> <p>More clarity on priority topics for research – to help funding bodies to target their resources more effectively.</p> <p>More public engagement. To fire people’s imaginations. To combat the stigma and myths. To build higher levels of public interest and commitment to dementia research.</p> <p>And this includes the delicate challenge of getting more people to volunteer to donate tissue or organs for dementia research.</p> <p>Third, greater collaboration. Becoming more than the sum of our parts. With stronger co-ordination and co-operation across disciplines and professions.</p> <p>Better ties between the public and commercials sectors.</p> <p>Less bureaucracy to foil and frustrate your work, something Michael Rawlins and others raised earlier this week.</p> <p><br />I know the new systems for simplifying applications and permissions are already helping to cut red tape.</p> <p>But as this report makes clear, there’s more to do.</p> <p>Fourth, perhaps most important of all: ensuring good research translates into better treatments and care.</p> <p>Research has to make a difference to patients. But it has to be allowed to make a difference.</p> <p>It needs oxygen – the opportunities, the access to triallists to help bring research programmes to fruition.</p> <p>And this means opening up the NHS and social care. Making it more receptive to innovation. Quicker at adopting new ideas. Easier for researchers to work with.</p> <p>And hence the plans to link research activity more closely with care and treatment pathways. Something that should give the research community more opportunities to work with people with dementia.</p> <p>Compared to other areas, the numbers with dementia taking part in research is low. We want to put that right.</p> <p>And then there’s the fifth priority, taking us back to where we started: improving the flow of investment into dementia research.</p> <p>Certainly, the money’s there. </p> <p>Overall government health research funding is increasing.</p> <p>But the degree of investment in any area of research should always be determined by the quality of the science, not the preferences of politicians.</p> <p>There are some great research teams already working in this area.</p> <p>But we still need more high quality research proposals coming through.</p> <p>That’s why I’m pleased we’ll be launching a new themed call on dementia research – to give dementia research the kick-start it needs.</p> <p>The call will cover seven of the NIHR’s main funding programmes:</p> <p>• Efficacy and Mechanism Evaluation<br />• Health Services Research<br />• Health Technology Assessment<br />• Programme Grants for Applied Research<br />• Public Health Research<br />• Research for Patient Benefit)<br />• Service Delivery and Organisation</p> <p>A comprehensive programme then, covering all areas of applied health science.</p> <p>The call will be advertised formally after the Ministerial Group completes its work.</p> <p>Though we’re announcing our intention today to give you more time to prepare winning bids.</p> <p>And I hope this will inject a sense of pace and purpose into other work we’re doing.</p> <p><strong>Conclusion</strong></p> <p>So to sum up … there are some tremendous projects already going on.</p> <p>Tantalising signs of some incredible breakthroughs on the horizon.</p> <p>Our job is to build on this. The themed call will help. But it’s only ever going to be one part of the solution.</p> <p>Success means the whole research community coming together – seeing the need, taking a lead, raising the volume? and the impact of dementia research.</p> <p>Let’s make this conference a catalyst.</p> <p>A hundred years on from Alois Alzheimer.</p> <p>But there’s cause for real optimism.</p> <p>A big opportunities lie ahead. Opportunities we can only grasp by working together. All of us pursuing a common aim and a shared strategy.</p> <p>That’s what we’re putting in place. And that’s what I hope you’ll help us to shape and deliver in the years ahead.</p> <p>So thank you again for your commitment and dedication, and I hope you enjoy the rest of the conference.</p> None Paul Burstow MP NIHR Dementia Research Conference Department of Health 2011-01-14 speech to the National Institute for Health Resarch (NIHR) Dementia Research Conference
<div class="subContent first"> <p>One of the first rules of politics is that new governments never talk about past successes.</p><p>We focus on change, not continuity. On what’s wrong, not what’s right. On where we’re going, not where we’ve been.</p><p>I want to break with that convention today. Mental health has moved forward significantly in recent years.</p><p>And we should acknowledge this.</p><p>I’m afraid the politician in me means I can’t resist saying ‘not before time’ and ‘not far enough’ …</p><p>But the point stands: some major steps have been taken.</p><p>Acute mental health services lifted out of obscurity. Better community support. Better outreach. More crisis services for those with the most severe mental illness.</p><p>And psychological therapies – breaking new ground. Transforming how we think about depression, anxiety and other common mental disorders. And giving GPs more options and patients more hope of recovery.</p><p>Real progress.</p><p>And progress that’s down to you.</p><p>To the members of the New Savoy Partnership and the We Need To Talk coalition – thank you for campaigning so effectively for change.</p><p>And to all of the therapists and professional leaders in the room today – thank you for delivering it in practice.</p><p>Still work to do, of course.</p><p>Because yes, there are issues in acute care. Issues around community treatment. Around variability of standards. Around co-ordination of local services.</p><p>Yes, we need to raise the profile of mental health, particularly amongst GPs and commissioners, which is a point I’ll return to later.</p><p>And yes, we need to reduce the persistent gap in outcomes between different social groups.</p><p>A gap highlighted by today’s report on the five year Delivering Race Equality programme, which I hope we can all learn from.</p><p><strong>The Mental Health Strategy</strong></p><p>Reducing these inequalities will be central to the new strategy for mental health when it’s published early next year.</p><p>The other thing this strategy will do is project a much broader vision for mental health.</p><p>A vision grounded in wellbeing.</p><p>And a vision that sees mental illness as one of the big social challenges of our time.</p><p>No longer just a Department of Health issue, or even just a Government issue.</p><p>A challenge borne by our society, and to be tackled throughout our society.</p><p>Mental illness is endemic.</p><ul> <li>One in six have a mental illness at any given point.  <br /></li> <li>Four in ten on incapacity benefit have a mental health problem.<br /></li> <li>Depression, stress and other mental disorders costing the NHS more than £10 billion. <br /></li> <li>And costing our wider economy at least ten times that amount.</li></ul><p>You’ve been asking for a more radical approach – and the Coalition Government is now answering that call.</p><p>David Cameron saying that general wellbeing should now become a key measure of our success is highly symbolic.</p><p>Why? Simply because what a Government measures affects what it does.</p><p>So this commitment really defines the Coalition’s approach to social policy.</p><p>Yes, we need economic growth, absolutely.</p><p>But after a painful recession, we also need to heal emotional wounds.</p><p>We need a psychological recovery alongside economic recovery.</p><p><strong>The value of IAPT</strong></p><p>And IAPT is key to this. By reaching into people’s lives, and reaching out across the services that support them, you can be a powerful point of connection. Brokers, if you like, of this new approach to mental health and wellbeing.</p><p>I had the pleasure of meeting some of your professional colleagues at a centre in Reading a few months ago.</p><p>I spoke to the service users, learnt about how these therapies had changed their lives, transformed their confidence, their outlook, their aspirations for the future.</p><p>There was a time when diagnosis of a mental health problem was the end as far as work goes. IAPT is changing that.</p><p>Everyone I met there had had their lives turned round by the services they received.</p><p>One lady had suffered a serious physical illness and had to leave her job. Going in and out of hospital, and then being stuck at home, she became depressed and withdrawn.</p><p>And so when she’d recovered her physical health, she was paralysed with fear and anxiety and couldn’t return to work.</p><p>Therapy made all the difference. She regained her confidence, she eased herself back to work, she got back to her normal self.</p><p>I know that stories like this inspire the work you do.</p><p>We need them to inspire others. To have the courage to come forward. To be open about their illness. To ask for help.</p><p>And this is where Sue’s [Baker, chair of Time To Talk] organisation comes in.</p><p>Reducing stigma. Puncturing myths. Dispelling prejudice. This is absolutely key to the change we need to see.</p><p>But, of course, opening people’s minds to mental illness is only half the battle.</p><p>People need to get the right support when they do come forward.</p><p>And today I want to share our plans for IAPT: how we plan to extend choice, improve access and start to mainstream the use of talking therapies within the NHS.</p><p><strong>Expanding the Programme</strong></p><p>First, we need to complete the existing training programme.</p><p>Two-thirds of the country already covered.</p><p>By the end of this financial year, 3,700 newly trained staff will be on board.</p><p>We will then go much further.</p><p>The funding we’re releasing from the Spending Review will mean that by 2015, every patient in the country should be able to get timely access to proven psychological therapies.</p><p>And, wherever possible, they should have real choice of approved therapies.</p><p>At the moment, IAPT is a little too much like Henry Ford’s business philosophy … you can have any therapy as long as it’s CBT.</p><p>To be fair, it wasn’t a bad model to get us on the road. But we do need to diversify. To open the door for other, equally effective therapies to help people with different needs.</p><p>So we’ll invest the money and work with the local NHS to upskill staff across four other NICE-approved therapies:</p><ul> <li>In counselling<br /></li> <li>interpersonal therapy<br /></li> <li>brief dynamic therapy; and<br /></li> <li>couples therapy</li></ul><p>Something the last government promised 12 months ago. We’ll actually deliver it.</p><p>But choice isn’t just about the type of therapy we offer. It’s really about autonomy. About giving people options about how they receive services, from whom, at a time and in a setting that suits them.</p><p>So IAPT sites need to deliver truly personalised care, as some are already starting to do.</p><p>And if choice is one side of the coin, then equity is the other.<br />IAPT must now reach out to a much broader range of people – old and young, and across the illness spectrum.</p><p><strong>Children and Young People</strong></p><p>You all know the value of intervening early. The cost of reaching out too late.</p><p>Up to half of all mental illness starts before the age of 14.</p><p>Untreated disorders can blight a child’s school years and future prospects in ways that are terribly difficult to recover from.</p><p>So we now want to develop a psychological therapies model for children.</p><p>We’ll do so by setting up pilot sites, where teams will train up staff to provide appropriate therapies for younger people.</p><p>And asking the crucial questions.</p><p>What’s the level of unmet needs?</p><p>Where and how should we offer these therapies?</p><p>How do we work with schools and children’s services most effectively?</p><p>The ambition here is very clear: to take the same step forward in access for children and young people that we have in adult services.</p><p>With psychological services designed for children, and to a significant extent designed by them.</p><p>We will use the knowledge and expertise of organisations like Young Minds and others.</p><p>To make sure this IAPT programme genuinely speaks to the needs of children, young people and their families.</p><p>What about the other end of the age range?</p><p>Analysis shows that over 65s made up just 4 per cent of those using IAPT. By our estimates, it should be nearer 12 per cent.</p><p>Why is this? Is stigma a problem?</p><p>Are GPs attentive enough to depression amongst older people?</p><p>Are we offering support in the right places – do we need to start offering home visits, for instance?</p><p>And how can we link this up with our Dementia strategy?</p><p>We need to find the right answers and we need to do it quickly.</p><p>There’s an added urgency here, given that the ban on age discrimination in health starts from April 2012. No time to lose.</p><p>Again we will need the help of key organisations to help us understand and overcome the barriers.</p><p><strong>IAPT Aad Severe Mental illness</strong></p><p>There are two other major groups not benefiting from IAPT.</p><p>The first is the one-and-a-half million people who suffer with severe mental illnesses like schizophrenia and bi-polar and personality disorder.</p><p>The National Institute of Clinical Excellence recommends psychological therapies, yet research by Rethink suggests that half of those with these conditions have never been offered these therapies.</p><p>Again, we need to do better, and again I want the voluntary sector and the professional community to lead us to the right solutions.</p><p>We’ll bring together Rethink, the Royal Colleges and other professional bodies to look at existing capacity, and develop appropriate training for their members and for practising therapists.</p><p><strong>IAPT and LTCS</strong></p><p>The other excluded group are those with medically unexplained symptoms and with long-term physical conditions.</p><p>People with diabetes, hypertension and heart disease have twice the rate of mental illness.</p><p>If you have two or more health conditions, you’re seven times more likely to have depression.</p><p>And this is reciprocal. Where the depression isn’t treated, your physical recovery suffers too.</p><p>Studies show diabetics with depression cost the NHS between 50 and 75 per cent more to treat than those in good mental health.</p><p>Which is a pretty active demonstration of the adage that there’s “no health without mental health.”</p><p>And that’s a principle that must be etched on the hearts of NHS commissioners.</p><p>We can no longer have a health service that patches people up physically, but leaves them struggling mentally.</p><p>We need a big shift in emphasis. Mental health on a par with physical health in the NHS.</p><p>The big question is how do we make this happen in practice?’ How do we ensure mental health doesn’t slip back in tougher times? To be blunt, how do we ensure there’s life after IAPT?</p><p><strong>A Firm Commitment</strong></p><p>Politicians talk in priorities. It’s our natural language. The problem is that we want to say everything is a priority, and that devalues the language.</p><p>So my advice is look at what politicians do, rather than what we say. That’s where you get the true picture.</p><p>Look at what we’ve done with IAPT.</p><ul> <li>Mentioned in both party manifestos and in the final Coalition Programme;<br /></li> <li>£70 million announced within weeks of the new Government to continue roll-out; <br /></li> <li>Another clear commitment made in the Chancellor’s Spending Review;<br /></li> <li>This speech from me today outlining the detail and making a number of firm commitments; <br /></li> <li>And in the mental health strategy, we will make the funding available to deliver these IAPT commitments.</li></ul><p>Be in no doubt. The momentum and the political will is there. This is a deep commitment – for me, for my party, and for the Government.</p><p>And the importance I attach to psychological therapies will be made clear in the NHS Operating Framework when it’s published in a few weeks time.</p><p><strong>Wider Policy context</strong></p><p>I know many are concerned psychological therapy is vulnerable in these tighter times.</p><p>And that concern is understandable.</p><p>Mental health services have had a tendency to be ‘last in and first out’ in the NHS of the past.</p><p>But not this time. The policy landscape is completely changed. And changed, I believe, in your favour.</p><p>Firstly, the shift from targets to outcomes will give mental health a new prominence in how the NHS is judged.</p><p>The new Outcomes Framework will paint a picture of what good care looks like.</p><p>In terms of patient experience. In terms of hard results. In terms of quality. But absolutely not in terms of process targets.</p><p>To give you a simple example. Under an outcomes model, the NHS isn’t tested on the speed at which you get your knee operation.</p><p>It’s tested on how quickly you get back on your feet. How quickly you’re pain-free. How quickly you can return to work. Real measures that matter to people.</p><p>And that broader outlook opens the door, it means that people’s mental health cannot be ignored if you want to secure the right outcomes. A very clear signal to commissioners.</p><p>The second thing we’re developing is a new tariff for talking therapies linked directly to the Outcomes Framework and ensuring providers are paid according to the contributions they make to those outcomes.</p><p>This will give commissioning teams a clear rationale for investing in psychological therapies.</p><p>Helping them to make sense of how these services contribute to better outcomes across the populations they support.</p><p><strong>The need for leadership</strong></p><p>It’s hard to break old habits. Commissioners, like everyone else, tend to stick to what they know best.</p><p>Some really ‘get’ it, really understand psychological therapies and the difference you can make. I think you’ll hear from a GP immediately after me, who fits that description.</p><p>Others need persuading. And that’s partly up to you. To start having conversations.</p><p>To understand the agendas and processes of emerging consortia.</p><p>To start building a compelling case for why investing in psychological therapies is worthwhile.</p><p>Don’t sit back and wait. Because the policy landscape is changing in another very significant sense.</p><p>Power is shifting. Moving away from the centre. With less prescription. Less command and control. More decisions taken locally. More flexibility for NHS leaders and their local government partners to run the show.</p><p>Now you could see this as a threat – that without central protection, you won’t get a look in during local decision-making.</p><p>But I’d sound a warning to the pessimists. The big danger if we allow this gloominess to take root is that it becomes a self-fulfilling prophecy.</p><p>We need strong, active, positive leadership.</p><p>Not just from the centre, and not just in terms of politicians like me making speeches.</p><p>But at all levels, in every part of the country, putting forward the case for psychological therapies.</p><p> <strong>The Value of Evidence</strong></p><p>Evidence is the ace up your sleeves.</p><p>Session-by-session outcome monitoring, in place across 90% of all patients, gives us a formidable picture of how these therapies improve a person’s recovery.</p><p>We need to make sure this is understood and heard by commissioners. Particularly in the context of QIPP. And particularly in the context of Joint Strategic Needs Assessment.</p><p>You can make an extremely strong case for why investing in therapies now can save costs down the line. Costs to acute care. And costs to social care and other public services.</p><p>So my message is this. Don’t simply wait for me to make that case, or for officials in Whitehall to come up with a new guidance or directives.</p><p>That simply isn’t the world we live in now.</p><p>It’s up to you, tapping into organisations like the New Savoy Partnership and others, to get the message across.</p><p><strong>Transparency</strong></p><p>And if we really want to open people up to talking therapies, then talking therapies themselves need to open up to people.</p><p>Greater transparency for patients and professionals.</p><p>Better information on what to expect from services and what to expect from different treatment options.</p><p>More meaningful data on the strengths and weaknesses of different providers</p><p>So, finally, we will publish the outcomes that different services have achieved.</p><p>We want to create a new ratings system for IAPT that allows people to compare local success rates.</p><p><strong>Conclusion</strong></p><p>Let me sum up before I hand over to you.</p><p>It’s human nature to be suspicious of change. I know many people are worried about the future.</p><p>But you have a clear and strong track record of success.</p><p>And so you should have good reason to be confident.</p><p>I’ve said very clear today. We want to build a mentally healthy society.</p><p>This commitment starts in Number 10, and reaches across and beyond Government, as you’ll see in the mental health strategy.</p><p>You’re a central part of that commitment.</p><p>We believe in IAPT. We believe in life after IAPT.</p><p>We trust in you. In your integrity. And in the work you do.</p><p>There is much to be optimistic about.</p><p>So be confident. Be positive. Embrace the NHS reforms. Embrace these plans for IAPT.</p><p>And together we can make it all happen.</p><p>Better services. More choice. Less stigma. Greater hope for the many affected by mental illness in our society. Thank you</p> <div class="contactsInfo"> </div> </div> None Paul Burstow MP New Savoy Partnership (Psychological Therapies) Department of Health 2010-12-02 speech to the New Savoy Partnership
<div class="subContent first"> <p>It’s a pleasure to join you today. Supporting carers is something I campaigned for passionately in opposition, so I’m determined to do all I can now I have the opportunity in Government.</p><p>I know from experience with my local carers centre in Sutton the issues that many of you face. The financial hardship. The loneliness. The barriers to work and a life outside caring. The stress and ill health that often accompanies their caring roles.</p><p>I also know the great, sometimes heroic, work you do. The love and dedication you show. The satisfaction you get from doing it, and yes, sometimes the anger with how things are.</p><p>And I suspect the mood of many carers can be summed up in three words.</p><p>Frustrated. Fed up. Frazzled.</p><p>I think some of the carers I’ve spoken to over the years had a few other f-words in mind. I’m very grateful for their restraint.</p><p>Certainly, I know the experience of caring can stir deep emotions.</p><p>Just last week, on Radio 4’s You and Yours Programme, I spoke to a gentleman who was providing 120 hours of care a week for his wife.</p><p>A break wasn’t an option as he said his wife wouldn’t accept a paid carer.</p><p>I don’t know the circumstances in this case, but I know other carers who in these situations feel trapped.</p><p>And just spending more isn’t an answer.</p><p>It would only be the tip of the iceberg.</p><p>To really chip away at the foundations of this iceberg, we need a different approach.</p><p>To make sure public services, the benefits system and wider society work together to give you the support you need.</p><p>It’s clear that we do need to do better.  That is why today we launch a new plan to help us do so.</p><p>There are many questions to answer.</p><p>How do we end the silos and the turf wars between different agencies that stop you getting the right help at the right time?</p><p>How do we open the eyes of NHS and social care professionals to the needs of the carer?</p><p>How do we close the gaps that fail young carers because adult services don’t see it as their business to consider the impact of a disability on young carers?</p><p>And how do we get the right kinds of action across wider society?</p><p>To reduce dependency.<br />To support your wellbeing.<br />To give carers more opportunities for flexible working.</p><p><strong>Personalising Care</strong></p><p>The first thing we must do is let go of this idea that the State has all the solutions.</p><p>Every carer is unique, and one size, like-it-or-lump it solutions don’t work.</p><p>So we need a shift in power. Away from Whitehall and town halls. Into the hands of individuals and families.</p><p>And that shift is embodied in a move to personal budgets. Personalised services that fit with you, your family and the person you care for.</p><p>By April 2013, every eligible person requiring care will have the right to get a personal budget from their council, preferably in the form of a direct payment that can be used to buy the services.</p><p>This means that more people will get control of the money spent and the decisions that affect their life.</p><p>It will change the complexion of care and support – making it more than just supporting an individual, but about supporting whole families.</p><p><strong>Developing the Care Market</strong></p><p>Of course, to make personal budgets work, there needs to be worthwhile services to buy.</p><p>So the second thing we need to do is develop the range of options available for carers.</p><p>For instance, new technology has a major role to play. We’re only just beginning to learn how electronic monitors and other extremely clever gadgets can help people retain their independence.</p><p>We’re already running the largest trial of assistive technology anywhere in the world, looking at how this can help people regain their confidence and reduce their reliance on carers.</p><p>And as we learn more about the effectiveness of this equipment, we want to make them far more mainstream. More visible, more commercially available for those who are not eligible for council support.</p><p>The best councils understand that more personalised, more effective care means listening to you and working with you far more than ever before.</p><p>That’s the shift in mentality we need to see across all parts of the country. A greater involvement and a greater sensitivity to your needs across public services.</p><p><strong>Better NHS support</strong></p><p>And that includes the NHS. Too often carers are the invisible partners in clinics or consulting rooms, rather than real experts that can help doctors get the best results for patients.</p><p>So the third key priority is to improve how the NHS responds to carers.</p><p>When we say “No decision about me, without me.”  We mean it.</p><p>Medical professionals have to get better – some, much better – at talking to carers. Explaining the options. Not just talking at you, but listening to your views. Giving you the information and the options you need to provide better care and support at home.</p><p>That may include difficult conversations. For example, one of the biggest shocks – and the thing that tips many carers over the edge – is managing incontinence. It’s rarely discussed. I think it should be.</p><p>That is why personalisation is just as crucial in the NHS, which is why we’re piloting personal budgets in health. I’ve seen how they can transform lives by putting people in control.</p><p><strong>GP training and awareness</strong></p><p>Of course, we also need to help you stay healthy and able to carry on.</p><p>GPs can make the difference, by asking how you’re doing, by picking up on the common problems – back problems, stress, depression – by generally making sure you’re in good health.</p><p>It’s a simple gesture but many GPs aren’t as aware, and some are perhaps not as sympathetic, as they could be.</p><p>That’s why we’re investing in training. To help doctors understand your needs and to help them to identify and support those who might not think of themselves as carers.</p><p>Equally, I know that many of you draw great comfort and strength by taking a break from your caring responsibilities once in a while.</p><p>That’s why we’re also providing the NHS with an extra £400 million to invest in breaks for carers.</p><p>This will help thousands of carers over the next four years to have a breather and a little time to yourself.</p><p><strong>Community Action</strong></p><p>And let me conclude with the fourth and final priority. I think perhaps the biggest opportunity of all. To look beyond public services and to foster a better environment for care across the whole community.</p><p>Call it Big Society, call it capable communities and active citizens, call it social action, it means the same thing.</p><p>This isn’t about lofty ideals either.</p><p>We’re taking concrete actions.</p><p>For instance, by investing in the voluntary sector, which I know can make a huge difference.</p><p>We’ve already provided more than a million and a half pounds to the three national care organisations this financial year.</p><p>We’re now providing a new grant to help various patient groups to reach out to carers and help them to get the advice and support they need.</p><p>We will also work with business and organisations to help foster a more care-friendly working culture in Britain.</p><p>UK plc has to respond to social change – to an ageing society, to growing rates of dementia – that means more people will need care in years to come.</p><p>As Maria will tell you, we will be looking at how we extend your rights, and encourage more organisations to be more sensitive and more flexible to carers’ needs.</p><p><strong>Conclusion</strong></p><p>So yes, we do have a challenge ahead of us.</p><p>And yes, Government must do more – and we will.</p><p>But this has to be a partnership, with everyone playing their part to change attitudes and transform opportunities for carers.</p><p>It’s not going to be easy. It’s not going to happen overnight either.</p><p>But Maria and I are very focused on this, and we’re keen to work with carers organisations and with all of you to make it happen.</p><p>As I say, I campaigned for all this in opposition – I’m going to work as hard as I can to deliver it in government.</p> <div class="contactsInfo"> </div> </div> None Paul Burstow MP Carers UK Conference Department of Health 2010-11-26 speech to Carers UK Conference
<div class="subContent first"> <p>I’m very pleased to be here – not least because I wanted to thank you for the unique and precious work you do within our communities.</p><p>The hospice movement has a rich and distinguished past: always at the heart of our communities, always centred on values of compassion and care, always searching for new ways to improve the quality of life for those you support.</p><p>I have close links with St Raphael’s Hospice in my own constituency, which provides some wonderful care for the people of Sutton.</p><p>In fact, just before the election I did a fire walk to raise funds.</p><p>I can say quite literally there were no cold feet here about joining the Coalition.</p><p>As I say, hospices have a distinguished past. And I believe there have a bright future ahead of them, both as providers of services and as a source of expertise and advice to others.</p><p>And so it’s fitting that your conference and your Report coincides with our new vision for social care.</p><p>It’s a vision built on the principles of partnership and mutuality – principles that already lie at the heart of the hospice movement.</p><p>A plan that’s all about changing the relationship between the State and the individual – shifting more power away from politicians like me, and into the hands of the people and families who use your services.</p><p>We want more personal budgets, more join-up between health and social care, and more variety and innovation in the organisations delivering care.</p><p>Earlier in the summer, the NHS National End of Life Care Programme, produced a framework talking about how social care should get more involved in planning and delivering end of life care.</p><p>Too often social care staff don’t have the confidence to discuss end of life care with services users, and yet their training in assessment and advocacy can mean they’re perfectly placed to have those conversations.</p><p>And hospices can help them. We absolutely want you to be at the heart of this new approach, working hand in hand with the NHS, and the wider care sector, to deliver better results for families.</p><p><strong>Capital Funding for Hospices</strong></p><p>But to achieve it, I know you need the right funding.</p><p>One of the first things the new Government did, nearly six months ago now, was to dispel any concerns about capital funding allocations to hospices.</p><p>We confirmed £40 million to support valuable projects around the country to renovate and improve facilities, many of them helping to support people receiving care in the community.</p><p>The decision was a mark of our support for hospices and for the valuable work you do – and I’ve seen how this money has transformed surroundings of St Raphael’s, which had been showing its age.</p><p><strong>Palliative Care Funding Review</strong></p><p>We also recognised from the off, that we need a sustainable funding system for the longer term.</p><p>The Coalition Document made it clear that we’re committed to per patient funding model for palliative care.</p><p>And back in July, we asked Tom Hughes-Hallett to begin an independent review.</p><p>Our aims are straightforward. We want a funding system that’s sustainable. That provides stability and security to plan for the long term. And that actively encourages community-based palliative care, to help people stay at home or in a care home.</p><p>Tom is looking at a range of options to make sure funding for hospices and other palliative care providers is fair.</p><p>He will be looking at both adults and children services – the first time the two systems have been considered together – with Professor Sir Alan Craft lending his expertise on children’s palliative care.</p><p>To give you an idea of the timeline: an interim report is expected shortly, the final report next summer, and we hope to announce the final decisions by the end of 2011.</p><p><strong>Spending Review</strong></p><p>And just recently, of course, we’ve had the Spending Review. Another clear sign that the Government is serious about defending health and social care.</p><p>Protection for NHS spending – a real terms increase over the next four years.</p><p>And protection for social care. Funding rising in line with need. Up to an additional £2 billion a year by the end of the Spending Review period – half of it from NHS.</p><p>And with it, clear instructions for the NHS that this £1 billion must go on social care.</p><p>No absorption, no hoarding within PCT baselines.</p><p>The money is there to invest in services that keep people independent, and out of hospital.</p><p>And it should act as a catalyst bringing health and social care services much closer together.</p><p><strong>Commissioning</strong></p><p>The Spending Review should be a platform for accelerating the pace of reform across health and social care.</p><p>The recent Demos report prepared for this conference shows there’s plenty of room for improvement in end of life care.</p><p>It’s really a riposte to those who respond to our reform proposals and say ‘if it ain’t broke, why fix it?’</p><p>The figure that stood out for me is this one, from the National Audit Office:</p><p>That four in every 10 patients who died in hospital had no medical need to be there.</p><p>That figure is based on a local study, and it means in one month alone, in just one city, 120 people died in hospital when they could have been at home.</p><p>I share your frustration, and your belief – that we can and should do better than this.</p><p>The palliative care review will look at the funding issue, but I’d suggest this is a question of outlook as much as resource.</p><p>We need more imagination, more radicalism, more courage in commissioning. Shifting the landscape of end of life care in favour of the service user.</p><p>And we need an energetic and confident third sector to help us do this.</p><p>The best commissioners are already challenging old conventions, already finding new ways of designing services, and new ways of bringing in hospices and other community organisations together to meet patients needs.</p><p>And hospices are often at the heart of it all.</p><p>Like in Oxford, where Sue Ryder Care is working with the local PCT to fund a specialist community matron to support people cared for at home.</p><p>Or in Wiltshire, where the Dorothy House hospice has developed a carers’ support group to help those looking after people at home.</p><p>Or in the South West, where NHS teams are working with hospices on education and training plans to support the End of Life Care Strategy.</p><p><strong>GP Consortia</strong></p><p>Now I know some of you are worried about how the new GP consortia will work, and what that will mean for future commissioning.</p><p>I’ll be looking very closely at how these new arrangements are working for end of life care.</p><p>But I would say, here and now, that I think GP commissioning have clear advantages over the current model.</p><p>GPs have a better understanding of patient needs, and better connections with the local community – more knowledge of what’s available locally to support patients at the end of life.</p><p>I firmly believe General Practice consortia will be advocates, not enemies, of hospices.</p><p>But I’d also say this: don’t sit back and wait.</p><p>Now’s the time to start having those conversations, sowing the seeds with local GPs – and with local authorities, who will play an increasingly important in co-ordinating care.</p><p>Many PCTs and councils are already moving toward joint-commissioning and planning through Health and Wellbeing Boards – and it’s vital the hospice sector is making its voice heard through these channels.</p><p>So my advice to you is: Step forward, don’t shrink back. Get to grips with the new structures. Understand the local agenda.</p><p>Above all, look outwards, not inwards. Look at how you can join-up with other services to meet patient needs, and create a compelling offer for local commissioners.</p><p>These are difficult financial times – but this is no excuse for slow progress.</p><p>Good end of life care can save money, and poor quality care can squander it.</p><p>I heard just the other day about motor neurone disease patients who couldn’t get respiratory support.  It would have cost a few thousands of pounds. </p><p>And the result? Six months in intensive care costing a million pounds.  This is the extreme, but it’s a salutary comparison. </p><p><strong>Linking up EOLC and LTCs</strong></p><p>And it brings me to an important question of joining up end of life care with the management of long term conditions.</p><p>Dementia is the most obvious case in point. We’re focusing on earlier diagnosis, because this gives people the chance to plan for the future.</p><p>And planning for the future does mean making choices about end of life care.</p><p>So diagnosis should be a trigger for discussions. About how you want to be cared for. How you want to live. Where you want to die.</p><p>We need these kind of open discussions between patients and doctors as an integral part of long term care planning.</p><p><strong>Cultural barriers</strong></p><p>Easy to say, harder to do.</p><p>Among public and professional alike, there is still a real reluctance to talk about death and dying.</p><p>And that needs to change.</p><p>A 21st century health service has to be more open and willing to talk about death.</p><p>Society itself needs to be more open and willing to talk about death.</p><p>So yes, I think we need to lift the veil again, and I absolutely support the work of the Dying Matters coalition to stimulate more debate about this issue.</p><p>I’m also pleased that the National Council for Palliative Care is one of the signatories to the National Dementia Declaration for England, published last month, which should help give voice to these important issues.</p><p><strong>Conclusion</strong></p><p>Ultimately, how we care for people towards the end of their lives defines us as a society.</p><p>The work you do – in helping people, and families, to share in a peaceful, dignified and pain-free death – is the finest expression of the compassion, respect and goodness we want to see in all our communities.</p><p>Helping someone to die well is the most precious thing we can give an individual and their family.</p><p>I appreciate and acknowledge your valuable work, and I hope we can continue working together to allow more people in future to experience a good death.</p> <div class="contactsInfo"> </div> </div> None Paul Burstow MP Help the Hospices Conference Department of Health 2010-11-16 speech to the Help the Hospices Conference
<p class="introText">It's six years since I last spoke at this conference.  I did so then as a Liberal Democrat shadow minister setting out a vision for social care.<br /><br />I don’t think anyone could have predicted the events of six months ago.<br /><br />The formation of a partnership government. The first coalition in over 60 years.<br /><br />So I come as the unexpected Minister. And I come bearing an unexpected message too – a Spending Review that gives us the chance to protect and reform social care.<br /><br />ADASS, the LGA, the NHS Confederation and many charities all told us that if you underfund social care, then you hurt the most vulnerable, and you undermine the NHS.<br /><br />Well we listened, we understood, we acted.<br /><br />The result is an unexpected settlement.<br /><br />A settlement which means councils can meet cost pressures and maintain services.<br /><br />Some have cast doubt about this. It has even been suggested that we are still £4 billion gap of what’s needed over the next four years.<br /><br />Claims and counter claims are part and parcel of any settlement.  But the tone has been alarmist. So let me spell out why there is no gap.<br /><br />But before I do, let me point out where we agree. <br /><br />We agree about efficiency. The LGA in its pre-Spending Review submission to the Treasury said that social care could deliver 3% efficiency a year over the next four years.<br /><br />That is challenging  and I don’t pretend otherwise. But it is achievable.<br /><br />However, claims that there is a £4 billion gap even after the additional £2 billion announced in the Spending Review are based on some flawed assumptions and poor maths.<br /><br />First, it is assumed that growth trends in pay and prices over the next twenty years are a guide to pay and prices pressures over the next four years.<br /><br />That clearly is not true. These are not normal times. The reality is that there will be a pay freeze for the next two years in the public sector.<br /><br />We also know the Office for Budget Responsibility tells us that independent sector wage increases will be slower than normal.<br /><br />So, for the next few years, cost pressures won’t be anything like the long term trend.<br /><br />The second flaw is to assume that reductions in central government funding mean an equivalent cut in revenues raised and spending power.<br /><br />This is just not true either. Central government funding is just one part of the equation any Council Treasurer has to balance the books.<br /><br />No one is talking about a 26% cut in Council Tax revenues or for that matter the income from charges and levies.<br /><br />Yet this is exactly what has been assumed to arrive at the £4 billion gap!<br /><br />Once these flaws are corrected the £4 billion gap disappears.<br /><br />And let me, reiterate what Helen Bailey from Treasury said earlier about what the social care settlement includes.<br /><br />First, Department of Health grant funding continues and will rise with inflation.  This year we allocated £1.3 billion.  By 2014 that will rise to £1.4 billion.<br /><br />Second, on top of the inflation indexed grant from 2011 there is an additional £500 million rising to £1 billion by 2014.<br /><br />Third, there will be extra money from the NHS.  Starting with £800 million next year and rising to £1 billion by 2014.<br /><br />So no cut in social care grants. An additional £1.3 billion next year. Rising to additional £2 billion by 2014.<br /><br />On top of this related areas, like Supporting People grant and Disabled Facilities grants, are both shielded from the 26% reduction.<br /><br />Taken together with the 3% efficiency this settlement does meet future demands.  Does allow services to be maintained and reformed.  And does provide a clear path through to 2014 and the new funding system that Andrew Dilnot is designing for us at the moment.<br /><br />Of course, the other charge levelled against the settlement is that the money won’t get through to social care.<br /><br />That NHS funding will simply be hoarded within PCT baselines. <br /><br />And that the extra money going through the formula grant will simply be swallowed up by other council departments.<br /><br />Well, the Secretary of State will talk more about the first point later this week – when he is here on Friday. But rest assured, we will ensure this NHS support goes on social care.<br /><br />On the second point, I have been at conferences and I have heard, “if only there wasn’t ring fencing.” <br /><br />Taking off the ring-fence has been a constant refrain from local government for years. <br /><br />And now we’ve got it. Real freedom for councils. Freedom to make their own decisions, to set their own priorities, to decide how money is spent. <br /><br />So this Spending Review offers a secure platform for the future. But let’s be clear – it’s a platform for reform, not for business as usual.<br /><br />THE BIG SOCIETY<br /><br />Our care system has now reached a critical point and funding is only one part of the answer. <br /><br />Pumping more money into an unreformed system to manage ever-rising demand isn’t sustainable.<br /><br />We need to rethink our whole approach, and tackle the drivers of demand, the vulnerability and isolation that applies pressure to the care system in the first place. <br /><br />Our society has changed massively in a short space of time. <br /><br />Networks of community and family support we’ve relied on for centuries have declined.<br /><br />In their place, the state has taken on an ever-bigger role in providing services and dealing with social problems. <br /><br />And the result? <br /><br />Communities have been disempowered and disconnected.<br /><br />Councils have become infantilised by decades of targets and central diktat.<br /><br />It’s taken us to where we are today, where costs are becoming unsustainable.<br /><br />That’s why we talk about the 'Big Society'.  <br /><br />Ending the dependency culture.<br /><br />Building open, capable and confident communities is what we want it to be about. It is not just the individual citizen but local government too<br /><br />Buttressing ties of family and mutual support.<br /><br />That is our vision. Not simply looking upwards to the state for answers, but outwards to people and communities.<br /><br />A Big and Open Society means a big shift of power.  A shift from the state to the citizen. From Whitehall to the Townhall. From provider to service user. <br /><br />And it also means a big opportunity. Because if are going to give people the power, if we support them to deal collectively with new challenges, then not only do we get better solutions, we make our communities stronger, and people less vulnerable. <br /><br />And if we do that we reduce the need for state help in the first place. <br /><br />Just imagine the potential for social care. Imagine if we can develop local support networks to build on the good examples  and reduce elderly isolation and vulnerability.<br /><br />Imagine the gains that can be made from supporting more older people in their community. <br /><br />Imagine if we can build a social movement, built on protection and mutual responsibilities, so that fewer people end up dependent on acute services. <br /><br />The answers are out there.<br /><br />Some of you may have heard reports over the weekend about importing ideas from Japan.<br /><br />We want to learn from all over the world. But actually you don’t have to go that far to see what’s possible. <br /><br />Go to South London. See the Southwark Circle programme. Linking local services with voluntary ones. Like help with shopping or home maintenance. A simple model having a major impact on people’s independence and autonomy.<br /><br />For example, the many Timebanks springing up around the country: practical, effective, affordable, recession proof ways of helping people create their own solutions.<br /><br />We want to unleash the talent, time and power of local innovation and community support right across the country.<br /><br />Through councils working with community organisations and others to develop innovative schemes like these.<br /><br />With more investment in preventative support, like telecare and home adaptations, to prevent or postpone dependency. <br /><br />And with more social enterprises. More user-led organisations taking the reins of service design and service delivery.<br /><br />PERSONAL BUDGETS<br /><br />Most important of all, we want people to get direct control of the money the state spends on their care. <br /><br />It is, now, fourteen years since the first legislation for direct payments. <br /><br />Yet still only 13 per cent of service users – 216,000 people – actually control the purse strings.<br /><br />We know that personal budgets give people more control over their lives and greater satisfaction with the services they receive. <br /><br />And in most cases they offer better outcomes at the same cost.<br /><br />Just last week, the Audit Commission asked why we’re not seeing faster progress.<br /><br />So, yes, we need to aim higher. To a point where everyone can benefit from a personal budget.<br /><br />I know everyone here believes this and this should be the direction of travel.<br /><br />But, of course, it’s not enough just to have personal budgets.<br /><br />We need to be sure they’re there for individuals and their carers, giving people meaningful choice and control over their care.<br /><br />Some authorities have been fantastic and models we need to see more of. <br /><br />They’ve shown it can be done.<br /><br />Tomorrow we’ll see that your leadership can make a real change at the launch of a partnership agreement that demonstrates this shared determination.<br /><br />But let me be absolutely clear personal budgets should be a right.<br /><br />PORTABILITY<br /><br />The same is true of portability. <br /><br />The lack of portability reveals a 19th century logic at the heart of 21st century social care. <br /><br />The logic of the poor laws. The complete antithesis of a person-centred approach. <br /><br />Again, it needs to change. <br /><br />Again, it won’t be easy. <br /><br />Again, we’ll need to come together to break down the barriers and deliver greater portability of assessments across geographical boundaries.<br /><br />PLURALITY<br /><br />Above all, we need to embrace plurality and partnership.<br /><br />We need a new scale of collaboration between the NHS, local government and the voluntary sector. <br /><br />Partnership like never before.<br /><br />An end to paying lip service.<br /><br />The beginning of the integrated, personalised services that we all know make sense but somehow have been out of reach.<br /><br />It’s something the last Government promised, but with a few honourable exceptions never realised.<br /><br />Why? Because the structures and incentives were wrong. Because the money followed the institution, and not the need.<br /><br />We’re determined that we can and must do more.<br /><br />The £3.8 billion from NHS capital over the next four years to support social care is a statement of intent. <br /><br />As is the £70 million already allocated this year for reablement.<br /><br />These sums are a catalyst but I don’t see this and these sums as the limit of collaboration. <br /><br />See it as a catalyst, a trigger to do much more together in future.<br /><br />And a trigger to bring on board the full range of organisations that can help you.<br /><br />Vibrant and creative social entrepreneurs.<br /><br />Voluntary organisations fully engaged as a partner and deployed at the grassroots.<br /><br />User led organisations working with Council and NHS commissioners to design and deliver services that meet new needs.<br /><br />Community groups committed to building those critical social networks that deliver results on a street-by-street basis.<br /><br />The best councils are stepping up their role as exceptional leaders, place and market shapers – helping to spark and support innovation to meet emerging needs.<br /><br />We need all councils to embrace this role.<br /><br />And that means stripping out the barriers that stand in their way.<br /><br />Let me give you some examples, like the lady in sheltered accommodation who is told to stop cooking for fellow residents because of environment health concerns.<br /><br />Or the gentleman who provides an informal ‘taxi’ service taking neighbours shopping who is told he needs to get a taxi licence.<br /><br />Let’s be clear. Where rules and red tape are an obstacle to realising a person’s freedom and providing them with the right care and support that is right for them.  We have to look critically at red tape. And whether that red tape should go.<br /><br />And the same rigour must apply to custom and practice masquerading as rules and regulations.<br /><br />We need a better attitude to risk.  Better safeguards against poor practice. Better protection against harm and abuse – absolutely.  But common sense and flexibility too in how we understand and manage risk. <br /><br />It’s all the more important as we give more power and control to the individual. <br /><br />Because giving people freedom of choice means they might make decisions that we disagree with, even disapprove of.<br /><br />Yet if the outcomes are clearly set out in the care plan, and the risks fully understood, then we have to let people make their own choices. <br /><br />Some might even call that liberal!<br /><br />Finally, we need to trust and empower you much more. <br /><br />Stripping out unnecessary bureaucracy.<br /><br />And reining back on regulatory pressures that are needlessly burdensome on your day-to-day work.<br /><br />You’ve told us that the CQC’s annual performance assessment of commissioning isn’t the best way of tackling under-performance.<br /><br />We’ve listened, we’ve understood, we’ve acted.<br /><br />And I can confirm today that we will not be taking forward these assessments from next year onwards.<br /><br />In their place.  Continuous improvement.  Real time, ongoing, relevant measures of performance, not the arbitrary snapshots that currently the system takes in.<br /><br />A more proportionate and constructive system. Built around local accountability. Driven by sector-led mutual support. Not the unhelpful stigma of ‘Priority for Improvement’ status.<br /><br />ADASS and the local government group are exploring how this will work. And we are working closely with them as we put the new arrangements in place.<br /><br />CONCLUSION<br /><br />So yes, the coming years will be tough for everyone involved in social care. <br /><br />Tough but not impossible.<br /><br />Local government has shown, time and time again, that it can rise to challenges.<br /><br />You’ve shown it in meeting efficiencies, year on year. Shown it in the leadership you brought to bear in shaping places and supporting communities.<br /><br />You’ve shown that local government is a reforming force.<br /><br />The Coalition is a reforming force too.<br /><br />And the Spending Settlement is a reforming settlement.<br /><br />The opportunity is there.<br /><br />An opportunity for better prevention built on full partnership between health and social care. We are prioritising to protect the vulnerable.<br /><br />For greater personalisation drawing on a vibrant and plural market.<br /><br />For higher productivity based on innovation and autonomy in professional practice.<br /><br />And a wider social movement in supporting our older people and preventing a need for high levels of services.<br /><br />That’s our vision for social care. <br /><br />It’s a vision that matters hugely to the hundred of thousands of fellow  citizens who rely on us.<br /><br />And one that I hope we can fulfil together in the months and years ahead. Thank you.<br /></p> None Paul Burstow MP NCAS Annual Conference Department of Health 2010-11-03 speech to NCAS Annual Conference
<div class="subContent first"> <p>It’s just over a century ago that Alois Alzheimer first described the distinctive plaques and tangles of the disease that bears his name.</p><p>A hundred years on, there is no cure, but there is hope.</p><p>As this year’s awareness campaign made clear, we can now do a lot to help people live well with dementia at all stages of the disease.</p><p>I want to talk today about how we achieve faster progress – from point of diagnosis right through to the care people receive at the very of their lives.</p><p><strong>The Coalition Approch</strong></p><p>We are, at heart, a reforming Government.</p><p>We believe in shifting power out of Whitehall – to the townhall, the professional, above all to Citizens.</p><p>We believe in giving health and social care professionals more discretion, more autonomy, and more responsibility to achieve the best for the families they serve.</p><p>And we believe, finally, in giving people more power and influence to control and shape their own future – particularly through user-led organisations, which can help us to design and deliver services that people really want.</p><p><strong>Transparency and Accountability</strong></p><p>The dementia implementation plan, which some of you helped us to shape, encapsulates these principles.</p><p>No more targets.</p><p>No more micro-management from Whitehall.</p><p>A new focus on outcomes, not processes or inputs.</p><p>More choice for the individual.</p><p>And more control passing from the centre to the grassroots – and, with it, responsibility and accountability.</p><p>We’ve said that every Primary Care Trust will now have to account for their progress on improving dementia care. Not to me. Not to policy teams in Whitehall. But to the local people they serve.<br />And we will insist on full disclosure. PCTs will be expected to publish details of how they’re spending the money for dementia.</p><p>By doing so, they’re opening the door to local challenge, giving people a voice if they feel they’re being short-changed.</p><p>But people must be ready to use that voice.</p><p>Charities, pressure groups and individuals themselves have to be ready and willing to interrogate local plans and insist on the high standards of care.</p><p>And we all have to learn to judge success, not by inputs and processes, but by outcomes.</p><p>It can no longer be good enough for the NHS to do great things for a person in hospital, and then let them down by not continuing that support in the community.</p><p>The new Outcomes Framework will give commissioners a clear, unambiguous picture of what they need to achieve for people with dementia and their carers.</p><p>And through joint strategic needs assessments, councils will take a lead role in making sure the right connections are made across health and social care to achieve these results.</p><p><strong>Hospital care</strong></p><p>So what are our priorities for dementia care? There are plenty of them set out in the Dementia Strategy.</p><p><br />But for the me, the priority can be summed up in a single word: dignity.</p><p>Preserving a person’s dignity has to be the first and last principle of dementia care, whether it’s in hospital, in a care home, or in a person’s own home.</p><p>It’s so often the simple things that can be overlooked. How a person is dressed in the morning. The care and attention paid to their personal appearance. Choice over when they take their meals. Control over how they spend their time.</p><p>Dignity and compassion have to be maintained throughout the person’s dementia journey.</p><p>And particularly at the very end of that journey – which is why I welcome the new resources published today by the National End of Life Programme.</p><p>Training and awareness is key to this.</p><p>And I’m afraid we have to acknowledge there is a training deficit in the NHS as far as dementia awareness is concerned.</p><p>Like all deficits, it needs to be tackled head on, and we’ve reflected this in the position dementia has been given in the new Operating Framework.</p><p><strong>Care Homes</strong></p><p>Of course, the same applies in care homes. I’m sure many of you were glued, as I was, to the Gerry Robinson documentaries last year.</p><p>These films revealed how well-run care homes became more popular and more profitable, as well as better places to live.</p><p>They showed how imaginative leadership to inspire staff and involve residents in the running of care homes transformed their self-esteem and improved the quality of their lives.</p><p>But the images that really stuck in my mind were the stark differences between the care homes.</p><p>In a successful care home, there was a flurry of activity and chatter – energetic staff, happy residents.</p><p>In a struggling care home the mood was almost palpably bleak. Carers demoralised, residents slumped lifeless in their chairs, drugged up on medication.</p><p><strong>Reducing Anti-Psychotics</strong></p><p>Again, it shows that we must insist on a much stouter defence of people’s essential dignity and human rights.</p><p>Nowhere is this more important than in reducing use of anti-psychotic medication.</p><p>Sube Banerjee’s report laid bare the human cost of inappropriate use of these drugs.</p><p>The headline figure is 1,800 deaths a year – but the cost to people’s quality of life far exceeds this.</p><p>We need a wholesale change.</p><p>The evidence is clear.  These drugs cut lives short. </p><p>They should not be routinely prescribed to people with dementia.</p><p>They should only ever be used as a last resort and then only for a short period.</p><p>So this is one area where I will be leading.</p><p>A national audit is underway and we will expect PCTs to publish their progress towards reducing usage.</p><p>Our aim: an overall reduction of two-thirds by November of next year.</p><p>But achieving these reductions isn’t achieved by a speech in a conference hall like this.</p><p>It’s achieved through action - through better practice in care homes and hospitals.</p><p>That is why Alistair is meeting with medical directors and the Royal College of GPs to look at how they can improve their record on anti-psychotic drugs.</p><p><strong>The Public Finances</strong></p><p>Now it would be wrong of me not to mention the financial context, something I know will be causing many of you here anxiety and concern.</p><p>So what does this mean for dementia care?</p><p>Well, even with the protection the Government has given to health and social care budgets, we still need to find significant savings to reinvest in improving care for the future.</p><p>More than £8 billion a year goes into dementia care, and the National Audit Office has suggested nearly £300 million a year could be saved.</p><p>So we need real imagination, boldness and creativity to find new ways of delivering care.</p><p>We need more examples like the GP-led memory service in Staffordshire – saving money precisely because it’s focusing on outcomes.</p><p>The team there has dramatically reduced hospital costs by bringing down the diagnosis time for dementia from three years to four weeks.</p><p>Let me repeat that. </p><p>Diagnosis down from three years to four weeks!</p><p>Not because of any national target. Not because of pressure from Whitehall.</p><p>But because they saw the benefits for patients.</p><p>In dementia, as with other fields of health, quality pays.</p><p>Just as efficiency without quality is unthinkable, so quality without efficiency is unsustainable. We have to achieve both.</p><p><strong>GP Awareness and Referrals</strong></p><p>So yes, we need more investment in memory services in our communities.</p><p>But we also need a shift in professional awareness and attitudes.</p><p>Older people with memory problems should never have their symptoms dismissed as just ‘part and parcel of getting old.’</p><p>We need a ‘safety-first’ approach in primary care. As with cancer, the professional response should be “if in doubt, let’s check it out”.</p><p>We’ll be working with GPs and other primary care teams to look at how we can achieve earlier diagnosis so we can do more to postpone dependency and reduce costs.</p><p><strong>Research</strong></p><p>And we make these savings for a purpose. So we can invest in the treatments and care models of the future.</p><p>Earlier this year I had the pleasure of chairing a lecture by Professor Chris Dobson at St Johns, Oxford.</p><p>He spoke of the extraordinary work done by his team on the disease mechanism behind dementia and the role of proteins in the body.</p><p>We need outstanding programmes like this to continue.</p><p>As the Chancellor confirmed last week, dementia research will be prioritised within the health research and development budget.</p><p>And I’m chairing a Ministerial Advisory Group to make sure dementia researchers get a fair share of the £1.7 billion research fund.</p><p>One of the many issues we’re looking at is how we can encourage more people to take part in medical trials.</p><p><strong>The Dementia Declaration</strong></p><p>And that leads me onto my final point.</p><p>Because dementia, as it tightens its grip on our communities, will be something that, touches all of us in our everyday life.</p><p>So we all need to wake up to what this will mean.</p><p>Not just in Government, not just in the NHS, not just across social services.</p><p>Every single one of us has to be ready for a future where more people have dementia, and more will be caring for them in our communities.</p><p>That means boosting understanding, awareness and engagement across our communities as a whole.</p><p>We need examples like the WRVS, which is helping its 50,000 volunteers to become more dementia-aware.</p><p>I know Lynne Berry will be speaking to you about this later.</p><p>And where organisations like WRVS lead, other will follow.</p><p>I’m particularly encouraged by the Dementia Declaration, which I’ll be formally launching in a moment, because it demonstrates the culture change we need.</p><p>Removing the reticence to help older people.</p><p>Banishing the ignorance and stigma surrounding the disease.</p><p>Encouraging more organisations to come forward and make a contribution.</p><p>I pay tribute to the 45 organisations who have signed up, and I hope many more will follow in their wake.</p><p><strong>Conclusion</strong></p><p>To sum up then, my message is simple.</p><p>It’s a message of hope.</p><p>Yes, the road will be tough, and the financial context will make things difficult.</p><p>But I think we can rise to the challenge and make this a breakthrough period for dementia care.</p><p>And let me leave you with a story that sums up why it’s so important we do so.</p><p>It’s about an older couple coming to terms with late stages of the wife’s dementia.</p><p>She had sadly deteriorated to the point where she no longer had any recognition of who her husband was.</p><p>She was often extremely agitated and frightened in his presence, which as you can imagine was a terrible situation for everyone concerned.</p><p>But amidst all of this, her carers found some refuge, some consolation and some hope.</p><p>The wife, they discovered, was once a very talented musician – that was how she’d originally met her husband.</p><p>And so they hired a portable piano that she and her husband could play on in the care home where she lived.</p><p>It was an experiment – just a hunch really – but the impact was immediate.</p><p>Playing a duet on the piano once a week, not only calmed her, it restored her connection with her husband.</p><p>For the time they were together at the piano, the smiles, the familiarity, the gestures of intimacy that defined their relationship returned.</p><p>It gave the family the best possible outcome under the circumstances – a few precious moments of lucidity amidst the confusion and fear.</p><p>A powerful story. A hopeful story.</p><p>A story that shows all the hallmarks of excellence in dementia care.</p><p>This is the excellence we must insist on in every part of country.</p><p>And it’s the excellence, with your support and hard work, we can achieve in the years ahead.</p> <div class="contactsInfo"> </div> </div> None Paul Burstow MP Improving Dementia Care Conference Department of Health 2010-10-26 speech to the Dementia Care Conference
<div class="subContent first"> <p><strong>Skills for Care: Social Work – Building the Workforce Together Conference</strong></p><p>It’s now nearly a year since the Social Work Taskforce first reported with its 15 recommendations.</p><p>Certainly plenty has changed.</p><p>Change in the political landscape – with a Coalition Government, now six months old.</p><p>In the professional landscape – with the first signs of real change in policy and practice through the social work reform board.</p><p>And change, of course, in the financial landscape I couldn’t make a speech without mentioning the Spending Review, of which I want to say more in a moment.</p><p>Dramatic times, and hugely difficult times for everyone working in public services, I recognise.</p><p>But what hasn’t changed in all of this, is the very thing that brings all of us here today.</p><p>The commitment to do the very best for the children, families and communities we service.</p><p>And the shared view that we need consistent and coherent programme of reform to achieve this.</p><p>This is a reforming Government.</p><p>Yesterday’s Spending Review was a reforming settlement.</p><p>It is true to the values we stand for set out in our coalition agreement .</p><p>A desire to share the burden of deficit reduction fairly, and to support and protect the most vulnerable in our communities.</p><p>A belief that we need to recast the relationship between the individual and the State so that more power goes to the individual.<br /> <br />And a commitment to put more trust and more responsibility in the hands of the frontline professionals, like social workers, who make all the difference to people’s lives.</p><p>Over the last decade or so, I know that social workers have felt they’ve been working with one hand tied behind their backs.</p><p>The job has become increasingly about managing processes and paperwork.</p><p>And yet the true role and the true potential, of social work is much, much more than that.</p><p>Much more than the salvage and rescue of social casualties.</p><p>Much more than pen pushing and form filling.</p><p>It’s about helping to unlock the potential of individuals and communities, to promote self care and self determination.</p><p>To achieve this, we have to free up the professional and rediscover social work’s original purpose.</p><p>Understanding individuals. Seeing the context of people’s needs. Working with more autonomy and resourcefulness to create the right outcomes for them.</p><p>The review that Professor Eileen Munro is leading into children’s service already shows we can start to streamline social work and hand power back to the frontline.</p><p>I’m keen we learn the lessons from this for adult services too – and this will be something you’ll hear a lot more about in the weeks and months ahead.</p><p><strong>Spending Review and Social Work</strong></p><p>Yesterday’s Spending Review makes this all the more important, and I want to say a little bit about what I believe it represents.</p><p>Nobody could stand here and deny there were tough decisions in the Spending Review that the Chancellor outlined yesterday - decisions that understandably cause anxiety and uncertainty for many.</p><p>But every line in the Chancellor’s statement was a necessary and proportionate response to the deficit legacy we inherited.</p><p>Tough choices that will bring sanity to our public finances, and stability to our economy as a result.</p><p>But, of course, it has to done in the right way.</p><p>We needed a fair settlement, a reforming settlement, a settlement that promotes growth in our economy and cohesion in our communities.</p><p>That’s exactly what the Chancellor and the Chief Secretary to the Treasury delivered.</p><p>The additional £2 billion injected into social care, in particular, presents a big opportunity and a big obligation for all of us in this room.</p><p>It means that, with serious increases in productivity, councils can meet the extra demands we’ll face in the years ahead.</p><p>And it provides a strong bridge to the new funding system for adult social care that Andrew Dilnott is designing for us at the moment.</p><p>This means no council needs to choose to restrict access to care – or, worse still, make slash and burn cuts.</p><p>But it can’t signal, absolutely mustn’t signal, a return to ‘business as usual’.</p><p>And my challenge to local government colleagues is this.</p><p>The Government has made the tough choices to provide resources for social care.</p><p>You now have the space, the opportunity – and dare, I say, the duty – to accelerate the pace of change.</p><p>To effect real changes in how we think about our role and our relationships with service users and other services.</p><p>Real improvements in how we integrate health and social care.</p><p>A renewed focus on outcomes, not processes to ensure we make every penny count for the people we support.</p><p>In a society where more disabled and old people will need care and support in the years ahead, there’s a powerful logic to this investment, and a compelling logic in half of the new money going through the NHS.</p><p>It’s the logic of prevention … of making sure the health isn’t just a rescue service, like the AA – on hand to pick us up when we break down.</p><p>And it’s the logic of integration … that health and social care working as one will always achieve more for people than if they remain two systems working apart.</p><p>And one thing is abundantly clear to me. Social workers are a vital thread helping us tie these two worlds together.</p><p>How well we free you to deliver for your service users defines how effectively we can support people with the resources we have.</p><p><strong>Retrench or Reform</strong></p><p>So I have a simple message. This cannot be a return to ‘business as usual’ as a result of the funding settlement for social care.</p><p>Just as the Coalition has made tough decisions, so councils will face tough decisions in other public services.</p><p>All of us have a responsibility to stretch every sinew to increase productivity and make sure every pound spent achieves real results for the communities we serve.</p><p>And it means council leaders across both children and adult services have a simple choice: retrench or reform.</p><p>If they retrench, and stick to old delivery models then they will prove the doom-merchants right…as there are plenty of them…and we will see falling standards as budget pressures bite.</p><p>Quality won’t improve; choice will narrow; the costs of unplanned care will rise.</p><p>If, however, they reform and embrace new ways of providing care and support for the most vulnerable, then we can kickstart, I believe, a virtuous circle of continuous improvement in which the focus shifts decisively to one that is about preventing and postponing dependency and ill-health.</p><p><strong>The Government’s contribution</strong></p><p>Make no mistake: changing social work is a key part of this.</p><p>It would be easy and understandable to take our eyes off the ball, given everything else that’s happening in public services.</p><p>But that would be a mistake – for professionals, for employers, for politicians and for the individuals and communities we support.</p><p>That’s why we’re already investing in new ways of doing things. £23 million for the Local Social Work Improvement Fund, which is helping councils pilot new approaches to children’s services. Stripping back the bureaucracy. Giving social workers back the autonomy and trust to do the right thing for children.</p><p>We’re supporting education and training.</p><p>£4 million for the Newly Qualified Social Work programme and nearly £100 million combined for bursaries and social work student placements.</p><p>Along with the Children’s Workforce Council, helping to attract and retain the highest calibre professionals into social work.</p><p>And finally we’re investing in leadership, through the College of Social Work – creating the powerful champion for the profession that we’ve need for so long.</p><p><strong>Consensus and co-operation</strong></p><p>But success isn’t just a matter of pounds going in, it’s measured by outcomes.</p><p>And what’s really encouraging is the mood of co-operation across and beyond the profession – a shared appetite to take this agenda forward and to make it your own.</p><p>Key decision makers in education and training – many of you here today – stepping up to the plate and pledging your support.</p><p>Likewise employers. Many organisations are teaming up to make sure the right placements are available to students, and that the proposed standard for employers’ is successfully implemented.</p><p><strong>The General Social Care Council</strong></p><p>Of course, good regulation plays a part in shaping good practice.</p><p>And I wanted to say something, finally, about the decision to switch responsibility for social work regulation from the General Social Care Council to the Health Professions Council.</p><p>Our view is simple. We want fair, consistent and proportionate regulation across all aspects of health and social care.</p><p>The best regulators are fully independent of Government, unfettered by any ties to Whitehall or Westminster.</p><p>The fact is GSCC is currently the only professional regulator directly answerable to the Secretary of State for Health.</p><p>It is unique in depending on funding from the taxpayer.</p><p>Last year, for instance, it got just over £15 million from the Department of Health to support its operations, and raised just £2.5m in registration fees.</p><p>And this year costs to the Department are forecast to rise to around £20 million.</p><p>If the GSCC were to achieve full independence, it would have to close the funding gap by charging significantly higher registration fees to individual social workers.</p><p>And my view was this would have placed a disproportionate burden on social workers.</p><p>That’s why we plan to transfer responsibility to the Health Professions Council.</p><p>It can draw on the economies of scale that come from regulating across health and social care.</p><p>It will, of course, need to gain a full understanding of the social work profession, so it can protect the public effectively.</p><p>And yes absolutely, it will need a new name to reflect its broader role.</p><p>But I am confident the HPC will be an effective regulator, and I know discussions are taking place, constructive and helpful, between the two organisations to ensure an orderly transition and I pay tribute to GSCC who are doing that.</p><p><strong>Conclusion</strong></p><p>So one year on from the Taskforce. An encouraging start. Real progress, real leadership, a real sense of partnership across the profession.</p><p>And six months into the Coalition, a clear message from me: continue where it works, change where it doesn’t.</p><p>The Spending Review is a key moment.</p><p>It is an adrenaline shot for the reform and improvement of all public services.</p><p>And it demands we all raise our sights, that we are ambitious about the difference reform can make.</p><p>Social work does have a key part to play in the future we want to build.</p><p>A more personalised future.</p><p>A more empowered future.</p><p>And a future where the judgements of professionals are properly valued, and the potential of service users is truly unlocked.</p><p>Over the next twelve months, let’s capitalise on this positive start and help the profession move forward as one to change lives for the better.</p><p>Even in this tough and difficult financial climate, there is still plenty to play for – and with your support, I know we can continue achieving great things for the individuals, families and communities we serve.</p><p>Thank you for everything you’re doing and I hope you enjoy the rest of this conference.<br /></p> <div class="contactsInfo"> </div> </div> None Paul Burstow MP Skills for Care Social Workers Conference Department of Health 2010-10-20 speech to the Skills for Care Social Workers Conference
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117042.jpg" alt="Paul Burstow, Minister of State for Care Services" /> </div> <p>Let me start by saying thank you to In Control for co-hosting this event and for the work they do across the country.</p> <p>And my special thanks to all of you who are taking this programme forward – both the people leading the projects, and the patients and families shaping the programme and making it your own.</p> <p>I know it’s been a busy, challenging, sometimes frustrating year for many of you – but I’m grateful for everything you’ve done to lay the groundwork.</p> <p>Now is the exciting bit, as we start looking ahead to see all this hard work bearing fruit for patients.</p> <p>The good news I can give you straight away is we’ve now confirmed the budgets to support these pilots: £4 million in total, with the level of funding to each pilot site staying the same as last year.</p> <p>I am also delighted to announce that Hull PCT has been awarded powers to offer direct payments, joining the eight who have already been given these powers.</p> <p>Well done to you all – I look forward to others joining this group.</p> <p>I hope all of this serves to demonstrate that this Coalition Government is committed to personal budgets.</p> <p>Committed because in so many ways, personal budgets encapsulate what we represent.</p> <p>Our single, radical, aim.</p> <p>To change the relationship between the citizen and the state.</p> <p>To do less to people, and more with them.</p> <p>And to ensure Government steps back, making the space for people to lead the lives they want, how they want to.</p> <p>In health and social care, that means giving people real choice over their treatment; real control over how money is spent; and real power to hold local services to account.</p> <p>The White Paper published on Monday sends the NHS a few very simple and unambiguous messages.</p> <p>Put the patient first.</p> <p>Spend less time looking upwards to Whitehall, and much more looking outwards to the people you serve.</p> <p>And deliver what they need as people not just as patients. The human side, not just the clinical side.</p> <p>Personal health budgets can help us achieve this.</p> <p>And so I’d say to you, these pilots are not so much about whether we do personal health budgets … so much as how we do them, where we do them and how they can work for patients and families.</p> <p>Our commitment is very real and very deep - though, of course, we do have to make sure the evaluation is thorough and that the pilots demonstrate impact and value for money.</p> <p>But the potential is huge. Let me give you a story that sums this up for me.</p> <p>An older lady who needed district nurses to come each day to dress diabetic leg ulcers.</p> <p>On one visit, the nurse took the time to ask her ‘What would make your life better?’</p> <p>What she said in reply was incredibly straight forward.</p> <p>Nothing to do with her clinical treatment. Nothing that would break the bank. Didn’t cost a penny, in fact.</p> <p>All she did was ask if they wouldn’t mind making her a cup of tea before they tended to her leg, rather than afterwards as they usually did.</p> <p>A simple, human request. Yet it made a massive difference to how she felt about her treatment, and the relationship she had with that nurse.</p> <p>It made her feel comfortable. Made the procedure more human, and less ‘clinical’ in the pejorative sense of the word.</p> <p>Or take another example. The case of a lady whose father had advanced dementia, but who didn’t want to move him into a care home against his wishes.</p> <p>She’s used a personal budget to provide much more flexible support, helping her to cope with the demands of providing 24/7 care.</p> <p>In particular, she got someone in on Saturday afternoons so that she could take her son out – something she wasn’t able to do previously.</p> <p>Her verdict is extremely powerful. “I felt in control”, she told us. “Before, it felt as if care was ‘done to us’. But a personal health budget made dad and I feel as though we were valued participants.”</p> <p>… Valued participants.</p> <p>That’s the shift in mindset we need to achieve.</p> <p>That’s what the White Paper is all about – captured in the maxim of ‘no decision about me, without me.’</p> <p>And that’s the power and the potential that personal budgets have for people and their families.</p> <p>They can also help us bring health, social care and the voluntary sector together in ways we’ve not seen before.</p> <p>I want a much stronger focus on integration between organisations than in recent years.</p> <p>And through personal budgets, we’ve now got the chance to put the tools of integration in the hands of individuals themselves.</p> <p>I know many of you are working with local authorities to support people with health and social care personal budgets. I commend that.</p> <p>And I hope it can help to rid ourselves of the barriers that frustrate patients and ultimately deny them the best possible care and outcomes.</p> <p>I’m talking about the arguments that can happen. Issues you will be familiar with, I’m sure.</p> <p>Of budget holders from councils and PCTs clashing over who pays for what, whilst patients are left in the middle and left in the lurch.</p> <p>If personal budgets can achieve one thing, let’s hope they can rid us of the unseemly stories of managers squabbling over whether a bath is a ‘social care bath’ or a ‘health bath’.</p> <p>I understand why it happens, especially when budgets are tight. But it misses the point.</p> <p>The person needing help doesn’t care who pays. They don’t distinguish between the organisation providing the services. Nor should they. They just want their needs met. With a little bit of kindness and dignity along the way.</p> <p>Personal budgets can help us end this stand-off.</p> <p>They can help us ensure the patient is never again caught in the crossfire.</p> <p>So I applaud the work you’re doing in this area.</p> <p>Of course, one of the big myths about personal health budgets is that they cost more and lead to waste.</p> <p>If you give patients a budget, so the argument goes, they’ll spend it on something ridiculous and the money will be wasted.</p> <p>Absolute rubbish.</p> <p>Look at places where they already use personal budgets – in the US and parts of Europe.</p> <p>And look at the experience of social care in England.</p> <p>You find this.</p> <p>People do make sensible choices.</p> <p>They often don’t want radical changes.</p> <p>And rather than wasting money, they spend it on better things.</p> <p>In other words, individuals are actually better guardians of the public purse than institutions sometimes can be. Precisely because they know what they need and know when they need it.</p> <p>It makes commissioning more efficient.</p> <p>And it also saves money down the line.</p> <p>I’ll give you another example. Take a young man with a spinal injury.</p> <p>He develops regular chest infections needing physiotherapy as well as antibiotics.</p> <p>Under the old system, he’d have to visit his GP and go through a long process of referral – during which time, his condition may have deteriorated to the point where he would need hospital treatment.</p> <p>With a personal health budget, his care plan enables his carer to arrange physiotherapy as soon as those early symptoms develop.</p> <p>Better for him, better for his family, better for the NHS and the taxpayer.</p> <p>Sounds simple, but I know making it happen is anything but.</p> <p>And today’s evaluation report shows the challenges you face.</p> <p>The practical challenges – the budget setting, care planning, the training.</p> <p>As well as the nuts and bolts of making sure advocacy and sources of advices are in place for patients.</p> <p>A couple of resources being launched today may help.</p> <p>First, In Control has produced a new guide which brings their expertise together and gives a clear structure for taking the work forward.</p> <p>And second, the Department of Health is launching new information on the regulations governing direct payments in healthcare. Some clear advice to make sure your pilots deliver.</p> <p>But the wider challenge is the cultural one.</p> <p>Of changing people’s mindsets.</p> <p>Of getting clinicians, financial managers and commissioners to look again at how they work and how they think about their responsibilities.</p> <p>And of breaking down the barriers that spring up across departments and organisations, and stand in the way of excellent patient care.</p> <p>This is tough. It is difficult.</p> <p>Changes like this need strong leadership and they will take time – but I know there’s plenty of determination and passion in this room to make it happen.</p> <p>And remember: what you’re doing here can be the prelude to something truly radical, something that can go beyond health and social care and redefine how we think about public services.</p> <p>Why shouldn’t we be thinking more broadly?</p> <p>Why shouldn’t we think in terms of personal budgets not only joining up health and social care, but actually linking all publicly-funded support.</p> <p>In effect, personal budgets could become the plan or agreement covering an individual’s whole needs.</p> <p>Think of the potential.</p> <p>An end to artificial boundaries between services and benefits.</p> <p>More opportunities for the voluntary sector to step in and play a much bigger role.</p> <p>Maximum choice, maximum control, maximum accountability handed to the individual.</p> <p>Total personalisation.</p> <p>That’s my vision. That’s my hope for the future.</p> <p>You’re at the heart of it, taking those first trailblazing steps in your area.</p> <p>Thank you again for your support and hard work.<br /></p> None Paul Burstow MP Personal Health Budgets Conference Department of Health 2010-07-15 speech to the Personal Health Budgets Conference
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117042.jpg" alt="Paul Burstow, Minister of State for Care Services" /> </div> <p>It’s a pleasure to join you today and my thanks to ACEVO and Action Planning for inviting me.</p> <p>This is actually my first ‘conference hall’ speech as a Minister.</p> <p>I’m delighted it’s to an audience so central to achieving better care and better health outcomes for people in this country.</p> <p>And to people and organisations sharing the values that will characterise our own approach. Our commitment to personalisation, to quality, to mutuality.</p> <p>Now I deliberately want to keep my remarks brief today. That’s because I’m here to listen to you, rather than talk at you.</p> <p>I want to hear the difficulties you’re coming up against. And I want to learn what we can do, as a Government, to help you keep doing the important work that you do in your organisations.</p> <p>This is a Coalition Government.</p> <p>We’ve set out an ambitious, shared programme for the future.</p> <p>The goal is a simple one, but also potentially very radical in its impact on our society.</p> <p>We want to redefine the relationship between people and services, between the citizen and the state.</p> <p>The State should do less to people, less for people. And more with people. More stepping back to make the space for people to lead the lives they want, how they want it.</p> <p>In health and social care, that means giving individuals and communities the whip hand.</p> <p>Real choice over their treatment and support.</p> <p>Real control over the way money is spent on their behalf.</p> <p>Real power to hold local institutions to account for poor performance, hence driving up standard for everyone.</p> <p>Quite simply, we can’t succeed in this without the third sector.</p> <p>Without organisations like Turning Point, which is doing so much to enable people past users of health and social services to shape the way these services work in the future.</p> <p>Or the First Step Trust, which is doing excellent work with ex-offenders and people with severe mental health problems.</p> <p>People who might otherwise end up back in prison or a high secure facility.</p> <p>They’re instead working in MOT garages, regaining their confidence and self-esteem.</p> <p>Having, as the Chief Executive of First Steps puts it, ‘this reason not to slip back into old habits’ gives them the hope of a much brighter future.</p> <p>I pick these two out, but I know there are stories like these in every corner of the room today.</p> <p>That’s the power and the potential of the third sector.</p> <p>You operate at a completely different frequency to statutory services.</p> <p>Tuning in to people’s needs in ways they can’t.</p> <p>Reaching out to excluded groups in ways they can’t.</p> <p>And providing diversity, innovation and expertise that enriches the support we can offer people.</p> <p>That means you’re central to our plans</p> <p>Central to reducing inequality.</p> <p>To empowering patients, service users and citizens.</p> <p>And to achieving higher standards and better results in more efficient and cost-effective ways.</p> <p>So the challenge is this.</p> <p>To foster the conditions in which social entrepreneurs can blossom, the energy of enterprise is harness for social ends, and in which the third sector can thrive and be recognised for what you do best.</p> <p>We’ll back you because of the expertise you have, the connections you make, and the community-based support you provide.</p> <p>So Andrew Lansley and I both agree that the third sector should be operating on a level playing field with the NHS and social care.</p> <p>The Coalition Programme makes it clear we want to give patients the power to choose any provider that meets NHS standards, within NHS prices.</p> <p>What matters to us is results: improving standards, higher quality, better outcomes for patients. Nothing less, nothing more.</p> <p>But to achieve this, we need to end the perverse incentives resulting from the targets and tick box culture that’s taken root in the public sector.</p> <p>It’s frustrating to hear stories of how this has affected some organisations, making them move away from what they’re good at, in order to meet a very specific PSA.</p> <p>By ending this target culture and the siloed outlook it produced – and instead placing a much greater emphasis on overall quality through outcome measures – I hope we can free the third sector to do what you do best.</p> <p>Looking out for the people you support, not looking up to Whitehall targets.</p> <p>Commissioners have also been held-back by the same Whitehall-led, tickbox culture.</p> <p>Making decisions based on targets, rather than on what their communities really need.</p> <p>That has to stop too.</p> <p>I want to push decisions as close to the individual as possible.</p> <p>And one way forward is through direct payments and personal budgets. We’ve also committed to extending the use of these.</p> <p>This will open doors for third sector bodies, both in providing services directly, and also playing a vital role in advocacy and brokerage.</p> <p>But this is a two-way street. Just as public sector organisations are being challenged to raise standards and cut costs, so charities and voluntary organisations will need to adapt.</p> <p>You will need to show your mettle. Demonstrate real success in improving outcomes and changing lives. Be savvy about how the local GP consortia or council operates. Tenacious in knocking on doors, and finding ways to access funds.</p> <p>The bottom line is that this a time for big ideas, and new ways of thinking about problems.</p> <p>We will need and welcome your insight as we move towards the Spending Review, to consider how we achieve the necessary savings.</p> <p>I hope today is the start of a productive dialogue between the third sector and Government.</p> <p>Because, whilst it will be a tough time, I do believe the door is wide open for you.</p> <p>And together I think we can achieve an awful lot in the years ahead.</p> <p>Thank you.<br /></p> None Paul Burstow MP ACEVO Funding for the Third Sector conference Department of Health 2010-07-01 speech to ACEVO Funding for the Third Sector conference
<p><strong>Check against delivery</strong></p> <p>We’re at an interesting point for health policy – a genuine turning point.</p> <p>For the last decade, the story has been all about size and scale.</p> <p>Do more, build more, launch more – that was the motto.</p> <p>But frankly, thinking back, it always made me think of that fantastic episode of Yes Minister, where Hacker visits the hospital with no patients.</p> <p>A hospital proudly described as one of the best run institutions in the country!</p> <p>Of course, the satire bites because of the substantial truth behind it.</p> <p>The old politics of the NHS has meant the physical building of hospitals often became more important than the services actually provided.</p> <p>Now acute care will always have its place – clearly, it’s vital – but times change.</p> <p>As people live longer and as care costs rise, buildings and institutions matter less. Services and outcomes matter more.</p> <p>The goal today isn’t building more hospitals for people, it’s actually keeping more people out of hospital.</p> <p>So perhaps Yes Minister wasn’t ironic at all, an empty hospital is perhaps the goal after all!</p> <p>It does mean what goes on outside the NHS is now every bit as important as what goes on within it.</p> <p>That’s why the work you do is so important – we need to do all we can to prevent illness and reduce our reliance on the NHS.</p> <p>That, more than anything else, will help us sustain those core principles of public-funded, free at point of need, healthcare.</p> <p>So how do we do it?</p> <p>People realised early on that what surrounds us defines us.</p> <p>The Institute itself was created because of the links the early Victorians made between illness and environment.</p> <p>This was a connection picked up by the poor law commissioner Edwin Chadwick, whose campaign to improve sanitation helped to bring about the Public Health Act in 1848.</p> <p>And with this came the first so-called “Inspectors of Nuisances” the early incarnation of today’s environmental health officers.</p> <p>And the rest, as they say, is history.</p> <p>So it’s a long and distinguished past you draw upon.</p> <p>And today, more than 150 years on, physical environment is every bit as relevant to our health challenges.</p> <p>It goes to the heart of what Michael Marmot describes as the ‘causes of the causes’.</p> <p>We see the Marmot review as our compass and guide as far as the future goes.</p> <p>It’s quite clear on the problem.</p> <p>A marked social gradient in health.</p> <p>Entrenched, stubborn and layered inequalities.</p> <p>A miserable chain of factors linking where you’re born to how healthy you are.</p> <p>And the environment is a key link.</p> <p>Obstacles and barriers to health are all around us.</p> <p>Concrete jungles breeding mental health problems.</p> <p>Damp and draughty housing aggravating asthma, inflaming sickle cell and respiratory diseases.</p> <p>The accidents, at home and at work, disproportionately affecting those from blue collar backgrounds.</p> <p>And poor food hygiene causing unnecessary sickness and distress.</p> <p>It’s our job to tear down these barriers – sometimes literally – to reduce inequality and improve health.</p> <p>Your work often goes under the radar, but it makes such a big difference to people’s lives.</p> <p>Few in my constituency in Guildford will realise the reason they can enjoy an evening out in our beautiful town, and a nice meal with friends without suffering afterwards, is because of the vigilant eye of the local environmental health team.</p> <p>And even within professional circles, there’s not enough awareness of the difference you make – and your potential to do more.</p> <p>I want that to change.</p> <p>We need to position health at the centre of community planning and at the centre of public policy.</p> <p>We need to do all we can to protect and defend against emerging threats to health – whether that’s food security or climate change.</p> <p>And we need to ensure this wide-ranging professional field has a place at the top table of discussions locally and nationally.</p> <p>Let’s be honest, that isn’t always easy.</p> <p>Trade-offs and compromises happen, even when the sun is shining financially.</p> <p>But, at the moment, with the outlook more gloomy, I can understand you must feel the scales are particularly tilted against you.</p> <p>So can we genuinely make progress at a time when all eyes are on the money?</p> <p>Can we continue to move forward when money is tight, and the priority is on economic recovery?</p> <p>Well, I think we can and I think we should.</p> <p>“The gold that buys health is never ill spent”, said the playwright John Webster.</p> <p>Four hundred years on, it’s as true today as it’s ever been.</p> <p>Better homes could save the NHS up to £600 million a year in treating respiratory infection.</p> <p>Better cycling and pedestrian routes can help us reduce obesity and prevent costs of £50 billion a year by 2050.</p> <p>Better parks and open space could reduce the incredible £2 billion a week that mental illness is believed to cost our communities and our economy.</p> <p>Sometimes a small investment can make a big difference.</p> <p>One of my favourite stories is the brilliant solution one trading standards team came up with to support healthy eating.</p> <p>It was quite simple really – and fiendish too: they placed salt shakers with fewer holes in the top in local fish and chip shops.</p> <p>The result? People consumed 50 per cent less salt in these shops.</p> <p>I guess that those that didn’t reduce their intake at least got more exercise shaking the salt out!</p> <p>It’s a classic nudge, and just one example of how creative partnerships – with business, with voluntary groups, with other government bodies – can make a real difference.</p> <p>Another thing that caught my eye is the fantastic work licensing teams are doing with local venues to improve young people’s health.</p> <p>Pubs and clubs, where young people naturally hang out, are perfect places for reaching out to them. For giving them support on their terms and on their patch.</p> <p>Tackling binge drinking obviously – but also other problems like drugs and sexually transmitted infections.</p> <p>I’m struck by the success councils have had in handing out condoms or even doing STI tests there-and-then at big city venues.</p> <p>In many cases, diagnosing and treating people who wouldn’t otherwise have known they had an STI – and might be spending the rest of their evenings blissfully spreading their infection around town.</p> <p>So again - a small commitment makes a big difference.</p> <p>We need more.</p> <p>We need the leadership and the strong collective vision to get all agencies working together.</p> <p>We need coherent, long term plans for improving health.</p> <p>And that’s what our public health White Paper is all about.</p> <p>To give local government, local services and local people the confidence and power to work together towards long term gains.</p> <p>Firstly, we’re putting in place a new way of measuring success.</p> <p>Out go the top down targets.</p> <p>In comes a new Outcomes Framework for public health.</p> <p>We want to unite the system around broad outcomes, rather than divide it through narrow, process-led targets.</p> <p>Second, a new ring-fenced budget. Promising stability and confidence.</p> <p>Public health practitioners are always looking over their shoulder as far as budget cuts go.</p> <p>Ring-fencing the budget sends out a signal.<br />No more hand-to-mouth strategies. No more volatility. No more feast or famine.</p> <p>We want you to build a clear, long term strategy.</p> <p>Third: new structures to provide local leadership and unity.</p> <p>Bringing together the different players in public health can be frustrating.</p> <p>I’ve heard it described as being like herding cattle.</p> <p>Plenty of noise, but difficult to get moving.</p> <p>So we’re taking a logical step.</p> <p>We’re bringing in people with lassos.</p> <p>The people are Directors of Public Health, which will be a clear figure-head for local community health.</p> <p>The lasso is the new Health and Wellbeing Board, which will help them to rope in the action and investment necessary to meet local needs.</p> <p>Not all Directors of Public Health come across as wannabe Clint Eastwoods, I realise!</p> <p>But they will be genuine shepherds for the cause – there to safeguard and secure all interests – and like any good rancher, looking out for their entire flock.</p> <p>And let me be clear: that absolutely includes district and borough councils.</p> <p>It’s something I know the Institute is particularly worried about – this fear that lower tier authorities will be forgotten or ignored.</p> <p>To be fair, it has happened in the past. County councils zooming off in one direction. Second tier authorities going the other way.</p> <p>Those days are over. Our reforms simply won’t work unless lower tier authorities and their workforce are in the loop.</p> <p>I’m not going to prescribe local structures, processes and membership. That, quite rightly, is best decided locally.</p> <p>But the Health and Wellbeing Boards and the Joint Strategic Needs Assessment should give all parts of the system a chance to get involved.</p> <p>No voice, no opinion, no professional group should be excluded if those outcomes are to be met.</p> <p>More than just sharing ideas, we also want people sharing investment. Thinking big. Thinking collectively.</p> <p>So there will be the scope and, indeed, the incentive – for people to pool budgets and work toward larger projects.</p> <p>The Health Premium – with more money for councils that improve health outcomes and reduce inequalities – is about lighting that touch paper. Sparking action. Stimulating the big ambitions.</p> <p>It also corrects a past mistake. The previous funding model could sometimes reward a lack of effort. The sicker a community became, the more the council got.</p> <p>We want to turn that on its head. We’ll be rewarding success, not failure, inviting the bolder ideas we need.</p> <p>At a national level, Public Health England will be the new home for all of those central functions within the environmental health field.</p> <p>Despite the financial environment, we’re absolutely determined to retain a strong and effective health protection workforce.</p> <p>So Public Health England will draw on the existing strength of the Health Protection Agency and others to improve our resilience to health threats.</p> <p>Its other key role will be leadership. Keeping this high on the agenda across Government. Acting as a champion for health improvement nationally and locally.</p> <p>So yes, we need to build up the evidence – the objective proof of why investing in the environment matter, and what sort of measures work best.</p> <p>And yes, we need to make sure your voice is heard across Whitehall.</p> <p>That’s why we’ve got the Cabinet sub-committee on public health, a Ministerial group bringing together Government departments to hold together national action on health improvement.</p> <p>In addition, the new Chief Medical Officer will be setting up an advisory committee to guide and shape the work of Public Health England.</p> <p>Both will help the environmental health professional to grow in influence and impact.</p> <p><strong>Conclusion</strong></p> <p>I’m not going to gloss over the obvious.</p> <p>These are difficult times.</p> <p>Difficult for many of you personally, working under the shadow of job insecurity or reductions to your budgets.</p> <p>I’m sorry for that, and I’m extremely grateful for the professionalism you’re showing under this pressure.</p> <p>Change is unsettling.</p> <p>But change means we can do things better.</p> <p>And, as someone once said, “sacred cows make the best burgers.”</p> <p>So my message is still one of hope and optimism.</p> <p>I think the reforms will make a positive difference.</p> <p>They will open up possibilities and potential for environmental health practitioners.</p> <p>I hope they will us to secure the improvements we all want to see.</p> <p>Environmental health has a long and distinguished past.</p> <p>We want it to have a bright and assured future too.</p> <p>And with your help I’m sure it will.</p> None Anne Milton MP speech to the Chartered Institute of Environmental Health conference Department of Health 2011-03-30 speech to the Chartered Institute of Environmental Health conference
<p><strong>Check against delivery</strong></p> <p>It’s now three years since Health is Global was published, nine months since the new Government was elected.</p> <p>So where are we today?</p> <p>Well, I think we have taken some steps forward.</p> <p>A UK-led resolution on pneumonia … A global alcohol strategy … A new code of practice on recruiting health professionals … all of them were highlights from last year’s World Health Assembly.</p> <p>In September, we also signed a major agreement with the Chinese government on information exchange and co-operation covering health system reform, climate change and development.</p> <p>But progress hasn’t been as swift or decisive as any of us would have like.</p> <p>Today is about changing that.</p> <p>It’s about releasing the handbrake and making up some ground. To fulfil the promise set out in Health is Global.</p> <p>Now at this stage, my original notes talked about “confirming the Government’s commitment to global health”.</p> <p>But let me ask the question many of you might be thinking.</p> <p>How credible is that commitment? How credible can it be given everything else on the government’s agenda at the moment?</p> <p>Can we compete with the difficulties at home and abroad … a messy financial situation … a painful programme of deficit reduction, a domestic health and social care system facing its own stiff challenges.</p> <p>As a Government, are we really serious about this?</p> <p>Well, Stephen and I, our ministerial colleagues, and the whole cabinet, all believe the same thing.</p> <p>Better global health isn’t just a noble aspiration or an end in itself.</p> <p>It’s vital for pursuing our national interests.</p> <p>Idealism combines with pragmatism to push this high up the agenda.</p> <p>The swine flu pandemic, still fresh in the memory, shows we must always be looking at new ways to work across borders to guard against threats to public health.</p> <p>The looming deadline for the Millennium Development Goals is a clear duty to press on with reducing infant mortality and deaths from HIV, TB and malaria in the developing world.</p> <p>And the health challenges we face in our own country … an ageing population … rising health costs … a growing tide of lifestyle disease … these are shared international concerns.</p> <p>Other countries are in exactly the same boat. And the more we connect, the more we can learn from each other about how to deal with them.</p> <p>And let’s not forget the other reason.</p> <p>As a former US president once said, “it’s the economy, stupid.”</p> <p>Last week, the Chancellor made it clear that supporting the life sciences is a key to sustained domestic economic growth.</p> <p>With three trillion dollars invested in healthcare systems each year, it pays to be a major player on the global scene.</p> <p>We need to present the UK as a centre of excellence for healthcare and research – and that means looking outwards, not inwards.</p> <p>So yes, the commitment is there. It’s there one hundred per cent.</p> <p>But that’s not to say there aren’t challenges. We don’t have a limitless budget. We don’t have limitless resources to draw upon.</p> <p>So this isn’t going to be about spending more, but spending better. Working across Government. Seeing the connections. Working with our partners at home and abroad to make the progress we all want to see.</p> <p>It also means being extremely clear about what we are trying to achieve. Global health is a very broad church – a wide agenda. We need to set some tangible measures to direct our efforts and marshal our resources.</p> <p>That’s what the new Outcomes Framework we’re publishing today is all about.</p> <p>Now Kathryn [Tyson] will talk you through the finer detail a little later.</p> <p>But I just want to say this. The framework isn’t a departure or change of direction. It’s entirely consistent, entirely complementary to the vision in the original strategy. It’s about improving the focus without losing the ambition.</p> <p>So if you think of Health is Global as a latté, then the Outcomes Framework is really the espresso shot – and don’t we all need that at this time of the day!</p> <p>By distilling the strategy, by concentrating people’s minds on what matters, we can make the resources we have count for more.</p> <p>I believe this can be the catalyst for some very important developments over the next six to twelve months.</p> <p>So what’s my personal focus? What am I going to do?</p> <p>Well, I’ll be looking carefully at what we can do to tackle non-communicable diseases in the run up to the UN high level meeting in September.</p> <p>I’m particularly interested in what comes out of the panel discussion on this later today.</p> <p>And, of course, the World Health Assembly in May is clearly another key moment for global health – and I’m keen to draw in your thoughts and ideas for that in the weeks ahead.</p> <p>Before I hand over to Stephen [O’Brien] to give the DfID perspective, let me make an obvious point.</p> <p>We can put what we like in documents and statements.</p> <p>I can stand here and say what I like.</p> <p>What matters ultimately is what we do, together, to change things.</p> <p>Your role – as our conscience; as the champions and cheerleaders for progress – is vital.</p> <p>Keep us on our toes. Engage constructively. Help us win the public argument. Keep giving us the ideas and insights to feed into international discussions.</p> <p>Because there are some big opportunities ahead of us.</p> <p>And if we can build those strong relationships and secure that flow of ideas, then I’m certain we can achieve great things in the years ahead.</p> <p>So thank you all for being here, thank you for everything you do – and let me now hand over to Stephen.</p> None Anne Milton MP speech to the Health is Global Forum Department of Health 2011-03-30 speech to the Health is Global forum
<p>(As delivered.)</p> <p>Thank you very much, Caroline [Flint].</p> <p>It’s my absolute pleasure to be here. I’d like to thank the Westminster Health Forum for the invitation, especially given the beautiful surroundings.</p> <p>I’m minded to accept more invitations to speak here – as many of you will know, the Coalition government has been quite clear about Ministerial travel costs. So any event within walking distance will rise to the top of the pile!</p> <p>But it’s also my pleasure to meet with people from such a diverse range of organisations; from industry, from health, from policing and from the third sector. It is vital that we continue to work together; across the boundaries between public and private, between government and not-for-profit.<br />Alcohol affects us all – it affects us as parents, as individuals, it affects families, neighbours and friends. Abused, alcohol reaches into every aspect of family and community life.</p> <p>And in alcohol policy, as in public health more generally, we need a whole life approach.</p> <p>We need to better understand what makes people drink too much. We need to better measure success in helping them drink less. And we need to better commission services to help people when drink becomes a problem.</p> <p>As public spending is subject to ever-greater scrutiny, and money gets ever tighter, we need to re-focus our resources on what works. And it is our belief that you cannot hope to meaningfully reduce alcohol harms by confronting supply alone. You must do something about demand.</p> <p>That means focusing on the evidence for behaviour change. It means going beyond passively providing information, and looking actively at the question of motivation.</p> <p>It is a path that is fraught with difficulties, the greatest of which is the tension between individual liberty and personal responsibility.</p> <p>Because much to the disappointment of some public health professionals, choice remains an individual pursuit.</p> <p>People are free to drink, and government has learnt to their cost what happens when it insists otherwise.</p> <p>We cannot frog-march people out of the off-license. We cannot compel them to stop smoking, or force them to practice safe sex.</p> <p>Our challenge is to make the case that freedom without responsibility is not sustainable.</p> <p>I have been clear – and the Secretary of State was clear yesterday – that lecturing people on behaviour change does not work.</p> <p>Legislation has its place and has a role to play in some instances, but we must focus on giving people the means to make the right decisions about their health. On tapping into the power of the group to influence the individual.</p> <p>We need to create a large space for health information to help people make good choices.</p> <p>Decisions about alcohol consumption must be informed in order to be meaningful. We want to improve alcohol labelling so that people can make decisions about alcohol armed with all the facts, and we are looking closely at the responses to the recent consultation.</p> <p>And it’s not to say that we don’t need regulation to ensure that alcohol is traded responsibly.</p> <p>The environment in which alcohol is sold and consumed must encourage better decision making, not risk taking.<br />Reviews on alcohol taxation and pricing will report in the autumn - and I know many of you from industry will be working with us on a Responsibility Deal.</p> <p>But it does mean we need to look again at how we can equip people with the right skills to make the right decisions at the right time. So that we can reduce the human cost of alcohol abuse, and the cost to the NHS, too.</p> <p>If we take young people at school, how we give them the skills to make decisions about the huge range of difficult choices they come up against.</p> <p>How when they are revelling in their immortality between the age of 14-24 we get them to behave responsibly.</p> <p>To do so means fundamentally changing our relationship with alcohol. It’s a relationship which reflects wider social problems – problems that cannot be solved from one Whitehall address alone.</p> <p>The change has to come from all sides. Retailers, advertisers, health professionals, government – everyone has a part to play. Every government department has a part to play.</p> <p>That’s where a movement like Change4Life comes into its own: by bringing together people from across sectors.</p> <p>We believe the next step is for Change4Life to become a genuine social movement, one backed by business. And we’re looking into extending that partnership to include the alcohol industry.</p> <p>The idea of partnership also informs our vision for alcohol policy across government.</p> <p>It’s a Department of Health issue, a Home Office issue, a Treasury issue, a work - or workless – issue, it’s an issue for local government, it’s a social justice issue.</p> <p>The Coalition’s Programme showed a clear commitment to tackling the problems caused by binge-drinking and under-age drinking.</p> <p>The Home Office and the Treasury will work together to restore the balance between responsible pricing and the interest of the community.</p> <p>And from a health perspective, we’ve made clear about our desire to empower local communities to be more involved in public health.</p> <p>It is a desire that will be realised in the creation of the Public Health Service.</p> <p>I believe that we can bring our national vision for public health together with new local infrastructures to deliver the health outcomes we need.</p> <p>By strengthening accountability and encouraging local ownership of public health strategies, we can allow a culture of leadership to blossom.</p> <p>By building evidence and evaluation into the system, we can focus our resources in the right areas.</p> <p>And by striking the right balance between incentives and environment, we can harness the power of social norms to change behaviour. To change our relationship with alcohol.</p> <p>In a few months, the Royal Society will celebrate its 350th anniversary.</p> <p>Much has changed since the Society was founded.<br />Yet our connection with the past is stronger, our attitudes more similar, than they might first appear.</p> <p>Early modern society recognised that alcohol was part and parcel of British life. Low-alcohol beers sat alongside strong imported wines. Drinking in moderation was considered healthy; drunkenness was seen as a sin.</p> <p>One of the Royal Society’s first Presidents, Samuel Pepys, makes plain the distinction.</p> <p>On one occasion he recalls drinking half a pint of wine mixed with beer ‘for health’s sake’; a tradition which thankfully has not survived.</p> <p>Yet by the end of the year he had taken a solemn oath to abstain altogether from wine, an oath which – like most New Year’s resolutions – lasted all of six weeks.</p> <p>His struggles with alcohol reflect the changes in society that were happening around him. As Britons grew wealthier and more worldly, so our access to alcohol grew. It would take a century of progressive deterioration before attitudes toward alcohol changed again.</p> <p>The problem now is all the more pernicious for its subtlety and its spread; nearly 10 million of us drink too much.</p> <p>Of all the numbers around alcohol, perhaps this is the most shocking: because people always underestimate their own consumption. And for too many of us, that underestimation is proving lethal.</p> <p>We are determined to tackle the harm alcohol causes – to our people, our society, and our economy – without affecting those who drink responsibly.</p> <p>We are determined to change our relationship with alcohol, to employ the power of the group to influence individual decisions.</p> <p>And we are determined to do so with the help of our partners - in industry, in government, and in the third sector. And with all of you.</p> <p>Thank you very much.<br /></p> None Anne Milton MP speech to the Westminster Health Forum on Alcohol Department of Health 2010-07-08 speech to the Westminster Health Forum on Alcohol
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117296.jpg" alt="Anne Milton MP, Parliamentary Under Secretary of State for Public Health" /> </div> <p class="introText">Anne Milton MP, Parliamentary Under Secretary of State for Public Health, speaks to the World Health Organisation Forum on Salt, June 30 2010</p> <p>(As delivered.)</p> <p>Thank you very much, Steve [Wearne, FSA].</p> <p>It’s my pleasure to be here today, surrounded by such a wealth of expertise and experience. And it is my privilege to address an audience who have contributed so much to improving health around the world.</p> <p>It seems appropriate to me that we meet under the auspices of the World Health Organisation; that we represent all corners of the globe. </p> <p>Because across continents, throughout civilisation, the history of salt has also been our history. </p> <p>Empires have been founded and kingdoms have fallen on this precious substance. It freed us from the seasons and gifted us travel. It gave life to early explorers and wealth to medieval miners. Whether extracted from the earth or harvested from the sea, salt has been the engine of wars, the builder of roads, and the creator of cities.<br />At the tables of the nobility, your position relative to the salt cellar either conferred status  or confirmed inferiority.</p> <p>Our relationship with salt has always been both blessing and curse. And today, we are paying a price for that relationship. As our understanding of the human body has grown, so has the realisation that overuse can pose a real threat to our health. </p> <p>Cardiovascular disease is one of the biggest challenges we face in health policy. Hypertension is one of the main causes of stroke and coronary heart disease. Around half of all stroke and heart disease deaths are attributed to high blood pressure. And there is strong evidence linking salt intake to increased risk of high blood pressure.</p> <p>The human impact is clear: millions of lives are affected in our country alone.</p> <p>But there’s a financial cost to be paid, too. We currently spend about £7.4 billion treating circulatory disease.</p> <p>I’m pleased that a number of the sessions over the next two days will look closely at how we measure the evidence for – and effectiveness of – salt reduction strategies.</p> <p>Because when it comes to health interventions, spending must be matched to evidence. It’s about what works.</p> <p>Advances in science offer us tempting glimpses of a future free from inherited disease. But getting to grips with salt reduction is one of the biggest, most basic improvements we can make to global health now.</p> <p>The World Health Organisation recognises the importance of this goal – and also recognises just how achievable it is.</p> <p>Their commitment to salt reduction reflects an understanding of the wide-ranging health impact of over consumption. Salt features in global strategies on both disease and diet.</p> <p>The WHO’s commitment is matched by our action to reduce salt consumption here in the UK.</p> <p>Manufacturers, retailers, and suppliers have joined with trade associations to bring about genuine change, cutting salt levels in some foods by half – and others by a quarter.</p> <p>And actually, there hasn’t been consumer outcry. There haven’t been protests in the street or a significant sales impact. Because much of the salt that we were consuming was hiding in plain sight.</p> <p>For most people, salt is something that’s found in savoury snacks. They think it’s only the pretzels and the pizzas that are responsible. Yet the food industry cut salt levels in breads, in cakes, in biscuits and breakfast cereals.</p> <p>The result? Average salt consumption in the UK has fallen by just under a gram a year, avoiding 6,000 premature deaths and saving £1.5 billion.</p> <p>Of course there’s a long way still to go. But the lesson of this successful start is the value of partnership.</p> <p>By working together with industry, together with the third sector and together with our citizens we can keep up the momentum. </p> <p>And actually, citizens are a vital part of that chain.</p> <p>Too often in public health policy, we focus exclusively on the health part, and forget about the public.</p> <p>The WHO, and governments around the world, have been right to work closely with industry on reformulation.</p> <p>The international nature of food production demands action across borders.</p> <p>And I’m proud that the UK leads a network of European countries running salt reduction programmes.</p> <p>But salt consumption also happens in the home – and some studies suggest that the culture of ‘celebrity chefs’ has contributed to soaring salt content in recipes, too.</p> <p>Government has a clear role to play in managing the nation’s intake.</p> <p>We can work hard from the centre, bringing everyone together to work towards a common aim.</p> <p>But government can only reach so far. We can’t step into peoples homes and stop them reaching for the cruet. </p> <p>There is an element of personal responsibility which cannot be ignored. For many people, decisions about food are no place for government. </p> <p>But if we can work together to increase public awareness, if we can give people the right information, if we can encourage them to think about the decisions they make at home and in the supermarket, we can keep up the momentum when it comes to reduction.</p> <p>Salt started out as a preservative, something that allowed us carry food with us and stray beyond the reaches of the autumn harvest.</p> <p>But as global trade increased and our world community came closer together, salt became less about food security and more about flavour.</p> <p>Many cuisines and many palates around the world are now dependent on it. Or rather, they think they depend on it.</p> <p>Information and co-ordination are the keys to breaking that dependence.</p> <p>By giving people the right information about salt content, we allow them to make a truly informed choice.</p> <p>And by co-ordinating our efforts on production and salt reduction strategies we can make the market fairer and healthier for all of our citizens.</p> <p>I’m looking forward to hearing about the results of your sessions on creating an enabling environment.</p> <p>Because although we’ve already secured a consensus on the need to reduce salt consumption, our next challenge is to make good on our rhetoric and start to change consumer expectations.</p> <p>So as I open the Forum, I want to thank you all for coming – and for signalling your desire to take salt reduction further.</p> <p>I know you have a busy few days ahead.</p> <p>But I’m sure that the expertise I mentioned earlier will be matched with energy and enthusiasm.</p> <p>And I know the work done at this meeting will help inform policy, here in the UK and beyond.</p> <p>Thank you very much.<br /></p> None Anne Milton MP speech to the World Health Organisation Forum on Salt Department of Health 2010-06-30 speech to the World Health Organisation Forum on Salt
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117296.jpg" alt="Anne Milton MP, Parliamentary Under Secretary of State for Public Health" /> </div> <p class="introText">Anne Milton, Parliamentary Under Secretary of State for Public Health, speaks at the launch of Men's Health Week, 14th June 2010</p> <p>(Not checked against delivery)</p> <p>Thanks very much. It's wonderful to be here in this historic stadium.</p> <p>Tonight, it is my absolute pleasure to be in the company of world-class professionals; not just from sporting disciplines, but from my own discipline – health.</p> <p>The Men's Health Forum have done so much on behalf of men's health; campaigning, researching, and speaking up for men across the country.</p> <p>I want to thank everyone at the Forum – and all those who have lent their support tonight – for their hard work in support of what is a worthy aim: to improve the profile of men's health.</p> <p>As I glance around this gathering of the great and good in male sport &amp;amp; male health, I cannot help but feel slightly out of place. I am the only female Minister in my Department; yet I am tasked with taking your agenda forward.</p> <p>But surely the lesson of the Forum's work is that advocacy cuts across barriers; that gender should be no obstacle to success.</p> <p>Sometimes the strongest voices come from outside the choir. And I want to reassure you that I share in your belief in a future where all men can achieve health and well-being outcomes that are second to none.</p> <p>The focus of Men's Health Week 2010 is a welcome one. To get a million more men physically active by the next Olympic year is an ambitious, but worthy goal. Because in preventing illness, in curbing the cost to the NHS, this is perhaps the single best health legacy we could aim for.</p> <p>We agree on the symptoms: that too many men are at risk of health problems which could be avoided by exercising. We agree on the diagnosis: that attitudes and lifestyles conspire to stop men remaining active.  And we agree on the outcome: promoting better health and improving treatment for men and boys.</p> <p>So the question now is what course of treatment will bring success.</p> <p>The Men's Health Forum have made some recommendations about how we might get men moving. I want to thank everyone who worked on these policy positions, and I want to let you know that we will be taking a closer look at them. We are open to new ideas; and we want to work with you towards our shared aims. </p> <p>It seems to me that the recommendations can be boiled down to two key steps: thinking more about the needs of men – about their attitudes, their behaviours, their motivations – and then taking those thoughts and building them in to the way healthcare is communicated and delivered in your area. And actually, that mirrors our approach to healthcare as a whole.</p> <p>We have always said that the best people to make decisions about local health needs are local health professionals.<br />We've taken the old top-heavy formation – where health policy is dictated from Whitehall and local clinical staff are left powerless – and turned it on its head.</p> <p>We want to empower health professionals in your area to decide on how best to address your health needs.  By shifting power away from central and regional bodies, we're freeing local staff – and local people – to choose what works for them.</p> <p>It's a simple idea, but it can radically change the healthcare is designed and delivered locally. </p> <p>A younger neighbourhood, with more kids and young families, will have different health needs to a suburb with more retirees. By giving local health professionals more control over their training and education budgets, we can free them to invest in the kind of training that will ensure the best health outcomes for their area.</p> <p>By appointing local directors of public health, who will make sure that councils and the NHS work together more closely, we can help bridge the gap between sports, physical activity and health programs happening in your area.</p> <p>Increasing local control also allows us to improve the way we communicate about health. For too long, Government's answer to health challenges has been to launch a big national awareness campaign. Sometimes, this has worked really well. When campaigns are carefully designed and cleverly crafted they can reach people across society.</p> <p>But as the Forum's own research makes clear, those messages aren't reaching everyone. Like the 45 year old with the dodgy knee who thinks because he can't play five-a-side he can't do any exercise. The stressed-out office worker who thinks he can't make time to keep fit. The retiree who's never exercised but still feels invincible.</p> <p>These are the men who are missing out on the message. These are the million men we want to get active. So how can we reach them?</p> <p>I believe we need a new way of encouraging public health. In the past, that might have meant paying a fortune for a glossy advertising campaign off the back of the World Cup. But the days of endless budgets for marketing are over. And actually, health happens much closer to home.</p> <p>A father and son might come here to Upton Park a couple of times a year, but they're at their local park every weekend.</p> <p>Different people will want to be active in different ways – whilst some men are avid sports fans, for others cycling to work might be the route to fitness.</p> <p>Rather than throwing money at the problem from the centre, I believe we can give local communities the power to decide what works for them.</p> <p>Rather than relying on an exclusive Premiership club buy-in, we want to see your local FC arranging events in your local area to get more men moving. Whether it's a masters league, an open training session, or a monthly fun run, the opportunities are endless – and more importantly, they reach men where it matters.</p> <p>Forty-four years ago, this club sent three men to represent the nation in the greatest competition of all. As we gather tonight in another World Cup year, it's our job to bring to use our creativity and energy to secure a similar legacy for men's health.</p> <p>I look forward to working with you to make that happen.</p> <p>Thank you very much.<br /></p> None Anne Milton MP speech at the launch of Men's Health Week Department of Health 2010-06-14 speech at the launch of Men&#39;s Health Week
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_118237.jpg" alt="Lord Howe" /> </div> <p class="introText">Lord Howe, Parliamentary Under Secretary of State for Quality, spoke at the King’s Fund, 7 September 2010<br /><br />(Checked against delivery)<br /><br />Last month my thoughts turned to one of the great moments in our country’s history.  The Battle of Britain was critical in altering events of the war and saving the lives and liberty of millions.</p> <p>In that same decade came an equally similar, if less immediately dramatic event. </p> <p>The coalition government of the time - it is surprising, isn’t it, just how radical coalitions can be - produced the Beveridge Report, which undertook to fight against the Five Giants of Want, Disease, Ignorance, Squalor and Idleness.  And on 5 July 1948, the National Health Service, the embodiment of that fight, burst upon the national landscape and quickly become our nation’s most treasured institution.  The doctors and nurses of the NHS may significantly outnumber ‘The Few’ who fought in the Battle of Britain, but their work has easily saved as many lives and has transformed those of countless others. </p> <p>I am deeply proud of our National Health Service.  I am proud of its values - of healthcare based upon the need of the patient rather than their ability to pay.  And I am deeply proud of the people who make it work, day and night, week in and week out.  Not only the doctors and nurses who for obvious reasons tend to get the credit.  But also the cleaners, the healthcare assistants, the porters, the physios, the occupational therapists.  And let us not forget the managers, who tend to get a rather unkind press at times, but not from my direction.  All are dedicated to improving the health of our nation and all will be vital as we improve the NHS in the years to come.</p> <p>And improve it must.  For although it has transformed life in Britain, although it saves lives on a daily basis and although we gladly look to it for guidance on how to live a healthy life, we all know all of us can do so much better. </p> <p>The last decade saw massive investment in the NHS.  Funding has now risen to more-or-less the European average.  Yet, while this has brought much needed new hospitals and equipment and many new doctors and nurses, it has not significantly improved what is most important of all, health outcomes. </p> <p>Despite everything that the previous government did, and it did a great deal, survival rates for cervical, colo-rectal and breast cancer are among the worst in the OECD.  We are on the wrong side of the average for premature mortality from lung cancer, and heart and respiratory disease.  And you’re more than twice as likely to die from a heart attack here in the UK than you are in France. </p> <p>Patients deserve better.  The NHS can be better.  And with the reforms we have set out in the White Paper, it will be better. </p> <p>There are many aspects of the White Paper that we could discuss today:  how we will give more power to patients to shape their own care; how we will inject local democratic accountability into the system; our clear focus on improving health outcomes rather than a maddening emphasis on process targets; or our plans to check the demand for healthcare through much better public health.</p> <p>But today is about commissioning and how we make it work better for patients.  So I think we should first pause to define exactly what we mean by that. </p> <p>Traditionally, governments of all colours have made the mistake of thinking that the best way to deliver healthcare was through some degree of central diktat.  That Ministers in Westminster and officials in Whitehall, by definition, knew best.  Speaking from personal experience, I know that this is not so.</p> <p>GP commissioning is a new approach to the design and delivery of healthcare.  It’s about understanding the needs of a local population, of groups and of individual patients.  It’s about working with patients and the full range of health professionals to agree and design the services that best meet those needs.  It’s about creating a clinical blueprint that forms the basis for contracts with providers.  And it’s about holding a range of contracts to offer choice for patients wherever possible and monitoring those contracts to make sure that services are delivered to the right standards of quality. </p> <p>Our proposals for GP commissioning will push decision making much closer to patients and local communities and ensure that commissioners are accountable to them.  It is the GPs on the ground who are best placed to lead.  For it is GPs who see patients with every conceivable ailment on a daily basis.  It is GPs who navigate the system every day on behalf of their patients.  And so it is GPs who we will empower to lead and transform the system in conjunction with their professional colleagues across primary, secondary and community care.  They will work closely with other professionals to design joined up services that make sense to patients and the public.</p> <p>This government believes that power is something to be given away, not hoarded.  Local services should be accountable to local people.  Working in partnership with local authorities, with the local HealthWatch, with the whole gambit of professions across the local health economy, GPs will be able to design better, more responsive and more accountable services.</p> <p>At the moment it is the job of the Primary Care Trust to commission services for their community, and some PCTs carry out this function with great skill and efficiency – I visited one last week.  But, to be frank, overall the quality of commissioning has been poor and inconsistent.</p> <p>By 2013, the power to commission most NHS services will shift from PCTs to consortia of GP practices, supported by the NHS Commissioning Board.  Of course, the real challenge will be moving from one system to the other.</p> <p>During this time, PCTs will have a crucial role to play in supporting GPs.  Sharing best practice and helping them understand some of the challenges that commissioning services will bring.</p> <p>But supporting GPs is not the same as leading them by the nose.  It is for GP practices to come together and form consortia.  And it is for consortia to decide how they will organise themselves.  PCTs will be invaluable to this process, but I think it is essential that the process is lead by general practice, not by Primary Care Trusts.</p> <p>At the same time, this is not about practices being on their own.  Effective GP commissioning will only come about when there is the full range of professional input.  Now GPs clearly have clinical expertise, they also have the power of referral, and they are very trusted individuals.  But I hope that all GPs would agree that to design and deliver complex services that meet the needs of local people requires an effective partnership with other health care professionals, including nurses, allied health professionals and hospital doctors.  They all have a role to play.</p> <p>Now, we’re not going to tell consortia how to organise themselves.  Some may take commissioning decisions collectively.  For instance, adopting a lead commissioner role could be a good route for contracting with a very large hospital trust and urgent care provider.  But other consortia may decide to do things differently. </p> <p>Consortia will decide what commissioning activities they undertake themselves and which they choose to buy in from outside.  Local authorities, private or voluntary sector bodies are all in a position to help them commission effectively.  We do not favour one sector over another, that decision is one for consortia.  Rather we favour a truly level playing field where the only determinant of who provides a service is the quality of that service.  We will do all we can to ensure that conflicts of interest never interfere with the delivery of high quality healthcare.</p> <p>There is no set model.  Consortia are going to evolve and grow organically in the interests of their patients.</p> <p>So when we get down into the minutiae of organisational structures, oversight mechanisms and financial management, let us always keep in mind the reason we are reforming health in this way.  It boils down to trust – this government trusts the men and women of the Health Service.  And we believe that by trusting them, by trusting you to organise healthcare, we will see markedly better outcomes for patients.</p> <p>I hope that this is the moment when GPs, and their colleagues throughout the Health Service, have all been waiting for.  What our proposals amount to is the bringing together of clinical decision making with the power to decide how money is spent.  I think that putting those two things together provides an extremely exciting prospect for Health Service.</p> <p>Many doctors I’ve spoken to have, in one way or another, described their frustration at how the system sometimes gets in their way.  They want to act in the best interests of their patients but for whatever reason they can’t.  I hope that the new system of GP commissioning will change this.  I hope that the end result is not only more cost effective care, but also better care.  That’s what all this is about - raising our game as a health service.</p> <p>For over 60 years, the Health Service has been valiantly taking on Beveridge’s giant of disease.  It has overcome considerable odds to improve our nation’s health beyond recognition and will continue to do so in the decades to come.  Yet from now on, it will not be Ministers like me in charge.  It will be patients and it will be you, the professionals, who are calling the shots.</p> <ul class="linksCollection"> <li><a href="" class="externalLink" target="_blank">Watch excerpts from Lord Howe&#39;s GP Commissioning speech on the King&#39;s Fund website <span class="tool-tip" title="Opens new window"><span class="accessibility"> (opens new window)</span></span></a></li> </ul> None Lord Howe GP Commissioning: Making It Happen Department of Health 2010-09-07 speech at the King’s Fund
<p>Hello Sarah [Montague], and hello everybody.  It’s great to be with you again and I am delighted I can just about see you with these lights, but, it is a great pleasure to be with you. </p> <p>Thank you once again for the opportunity to be here with the NHS Confederation.  I know it has been a busy year.  A lot has been done.  A lot has been achieved over the last year.</p> <p>Let us just remind ourselves of some of them.  Over the past 12 months:<br />• We have seen breast and bowel cancer screening increasing faster than scheduled. <br />• We have seen MRSA blood stream infections down by 17 percent.<br />• C.diff down by 15 percent. <br />• 19 out of every 20 women now seen by a midwife in their first trimester during pregnancy.  That is up by 8 percent. <br />• Almost three quarters of a million more people accessing NHS dentistry.<br />• Waiting times in the NHS, referral to treatment average waiting times, lower than it was at the time of the General Election. <br />• The numbers of people being put in to mixed sex accommodation when they should not, down by 83 percent. </p> <p>Now, all of this in a year which also saw the severe winter; the impact of flu again; significant increases in demand; over half-a-million more people treated in hospital; over 100 thousand more diagnostic tests. </p> <p>And all of that achieved with spending in the year just finished, 2010-11, 2.2 percent higher than in the previous year.  And delivered with a strong financial performance – a surplus from Strategic Health Authorities and Primary Care Trusts in total of over £1.3 billion. </p> <p>So, it is a time of change, I know that.  A time of great challenges, not least in continuously improving the service that we provide to patients. </p> <p>But the people of the NHS have yet again proved how, through commitment, dedication and skill, they can continuously improve that care for patients. </p> <p>So I just want to say firstly, for all that has been achieved over this year, thank you. </p> <p>Last year has been busy for other reasons too. </p> <p>• A time of change in terms of how the vision and purpose of the National Health Service is to be established. <br />• A White Paper last July. <br />• A statutory consultation through to the autumn. <br />• A response at the end of the year.<br />• and the Bill published in the New Year. </p> <p>But of course while we were pressing ahead there grew an increasing perception amongst some people, perhaps too many people, that the Bill could pave the way for things that they did not want. </p> <p>At the same time, I think we all know that a big gap opened up between what was actually happening on the ground and what was perceived to be happening in the Health Service by the commentariat at Westminster. </p> <p>So, we needed a way to re-connect.  To re-assure those with genuine concerns, to learn from those already implementing the changes locally about how to make the Bill... the policies... the implementation of modernisation – meet their needs in the future. </p> <p>So, in April we did take an unusual step of pausing the progress of the Bill. </p> <p>The NHS Future Forum under Steve Field's leadership enabled us to look again at how the Bill was constructed and indeed how it was to be implemented and some of the issues related to it. </p> <p>Issues not only that were already in the Bill, but some like education and training, which people felt rightly needed to be considered right alongside it.  It gave us an opportunity to address head on concerns people had. </p> <p>Some people were genuinely concerned about the impact of competition on the NHS that it would be promoted as an end in itself and not in the interests of patients.  We will not do that.</p> <p>Competition will only ever be used as a means of improving care for patients.  What matters is that we create a level playing field that allows the best health care providers to flourish. </p> <p>Some groups of clinicians, like the Royal College of Nursing, were concerned that the make up of local commissioning was too narrow. </p> <p>The pause allowed us to ensure, rightly, that commissioning is about clinical leadership.  And that is across and beyond the general practice, it is even actually beyond health care.  It is health and social care.  Bringing people together to design better services. </p> <p>And we knew from the many letters we received from members of the public that people feared, perhaps were told they should fear, that the Bill would undermine the values of the NHS. </p> <p>I would never let that happen.  But we have now, I hope, re-assured people of our commitment to the fundamental values of the NHS. </p> <p>Something here with the NHS Confederation conference I have done year after year after year, and indeed, some of you will remember we have done that here with David Cameron with the NHS Confederation in years past. </p> <p>A commitment to an NHS available to all, based on need, free at the point of delivery.  And strengthening the NHS Constitution as the basis for what we do. </p> <p>The pause gave us the opportunity to build then a greater sense of ownership.  Essential for proper implementation.  And it enables me to assure you that the Coalition Government is fully committed both to the NHS and to its modernisation. </p> <p>Now, the Future Forum did a great job and I would like to thank all of them, and include all of the managers who worked so hard to develop its recommendations. </p> <p>They recommended that the pause should end.  It has.  But that does not mean that we have stopped listening. </p> <p>On Monday, I will discuss directly with members of the Future Forum what implementation challenges they might help us with next.  That process of listening, engagement, and co-production of implementation of modernisation will be a continuing feature of how we do our business. </p> <p>While there have been substantial changes, the guiding principals remain.</p> <p>I said to you last year that patients must be at the heart of everything that we do, not just as beneficiaries of care, but as participants in its design.  Making the principal of no decision about me without me one that is imbued in the practice of the National Health Service. </p> <p>That still stands.</p> <p>Last year, I said we need a rigorous focus on outcomes with the ambition of securing results on health care services in this country that are amongst the best in the world. </p> <p>That is still true. </p> <p>Last year I said we must set professionals free to use their clinical judgment to do their jobs to the best of their ability, and on the basis of the evidence. </p> <p>That vision also remains.  And, our determination to put clinical leadership and decision making close to patients in order to deliver the best service for patients. </p> <p>And last year I underlined the central importance of emphasising a Public Health Service that worked on a both more integrated basis, and impacted on the wider determinants of health. </p> <p>That we are pursuing. </p> <p>And I said we were committed to the modernisation of social care and to its reform.</p> <p>And that, too, we are pursuing. </p> <p>But my main message to you today is that after the pause it is now time to move forwards and to get on with improving services for patients. </p> <p>Listening to General Practitioners at Pathfinder events or at the National Association for Primary Care, I know that while our plans were in flux some became less keen to commit to long-term changes.  Some of them, some of you, I am sure, will have felt unsure about how to proceed. </p> <p>Well it is now time to re-gain the momentum, to get back on the front-foot, to focus again on the challenges that we all face. </p> <p>And to underline that return of momentum, I am glad to announce today the fifth wave of Pathfinders for Clinical Commissioning Groups.  35 new pathfinder groups, bringing the total to 257, covering almost 50 million people, 97 percent of the population in England. </p> <p>Some Primary Care Trusts have already delegated budgets and commissioning responsibilities to Pathfinders, and I hope to see the great majority do so by next April. </p> <p>If 2012-13 is generally to be a year of preparation, it needs to include a substantial delegation of responsibility in the course of the coming year. </p> <p>By October next year, the NHS Commissioning Board will begin the process of authorisation of Clinical Commissioning Groups, delegating budgets to them directly, and by April 2013, Commissioning Groups will start to take statutory responsibility in their own right. </p> <p>You will hear more about this tomorrow from David Nicholson, but it will be the mission of the NHS Commissioning Board to support local clinical commissioning groups to get up and running as quickly as is practical to do so. </p> <p>Only when commissioning is both clinically led and locally led can it bring about the transformation so critical to meeting the challenges of the years ahead. </p> <p>Now, those challenges are great.  As I see it there are four major challenges facing the NHS and facing you as managers in the service. </p> <p>• To increase productivity. <br />• To improve patient care. <br />• To re-shape how that care is delivered. <br />• And to integrate care around the needs of patients. </p> <p>First then, dramatically increasing productivity year-on-year.  By treating more people closer to home; by focusing on prevention as much as on cure; by eliminating errors and avoidable harm; and by integrating care around the needs of patients. </p> <p>Making big savings and increasing productivity must be about delivering more productive care, more integrated care, more preventative care, more accessible care.  It can not be about crude cuts to services.  Not when it can be about making them better.</p> <p>Second challenge I will suggest: To improve the quality of patient care. </p> <p>I know that people are satisfied, many very satisfied with the National Health Service.  But, we cannot turn that level of satisfaction on the part of the public in to an excuse for complacency on our part about the service that we can deliver in the future. </p> <p>We know, not least because for example of what we have seen in the atlas of variation published in December, we know that there is still too great a variation in the quality of care in different places across the service. </p> <p>Look just last week, for example, at the report produced by Tom Hughes-Hallett and the variations he was able to demonstrate in access to palliative care and the quality of end of life care. </p> <p>We must make excellence standard.  The NHS can do better.  We all know that, it is not to criticise what has been achieved in the past because so much has been achieved, but we all know that there is variation and unacceptably poor standards in some places just as there is excellence in others.  We must make excellence the norm. </p> <p>We need to measure more. <br />We need to publish more. <br />We need to incentivise more. </p> <p>And in coming years we will give England the most transparent health care system in the world.  The Prime Minister said this morning that transparency is a central tenet of this Government's approach to improving all public services.</p> <p>Up to now, this approach has been demonstrated in relation to aspects of access to care in the NHS like waiting times. </p> <p>But in the coming years, we must also publish far more data on clinical outcomes for the public and for professionals to see.  Data like hospital mortality rates for bowel cancer, published for the first time in April this year, which showed mortality rates that varied from 1.7 percent to 15.6 percent. </p> <p>Every doctor and every nurse and every manager and every health care provider wants to be as good as they possibly can be.  And in a more transparent National Health Service everyone will see just how good they are. </p> <p>And then professional pride, patient choice, and indeed, proper incentives, will drive outcomes up.</p> <p>The third challenge is to re-shape NHS care. </p> <p>More community based care.  Like I saw for myself in Whitstable where no longer do people have to go to hospital for endoscopy; they can have one at their local GP surgery. </p> <p>Equally more specialist care taking place in centres of excellence.  Like the new centre that I was able to join in launching at the Queen Elizabeth hospital in Birmingham.  The Centre for Surgery Re-Construction and Microbiology.  Bringing together trauma surgeons and research scientists from the military and as well as the NHS; pushing the boundaries of what we can achieve in major trauma care. </p> <p>Now, every provider, especially hospitals, needs to take a deep look at the services they provide and how they provide them. </p> <p>The best hospitals already no longer think of themselves as a physical place, bricks and mortar, but as a service provider of excellent health care.  Not so much a hospital trust, or a mental health trust, but a health care trust. </p> <p>Like in Croydon: Croydon Health Services providing both hospital and community services through a range of community and specialist clinics right through their area.  This flexibility makes adapting creatively to changes and needs far easier. </p> <p>But change, even when it is clearly clinically justified, is not easy.  People often form a strong emotional bond to the places where their life may have been saved or that of a loved one.  So, it is incumbent on us to make the argument for pressing forward.</p> <p>Change must be – and seen to be – clinically, not politically led. </p> <p>Of course, the NHS will always be political to an extent.  Government sets the overall budget, we have amended the Bill, we have re-affirmed Ministers are accountable over all with a duty to promote a comprehensive Health Service. </p> <p>But for the future, we need much less political interference in the day-to-day running of the National Health Service. </p> <p>There may be a lot of guidance and direction at the moment through transition, but, the objective is then to liberate the NHS. </p> <p>NHS accountable to patients and accountable for the results that are being achieved.  Because we know where decisions are clinically led based on the latest evidence and where patients and the public have been properly involved in their planning and design, services will improve. </p> <p>Our fourth challenge is to cut bureaucracy and to integrate services around the needs of patients using more resources at the front line. </p> <p>Last November, my father died.  His care was good.  With the support of the NHS community services where he lived and indeed Marie Curie cancer care services, he was able to have, I think, a good death. </p> <p>It was not an experience of health care without its problems.  The people in the NHS who looked after him were very good but the service, especially in the early stages, was fragmented and uncoordinated. </p> <p>I remember at one stage I could not work out who was in charge actually: his GP, oncologist, palliative care consultant or the hospice? </p> <p>There are too many hoops for patients to jump through.  Too many administrative obstacles for clinicians and managers to negotiate.  All getting in the way of the integration of services built around patients. </p> <p>Now, you all know I have been a critic of excess bureaucracy, of red tape, of an over-administered National Health Service. </p> <p>But I also know from long experience of talking to many of you and your colleagues around the NHS that you are vocal opponents of excessive bureaucracy. </p> <p>Some of people who have been most vociferous to me about how they could deliver services more effectively if only the bureaucracy would led them get on with it, have been the Chief Executives of Foundation Trusts, who believed they were being given greater freedoms. </p> <p>So what we have to do is we have to stop the bureaucracy that gets in the way.  We have to stop it if it stifles innovation.  If it gets in the way of providing patient centred care. </p> <p>But that is not to say that management is not important.</p> <p>Management is vital. </p> <p>Without high quality management, we can not hope to meet the challenges we face. </p> <p>Without good managers, we cannot achieve the efficiency and effectiveness gained so vital in the Health Service.</p> <p>Without good managers, we cannot take the leaps forward in the patient care. </p> <p>Without good managers, we cannot re-shape NHS services. </p> <p>Without good managers, we can not achieve integration of services.</p> <p>The modernisation we know we need is as much about managers leading modernisation as it is about clinicians.  But, the essence of it is providing that leadership together. </p> <p>As I have said to you before, and I will keep saying, where we have in the National Health Service doctors and nurses and health professionals who treat managers as “them”, the service is bound to fail. </p> <p>Where we have the health professionals who provide care who see managers and management as “us”, then we are going to succeed. </p> <p>Because management is integral to the process of delivering best practice. </p> <p>And, leadership in the National Health Service will come from clinicians, and it will come from managers.  But, it must not be seen as something that occurs separately.  It must be something achieved together. </p> <p>Now, the challenges that I have been talking about, the changes I have been talking about, they are going to have an impact on each  and every one of us. </p> <p>There is a huge amount to do, a huge amount to get to grips with, and I know that it can be a tough time.  It is a tough time across the public services. </p> <p>Just a fortnight ago, I was with the Local Government Association and there are many in Local Government who are grappling with very serious levels of demand, and doing so with fewer resources. </p> <p>I understand the difficulty the position some of you find yourselves in as a consequence of changes.  But, not to change is not an option. </p> <p>Change needs champions.  So, patients need you to be those champions.  To do what is necessary to make the transition to a modernised National Health Service one that is smooth and effective.  To realise the opportunities that change brings, using your knowledge of the service. </p> <p>So it is time now to look those challenges in the eye, to do what is necessary to meet them, to regain the momentum.</p> <p>And I do ask you to return to all of your organisations right across the National Health Service with one simple message:</p> <p>The pause is over.  It is now time to act. </p> <p>Thank you all very much.</p> <p> </p> None Andrew Lansley CBE MP NHS Confederation Department of Health 2011-07-07
<p>Thank you Johnny [Marshall].</p> <p>I’m not sure if it was case of extraordinary foresight on your part or if the fates are particularly interested in the modernisation of the NHS, but rarely has there been a more perfectly timed conference than this one.</p> <p>For on Monday the Future Forum, under the chairmanship of Professor Steve Field who will be here this afternoon, published its report on the modernisation of the NHS.</p> <p>And we have accepted all of the Future Forum’s core recommendations.</p> <p>The objective of the Future Forum – made up of 45 of this country’s most eminent and experienced health and care professionals and wholly independent of government – was to look again at the detail of the proposed modernisation programme, including the proposals in the Health and Social Care Bill, and to see where it can be improved.</p> <p>Not to tear it up. </p> <p>Not to start from scratch. </p> <p>Not to reject or undermine the fundamental principles of the reforms and the Bill. </p> <p>Not to prevent you, some of the most enthusiastic early adopters of modernisation, from moving ahead with your plans – making the NHS better for patients.</p> <p>But legislation imposes an extra discipline.  It’s about setting the direction of the NHS for the next generation or more. </p> <p>While delay can be frustrating, especially if you have already started to put plans in place in your own communities, a pause in order to get things right, to make the Bill as good as it can possibly be is, I believe, the right thing to do.</p> <p>The service can adapt and improve as we modernise and change. <br />But the legislation cannot be continuously changed. </p> <p>On the contrary, it must be an enduring structure and statement. </p> <p>So it must reflect our commitment to the NHS Constitution and values. </p> <p>It must incorporate the safeguards and accountabilities that we require. </p> <p>It must protect and enhance patients’ rights and services. </p> <p>And it must be crystal clear about the duties and priorities that we will expect of all NHS bodies and in local government for the future.</p> <p>The values of the NHS – high quality care, free for all, based on a person’s need and not their ability to pay – the sense of security and social solidarity it brings – are what makes the NHS special.</p> <p>They are why we care so deeply about it. </p> <p>Why I care so deeply about it. </p> <p>And I will never – never – do anything to harm or undermine those essential values.</p> <p>But I will also never rest while the NHS can be made better. </p> <p><strong>The case for reform - financial</strong></p> <p>We face a situation where if we do nothing, we risk doing what we wish most to avoid – we risk damage to the NHS.</p> <p>The case for change is two fold.  Financial and clinical.  Either one would be enough to make modernisation essential. </p> <p>Enormous financial pressures loom large on the horizon </p> <p>Studies suggest half of all growth in health spending is down to technological change.  Medical advances and new technology mean that procedures that were once too dangerous even to contemplate are now commonplace. </p> <p>20 years ago the risk of complications during surgery ruled out hip replacements for the over 85s.  Today they are routine. </p> <p>Over the last twenty years or so, admissions per head – the amount of care the average person receives – have increased by almost 150% for the over 85s.</p> <p>Treatments evolve, lives are saved and people’s quality of life improves. </p> <p>This is great news for patients but it does have cost implications for the NHS. </p> <p>And people are living for considerably longer than they did when the NHS was first created. </p> <p>With no change, the NHS will need £130 billion by 2015.  Even with the extra £11.6 billion we are investing in the NHS, that still leaves a potential funding gap of near £20 billion.</p> <p><strong>Case for change - clinical</strong></p> <p>So there is a financial imperative to make the NHS far more efficient and far more productive.  But that is not the only reason the NHS must modernise.</p> <p>The fact is, as good as the NHS can be, and it can be truly excellent, it can be much better.</p> <p>Internationally, in many areas we compare poorly with others.  While cancer survival rates are improving, if they were as good as the European average, we could prevent 5,000 people from dying of cancer every year. </p> <p>And, as confirmed by the King’s Fund just last week, around 15,000 over-75s die prematurely every year in the UK when compared to the best performing countries world wide.</p> <p>But it’s not only internationally that the comparisons are stark.  Depending on where you live in England, the care you receive can vary wildly.</p> <p>In April, the National Cancer Intelligence Network published, for the first time, mortality rates 30 days following surgery for bowel cancer.  The average across the country was 5.8%.  But that national figure masks huge variation.  From just 1.7% at one end to 15.6% at another.</p> <p>Now of course this doesn’t automatically mean that care at one place is necessarily better or worse than elsewhere.  Local differences in the age and health of the population explain some of the variation.  But not all of it.</p> <p>The more data we see about the clinical outcomes of NHS care – and in the coming years we will see a lot more – the clearer the case for change becomes. </p> <p><strong>Principles of modernisation</strong></p> <p>And change is coming.  But not just any change.  Change based on the principles we all agree are essential to the long term improvement of outcomes for patients.</p> <p>First and foremost, that patients should no longer be passive recipients of care, but active participants in it. </p> <p>That they should have real choice as to how, where and by whom they are treated. </p> <p>That they should be an equal partner in decisions taken about their care. As Tuckett said, it will be a meeting of experts-clinicians and patients themselves.</p> <p>That there should be no decision about me, without me.</p> <p>Second, that clinicians should lead the design of services.  The clinicians I spoke to – and there were many of them – had had enough of being micro-managed from on high by politicians chasing the headlines or overly-administered by layer upon layer of suffocating bureaucracy. </p> <p>You all know...  The top-down approach just doesn’t work any more.  It smothers innovation, undermines professional judgement and leads to worse, not better care for patients.</p> <p>And third, with money tight – and to be honest, even if it wasn’t – we need to focus all of our resources, all of our talent, all of our energy on the things that really matter most to patients.  We need to focus on outcomes. </p> <p>Of course, the amount of time that people wait for an operation or to be seen in A&amp;amp;E is important.  But I don’t think anyone believes for a moment that it is the only thing that’s important.  Waiting times will remain low – that much is guaranteed by the NHS Constitution – but we must look beyond them.</p> <p>We must look at whether an operation was a success.  At survival rates.  Recovery times.  At time spent in hospital.  At whether a patient was able to retain or regain their independence.  We need to see what their overall experience of the NHS is like.</p> <p>Because healthcare should be about quality as well as quantity.</p> <p><strong>The Future Forum</strong></p> <p>So a patient-centred, clinically-led, outcomes-focussed NHS is the prize. </p> <p>That is what David Cameron and I set out to achieve in 2007 when we published our first Health White Paper when in Opposition. </p> <p>It was our goal last year when we published the Health and Social Care White Paper and when we published the draft Bill.</p> <p>And it remains our goal today.</p> <p>But just as we need to focus on outcomes when it comes to patients, so we should focus on outcomes when it comes to drafting legislation.</p> <p>While many were enthusiastic about our plans for modernisation, some did have genuine concerns. </p> <p>Some of you here may have been concerned that the detail of the Bill would not actually deliver our vision for the NHS. </p> <p>If the Bill could be improved, if there was anything that could be done to improve the NHS for patients and for the taxpayer, then it is right that we listen and act to improve it.</p> <p>This isn’t something we as a government feel we need to be defensive about. </p> <p>We all want to give patients the best possible health service. </p> <p>So we invited Steve Field to lead the Future Forum and for the eight weeks he and we have been listening to the thoughts of people, the views of clinicians, of patients and of members of the public.</p> <p>So just as we want to shine a light on the performance of the NHS, we have shone a bright light on the detail of the Bill and on how the proposals in the Bill would be implemented.</p> <p>The Listening Exercise has really exceeded my expectations of it, especially in terms of engagement with NHS staff. </p> <p>The Forum has been an invaluable source of expert advice.  And I truly believe it has enabled us to improve the Bill, improve our proposals overall and will help us to improve the NHS.</p> <p><strong>The Future Forum Recommendations</strong></p> <p>We accept the NHS Future Forum’s core recommendations.</p> <p>We will make the necessary changes to the Bill, changes that will align it even more closely with our vision for the NHS.  We will also reflect the Forum’s recommendations in how we implement the proposals in the Bill, for instance in how the NHS Commissioning Board is set up and how commissioning groups are authorised.</p> <p>While the recommendations cover a wide range of topics, from research to education and training, and from the role of the Secretary of State to the NHS Constitution, I want to focus on those most relevant to you as commissioners.</p> <p>The changes to GP Consortia, to governance and accountability arrangements, to competition and to the schedule for change.</p> <p><strong>Clinical Commissioning Groups</strong></p> <p>As you know full well, for commissioning to be effective it must include a wide range of people in the design of high quality local services – including a range of clinicians, patients and patient groups, carers and charities. </p> <p>So to reflect what many of you are doing on the ground, GP Consortia will from now on be known as Clinical Commissioning Groups. </p> <p>Still statutory bodies.</p> <p>Still comprising GP practices coming together with a collective responsibility for their practice population and local population,</p> <p>Still covering the whole country. </p> <p><strong>Clinical Networks and Senates</strong></p> <p>To support you in commissioning, the independent NHS Commissioning Board will develop the existing clinical networks, which will be there to offer advice on how specific services, like cancer, stroke or mental health, can be better designed to provide effective care.</p> <p>You know full well, no one group of doctors can design services in isolation.  The changes we are making are about making it easier for you to continue what so many of you are doing already – coming together with a wide range of colleagues within and beyond the NHS to design integrated local services.</p> <p><strong>Integration</strong></p> <p>To reflect the central importance of integrating services, Commissioning Groups will now have a duty to promote integrated health services and integrated health and social care – designed around the needs of users.</p> <p>To support greater integration with council run services, Commissioning Groups will be encouraged to ensure that their boundaries do not cross those of upper tier and unitary local authorities.  Or if not to demonstrate to the NHS Commissioning Board a clear rationale for not doing so in terms of benefits to patients.</p> <p>This will make it easier for you to work more closely with social care and public health commissioners, pooling budgets where needed, to improve the general health of your local population.</p> <p><strong>Governance</strong></p> <p>Because it’s public money being spent and because the health of the public is at stake, every Commissioning Group will have a governing body that will ensure that all decisions are made in an open and transparent way.</p> <p>This governing body will have at least two lay members – one with a need to focus on championing public and patient involvement, the other overseeing key elements of governance, such as audit, remuneration and managing conflicts of interest.</p> <p>And while we won’t prescribe in detail the wider make up of the governing body, it will need to include at least one registered nurse and one secondary care specialist doctor. </p> <p>To avoid any potential conflict of interest, neither should be employed by a local health provider.</p> <p>These governing bodies will meet in public and publish their minutes, and clinical commissioning groups will need to publish details of contracts they have with health service providers.</p> <p><strong>Patient and public involvement</strong></p> <p>I have always said that I want there to be “no decision about me, without me” for patients and their own care.  The same goes for the design of local services. </p> <p>So we will further clarify the duties on the NHS Commissioning Board and Clinical Commissioning Groups to involve patients, carers and the public.  Commissioning Groups will have to consult the public on their annual commissioning plans and involve them in any changes that affect patient services.</p> <p><strong>Choice and competition</strong></p> <p>One of the main ways that patients will exercise their influence within the NHS, of course, is through their choice of provider.  This remains essential to our plans.  We will amend the Bill to strengthen and emphasis a commissioners’ duty to promote patient choice.</p> <p>Of course patient choice implies competition.  And competition remains an essential means for driving up standards and quality of care.  But it has always been a means, and not an end.</p> <p>We will still maintain our commitment to extend patient choice of “Any Qualified Provider”, but in a more phased way, starting from April next year.</p> <p>Choice of Any Qualified Provider will be limited to those areas where there is a national or local tariff, ensuring that competition is based solely on quality and not on price – which was always our intention.</p> <p>Now, there will be some areas, such as A&amp;amp;E or critical care, where this isn’t practicable. </p> <p>But there are others where there is already strong demand for more choice – such as community services.  This is where we will begin to introduce Any Qualified Provider.</p> <p><strong>Timetable</strong></p> <p>Finally, I want to focus on the timetable.</p> <p>I know some of you have been frustrated by the pause and will be anxious to press on with your plans on the ground.</p> <p>But I hope you will see the importance of taking our time to get it right.</p> <p>And now, let me be absolutely clear, that there is absolutely nothing to stop you from pressing ahead.</p> <p>Strategic Health Authorities and Primary Care Trusts will still cease to exist in April 2013.  By then, all GP practices will be members of either a fully or partly authorised Clinical Commissioning Group, or one in shadow form. </p> <p>We cannot have gaps in coverage, nor a two-tier system, so we will establish Clinical Commissioning Groups covering all of England by April 2013.  That is the essential building block for new accountability.</p> <p>If your Commissioning Group wants to press ahead with seeking authorisation, you will be free to do so.  But we will make the timetable more flexible so that no one is forced to take on new responsibilities before they are ready.</p> <p>In other words, April 2013 will not be a ‘drop dead’ date for the new commissioners.  Instead, individual Clinical Commissioning Groups will be authorised to take on budgetary responsibilities as and when they are ready to do so. And before April 2013, we will secure as much delegated responsibility as we can so that you can shadow and fully understand responsibilities.</p> <p>Where a Clinical Commissioning Group is not able to take on some or all aspects of commissioning, the local arms of the NHS Commissioning Board will commission on its behalf.</p> <p>Similarly for providers of care.  All NHS trusts will be required to become Foundation Trusts as soon as clinically feasible, with an agreed deadline for each trust.  But is any of the remaining NHS Trusts cannot meet Foundation Trust criteria by 2014, we will support them to achieve it subsequently. </p> <p>And when it comes to the education and training of NHS staff, we need to ensure a safe and robust transition to the new system.  It is vital that this is introduced carefully and without creating instability, and we will take the time to get it right, as the Future Forum has recommended.  And we’ll publish more detail in the autumn.</p> <p>But during the transition, we will retain postgraduate deaneries, and give them a clear home within the NHS family.</p> <p><strong>Conclusion</strong></p> <p>So for those of you concerned that the listening exercise represents a tearing up of our plans to modernise the NHS, don’t be.</p> <p>For those of you worried that in places the detail of the Bill was at odds with the principles of reform, be reassured.</p> <p>For those of you who considered the whole listening exercise was nothing more than a PR stunt, clearly, it wasn’t.</p> <p>I am proud of the work we have done these last eight weeks.</p> <p>I would like to thank you for the contributions so many of you will have made these past months. </p> <p>Changing the NHS is not easy. </p> <p>But I truly believe that by working together, as we have done...</p> <p>By putting the needs of patients first, as we have done...</p> <p>By being clinically led, as we have been...</p> <p>And by focussing on the outcomes, as we have done...</p> <p>We will not only have a better Bill, we will also have a better NHS and, in time, far better outcomes for patients.</p> <p>Thank you.<br /></p> None Andrew Lansley CBE MP Commissioning 2011 Department of Health 2011-06-15
<p>At home, two of this government’s highest priorities are to return the country to the path of economic prosperity and to give people, especially the poorest and most vulnerable in society, access to excellent healthcare, with outcomes that are consistently amongst the very best in the world.</p> <p>Those two priorities are also present when we look beyond our own borders. </p> <p>We want to do everything within our power to bring sustainable growth to all the countries of the world – and to the poorest in particular. </p> <p>And we want that growth to bring with it improving health outcomes that will in themselves underpin future prosperity.</p> <p><strong>Interdependence</strong></p> <p>Why are these priorities so important?  Why are we interested in the health and prosperity of those who don’t live here; and who don’t pay taxes here?</p> <p>They’re important because we understand that today more than ever before – our national interest cannot be defined simply by what happens within our own borders – if indeed it ever could.</p> <p>Because the strength of our economy, the health of our society and the success of our nation depends on the strength of our partners around the world.</p> <p>Because we understand the fundamental importance to our long-term national interest of making the lives of others, wherever they may be, better than they are now. </p> <p>And one of the main ways of achieving this is through improving health.</p> <p>The health challenges we face in Britain - an ageing population, the increasing costs of healthcare, a rising tide of lifestyle related diseases – these are not unique to us as Margaret so eloquently said.  They are shared and international concerns.</p> <p>Across the globe, we share a common destiny. </p> <p>Borders are more open; travel is faster, more frequent and more affordable; our economies are more integrated than at any time in human history.  .</p> <p>This interdependence means that, to a greater degree than previously imaginable, we share in each others’ prosperity – and indeed hundreds of millions of people lifted from poverty in China in recent decades can testify to that. </p> <p>But we also share the risks of failure. </p> <p>The risk of climate change – where the effects are felt by all, irrespective of borders.</p> <p>The risks of diseases and infections – as the H1N1 pandemic demonstrated or as Margaret demonstrated in relation to the recent E. Coli outbreak, it can spread very quickly from country to country.</p> <p>Or indeed the risks of collapsed and failed states bringing terror and conflict into the world.</p> <p>Acting alone in any of these respects is not an option.  Acting together, acting in common purpose, that is the only way forward.</p> <p><strong>Economic interests</strong></p> <p>Of course, especially in times of economic difficulty, as Margaret said of financial austerity, we do all of us need to look after our own economic and trade interests.  Without a strong economy there is little we can do in any arena. </p> <p>I do want British companies, British healthcare organisations to succeed abroad, bringing more jobs and more prosperity to our people.</p> <p>We’ve seen some examples - Moorfields Eye Hospital has a new facility in Dubai, and Imperial College Hospital operates a diabetes clinic in Abu Dhabi.  They are pioneers, seeking new opportunities on a global basis for the NHS and indeed by doing so providing new streams to fund better care for NHS patients.  I want more of this.</p> <p>And some Trusts with well-developed international reputations, such as Great Ormond Street Hospital, already treat international patients here in England. </p> <p>Revenue again that is then invested back into the NHS to provide ever better care for NHS patients here in Britain.</p> <p>The UK has long been a global hub for research and clinical expertise.  The life sciences are of particular importance to our economy now and for the future.  We want to build that base we have had here for many years in the future.  Encouraging global leaders like GSK to build on their success, creating new jobs and indeed many new treatments.</p> <p>Always attracting new investment, always pushing the boundaries of medical science for the benefit of all.  Giving UK companies and NHS organisations that have so much to offer the world every opportunity to do so.</p> <p>And with three trillion dollars invested in healthcare each year around the world, it pays to be a major player.</p> <p><strong>Development</strong><br /></p> <p>But above and beyond self-interest, there is enlightened self-interest.</p> <p>I am deeply proud of the fact that Britain has forged a reputation as one of the leading voices and principal donors in international development.</p> <p>This is perhaps most obviously apparent in our commitment to lifting our development spending to 0.7% of gross national income.  A commitment made by the last government at Gleneagles in 2005 and one that will be realised by this government in 2013.</p> <p>The international community can depend on the UK to keep its promises on development spending, and to use its influence to encourage others to do the same. And we know what that will enable us to do.</p> <p>Training midwives to help make childbirth the joyful experience it should be instead of the potential death sentence it too often still is.</p> <p>Working to eradicate the scourge of polio and Guinea worm disease.</p> <p>Providing safe, fresh drinking water which can transform lives not only through an almost instantaneous improvement in their health, but also by freeing girls – because it is invariably they who work so hard to collect it – to go to school or work, improving their lives and those of their families still further.</p> <p>And of course vaccinating children against diseases like severe diarrhoea that, for the sake of a few pounds, would otherwise kill them.</p> <p>This has been a good month for progress in vaccinating children.  Earlier this month, GSK announced that it would make its rotavirus vaccine available to GAVI for two thirds the price at which it is currently available.</p> <p>And of course, at today’s GAVI Replenishment Conference, I was delighted that the Prime Minister, David Cameron was able to announce an additional commitment of £814 million.  Money that, between now and 2015, will help vaccinate over 80 million children and save 1.4 million lives.  That’s one child’s life saved every two minutes.</p> <p>We – government and industry – understand that, in the long term, their interests, the interests of those people who we help are our interests.  Because their problems, left unchecked and ignored, will sooner or later become ours whether we like it or not.</p> <p><strong>Security</strong><br /></p> <p>For when people are poor, desperate and without hope, chaos can be close at hand.  States that are today fragile can, without outside support, soon fail.</p> <p>And the risk of failed states are huge – unleashing fear and hatred that can bring terrorism, or conflict, unchecked immigration and crime to our doorstep.</p> <p>David Cameron said only last month at the G8 in Paris, “If we [had] spent a fraction of what we are paying now in Afghanistan on military equipment, into that country as aid and development when it had a chance perhaps of finding its own future, would that have not been a better decision?”</p> <p>No country can escape the logic of global interdependence, accepting the bountiful pros while somehow avoiding the inevitable cons, no matter how much we might want to.</p> <p>So the question is, if we are all in this together, what should we do about it?</p> <p><strong>Britain’s response</strong></p> <p>Britain’s answer is to make Global Health an explicit aim of our foreign and economic policy. </p> <p>At home, we are working to ensure that all relevant government departments work together – sharing information and developing common goals and working to a shared strategy.</p> <p>Abroad, we need to work ever more closely with other governments and with international organisations like the WHO and across civil society. </p> <p>Making and exploiting the connections between us, making the most of the talent, the expertise and the passion that exists in abundance out there in the world, and putting that work to the benefit of humanity.</p> <p><strong>International cooperation</strong></p> <p>Two years ago, the H1N1 pandemic affected just about every country on the planet.  The global response was swift, calm and impressive. </p> <p>I would like to pay particular tribute to Margaret for how she and her colleagues at the WHO handled that particular crisis.  A crisis that, throughout, was characterized by a high degree of international cooperation, openness and trust.  An approach, I was pleased to see, that was vindicated in a recent review of the WHO’s actions.</p> <p>We of course were also lucky.  That particular flu strain proved in the event to be relatively mild.  Of course, we may not be as lucky next time. </p> <p>That is why all countries must continue to work closely together:</p> <p>• to develop adequate warning systems,<br />• to quickly develop, produce and distribute effective treatments<br />• and to agree protocols of how the business of the world economy can be sustained during times of crisis.</p> <p><strong>Value for money</strong></p> <p>But we must also be clear as to the political and financial realities that donor countries face. </p> <p>Everyone is under pressure at the moment. </p> <p>Under pressure to put aside their development commitments and to contribute less than they promised. </p> <p>Under pressure to turn their backs on free trade and to try to protect jobs at home by raising trade barriers.</p> <p>Under pressure to think of the national interest in the narrowest of terms.</p> <p>We must and we will resist those pressures.</p> <p>So here in Britain, we will not make the world’s poor pay the price for the debt crisis by abandoning our commitment to the 0.7% objective. </p> <p>We will not seek the false shelter of protectionism.</p> <p>We will not close our eyes to the realities of a modern, integrated and globalised world.</p> <p>Instead we are determined to prove to our citizens that the money they spend is making a genuine difference.</p> <p><strong>Outcomes Framework</strong></p> <p>That is why we updated the original Health is Global strategy through an Outcomes Framework For Global Health.</p> <p>Here in England, we are modernising the National Health Service.  One of the most important elements of this modernisation is measuring how effective the NHS is in terms of the health outcomes it delivers for patients. </p> <p>So instead of saying that so many operations must take place, we want to measure the survival rates for those operations – to measure, publish and improve.</p> <p>That way, not only can we in government, but clinicians and, most important of all, patients, can see just how good services are.  And if there is a problem, then clinicians will be challenged to sort it out.<br /></p> <p>Such an approach in this country for cardiac surgery has halved death rates in England over the last 5 years.</p> <p>As at home, likewise abroad.  The Health is Global Outcomes Framework brings tangible, measurable outcomes to bear on our efforts to improve global health.  Focussing on some of the greatest challenges to global health across the key areas of for example global health security, health in development, and trade for better health:</p> <p>• on food security,<br />• access to affordable immunisation and treatment,<br />• adapting to the effects of climate change on the health of the very poorest communities,<br />• And strengthening local health services to improve lives, reduce preventable death and improve prospects for peace and security.</p> <p>In this way – working together across departments – we can focus our resources not only on what matters most, we will be able to see far more clearly whether or not what we are doing, whether the billions we are spending, is having the desired effect.  And if it’s not, we can adapt and change what we are doing.</p> <p><strong>Global Health Diplomacy</strong></p> <p>Taken together...</p> <p>• the realisation that our interests reach far beyond both our own borders and our narrow, immediate economic interests,<br />• and the clarity of purpose that the Global Health Outcomes Framework brings with it...</p> <p>... means the traditional approach to international relations is evolving. </p> <p>Global health is now central to effective foreign policy.</p> <p>You cannot separate health from security – not when so much of our security means preventing or dealing with the aftermath of natural disasters, civil conflicts or of pandemics.</p> <p>You cannot separate health from economics – not when a new pandemic could bring the global economy to an abrupt standstill or when positively life sciences and health industries have so much to contribute to global growth and trade.</p> <p>And you can never separate health from our desire for social justice – for all people, from all countries, of all incomes, to share the dignity of good health.</p> <p>The WHO will be central in tackling the challenges we face.  I would like to applaud the determination and leadership that Director General Chan has displayed in helping the organisation adapt to the changing nature of these challenges.</p> <p>I hope that all countries will join the UK in integrating the global health agenda into all aspects of their foreign and economic policies and continue to work together and with organisations such as the WHO to meet the Millennium Development Goals. </p> <p>For when we work together, everyone benefits.<br /></p> None Andrew Lansley CBE MP The Rise of Global Health in International Affairs, Chatham House Department of Health 2011-06-13
<p>Thank you Kate [Lobley, Director of Leadership, The King’s Fund].</p> <p>As the Prime Minister set out so clearly this week, the NHS faces some significant long-term challenges.  An ageing and increasing population, increasing burden of chronic disease, rising costs of drugs and treatments, and growing, almost insatiable public expectations.</p> <p>If we choose to ignore these pressures, if we stick with the status quo, then in the years ahead the NHS will face a genuine crisis.  One that would threaten the core values of a comprehensive health service, available to all, free at the point of use and based on need.</p> <p>This government will not allow that to happen. </p> <p>But given the financial context, how to ensure the NHS is not only sustainable in the long term, but that it gets better?  That it gives the people of this country healthcare that is consistently among the very best in the world?</p> <p>I think the answer is straight-forward.</p> <p>You put the right people in charge. </p> <p>You make it crystal clear what it is they are trying to achieve and how they will be held to account.</p> <p>And you then do everything in your power to support them in what they are doing. </p> <p>Where they need extra powers or resources, as far as you can, you supply them.  Where there are obstacles, you remove them. </p> <p>That is what happens every day in successful organisations around the world.  And it is what I want to happen in the Health Service too.</p> <p><strong>Leadership</strong></p> <p>Today is about leadership in the NHS.  About what good leadership can do for patients and about how we can support and nurture current and future leaders within the Health Service.</p> <p>Note that I say ‘leaders’ – not leader.  For leadership in the Health Service cannot be about one person at the very top.  The leadership style of Henry V on St Crispin’s day – the man on horseback- as dramatic and inspiring as it is, just isn’t appropriate for something as vast, as complex or as subtle as the NHS.</p> <p>The Health Service needs far more than that.  It needs leaders at every level, in every institution and in every profession. </p> <p>And the people that I believe, first and foremost, should be leading the NHS are clinicians.  GPs, hospital doctors, nurses, pharmacists, allied health professionals, scientists. </p> <p>We need people in every area to step up to the plate and lead. </p> <p>No profession can be left out if we are to deliver truly integrated, high quality healthcare for everyone in the country.</p> <p><strong>Managers</strong></p> <p>And when I say that, I include managers.  But leadership and management are not the same.  Some managers are leaders in the service now, like David Nicholson.  Others will be leaders in the future – but not just because they rise up the managerial ladder.  Management is one of the professional disciplines inside the NHS, but it is a support to clinical leadership, not a substitute for it.</p> <p>Just so there is no confusion, I know that high quality managers are essential to the effective and efficient running of the NHS. </p> <p>No fundamental change in any NHS organisation ever came about without the support of managers – people who are every bit as committed to the health service and to improving patient care as clinicians.</p> <p>The problem is not the people, it’s the system.  Managers are placed in an impossible position. </p> <p>Too often in the Health Service, change is seen as a process whereby managers tell clinicians what to do.  But why is this the case?  It’s because people like me in government are constantly ordering them to do it.</p> <p>So you end up with a top-down, command-and-control system with the Health Secretary driven more by that day’s headlines than the best interests of patients.</p> <p>He then gets his officials to come up with some ploy that he can sell to the press, tells all NHS managers to carry it out and then claim to be saving the day. </p> <p>Managers are then left to force it through on the ground – whatever the clinicians might think and whatever the consequences down the line for patients. </p> <p>So you get new initiatives with exciting names.  Policies that sound great, but amount to little more than hot air.</p> <p>The result?  Emasculated and frustrated clinicians, overstretched managers caught in the middle and patient care that is at the political whim of whoever happens to have won the previous election. </p> <p>And over the years, the accumulated weight of countless...</p> <p>• initiatives to implement,<br />• targets to meet,<br />• reports to produce<br />• and boxes to tick...</p> <p>...means that the NHS isn’t managed.  It’s bureaucratised.</p> <p>Managers are no more free to run their organisations than clinicians are.  Over these last seven years, it was as often managers who told me to get rid of the top-down culture as it was nurses or doctors. </p> <p>And while those who work in the Health Service add “frustration” to their job descriptions from day one, it’s patients who lose out on the potential benefits of a truly clinically-led Health Service.</p> <p>It’s been like this for decades.  It cannot continue for another.  It’s time that politicians and managers handed the controls over to the people who really understand the needs of patients and how to serve them best – to clinicians.</p> <p><strong>King’s Fund report</strong></p> <p>Today, the King’s Fund’s Commission on Leadership and Management in the NHS has published its report.</p> <p>I very much welcome the report.  It speaks to the same ambition that I have for the NHS.  For a Service led from the front.  An integrated NHS that is focussed on improving clinical outcomes and nothing else.  A Service that is well managed, not overly administered.</p> <p>I understand the caution around the size of reduction to the management and administration budgets.  But most of these will come from the abolition of Primary Care Trusts and Strategic Health Authorities. </p> <p>Across the public services, similar reductions in administrative costs are required.  In the NHS, we can see how we can achieve this by changing the shape and burden of administration, not just the numbers of administrators – not keeping the system the same and asking fewer people to run it, but reducing the scale of administration alongside the cost.</p> <p>By handing power to clinicians and by ending the constant micro-management and over-burdensome performance management of the NHS, much of this work will no longer be needed.</p> <p>Where I fully agree with the report is in the vital importance of high quality leaders and managers.  The gains made in recent years must be maintained and built upon.  Every NHS organisation and provider must take their staff development role incredibly seriously, especially new entrants from the charity and independent sectors.</p> <p>I’m keen to continue the excellent work of the National Leadership Council.  Just last week, I announced that we would fund a further 60 Fellows as part of the Council’s Fellowship programme, developing tomorrow’s leaders from all parts of the Health Service,. </p> <p>Every one of whom will make their own individual mark on their local NHS, and collectively make a real and lasting difference to the level of leadership within Health Service as a whole.</p> <p>The King’s Fund report says that the NHS needs a national focus on leadership and would welcome a national leadership development centre. </p> <p>I am now considering the idea of a national centre.  I know there are some interesting and novel schemes already running.  For example, the innovative programme at UCLH, which has drawn on models of leadership from the armed services.  We’ll respond to this and the other recommendations once the listening exercise has closed.</p> <p><strong>Outcomes</strong></p> <p>I said at the beginning that if you want to achieve success in an organisation you first have to put the right people in charge.  But that’s not all.  You then need to be clear about what they are trying to achieve and show them how you will hold them to account for that.</p> <p>So let me ask you a simple question.  What’s the NHS for?  We all know when we see it: supporting childbirth; promoting good health; treating illness and injury and promoting recovery; care for those with chronic illness; care when dying.</p> <p>But if this is what the NHS is for, why have we never measured in a systematic way how well it’s achieving these aims?  Of course, these things are not always easy.  But they are worth the effort.</p> <p>What is the gain if you treat people in a shorter period of time if the quality of the care and the quality of the outcomes were to be poor?  Too often we measure the success of the Health Service by the number of units it processes, not by how well it improves people’s lives.</p> <p>So from now on, I want all parts of the NHS to be judged on the clinical outcomes they achieve.  We published the Outcomes Framework in December to help all clinicians to pull in the same direction.</p> <p>• Reducing avoidable mortality;<br />• enhancing recovery after treatment;<br />• improving the quality of life for people with chronic conditions;<br />• maximising safety and cutting the number of infections;<br />• and continually improving patients’ experience of their own healthcare.</p> <p>To flesh out the detail, NICE is developing a library of condition specific Quality Standards.  These will mean that, over time, every clinician – and every patient – will be able to see just what excellent care really means and judge whether they are receiving it.  These aren’t targets by another name.  They state what should be achieved, not how clinicians should achieve them.</p> <p>As General Patton once said, “Don't tell people how to do things, tell them what to do and let them surprise you with their results.”</p> <p>And because all providers of NHS care will be aiming for the same high quality outcomes, I, the NHS Commissioning Board, General Practice Consortia, local authorities and, most importantly, patients themselves will be able to hold providers to account for delivering that excellent care.</p> <p><strong>Integration</strong></p> <p>And more often than not, delivering excellent care will mean delivering integrated care. </p> <p>But unfortunately, the NHS is not particularly good at integration.  What it is good at is episodic care. </p> <p>If you’re young and relatively healthy but fall ill with a specific disease, or have a particular injury, the Health Service is excellent at taking you in, making you better and sending you on your way.</p> <p>The problem with this is that the vast majority of the people the NHS looks after don’t fit that description.  Most of today’s patients are older and with one, or often more than one, long-term condition.</p> <p>So you have the typical example of an older person with terminal cancer, having to rely on her daughter to coordinate care between her GP, community nurses, hospitals and social care because they can’t quite seem to join up the dots by themselves. </p> <p>And what about the many who don’t have someone to fight their corner?  What happens to them?</p> <p>The needs of patients are too often not catered for by the strengths of the Service.  The result is that, far too often, care today in the NHS is fragmented. </p> <p>A patient with COPD might be treated by her GP, by a pulmonary specialist, and by a community nursing team. </p> <p>• Three separate groups of people to contact,<br />• three separate sets of forms to fill in,<br />• and three separate notes to keep track of. </p> <p>All this with the patient in the middle, often the one who has to try and coordinate their own care between them.</p> <p>Or look at end of life care.  At the end of their life, most people want to die in their own home.  But the fact is that most people actually die in hospital. </p> <p>This isn’t because of the high level of intensive, hospital based care they need. </p> <p>It’s not because the people who work in the NHS don’t want to provide the very best care to their patients. </p> <p>It’s simply because the system isn’t set up to provide the quality of out-of-hospital care needed to help patients die at home.</p> <p>• The system of tariffs doesn’t encourage hospitals to do it.<br />• The people with the money, the PCTs, often aren’t aligned properly with clinicians.<br />• It’s hard for the voluntary sector – organisations that can add so much at the end of a person’s life – to offer their services.<br />• Patient experience and outcomes aren’t measured.<br />• And all too often, health and social care organisations just don’t join up.</p> <p>But there are examples where people have joined together to beat the system.  Since 2004, the Marie Curie Cancer Care’s ‘Delivering Choice Programme’ has taken a whole system approach to end-of-life care.  Working across all those involved – the NHS, the voluntary sector, social services and carers – to provide 24-hour, patient centred care for those at the end of their lives.</p> <p>The evaluation of the first scheme in Lincolnshire, carried out by the King’s Fund, found that deaths at home rose from 19% to 42%, while deaths in hospital fell from over 60% to just 45%.  All the while being cost neutral.</p> <p>Another important opportunity for joined-up services is in urgent care.  Services are too often fragmented, varying in quality across the country and often confuse patients into using inappropriate services – like going to A&amp;amp;E rather than seeing their GP.</p> <p>But by adopting new technologies to encourage greater self-care, by introducing the ‘111’ telephone number as a single point of contact for non-emergency care and by giving local commissioners the freedoms they need, we can change this. </p> <p>We can deliver a properly integrated urgent care system that turns the NHS into a 24/7 service, and makes phrases like “out of hours” feel redundant.</p> <p>Care needs to be organised not around the needs of a particular provider, but around the needs of the individual patient. </p> <p>To have good care, care needs to be integrated.</p> <p><strong>Choice and competition</strong></p> <p>Another thing that is essential for achieving excellence is involving the patient in their own care.  This means more than just explaining things to people.  It’s bringing them into the decision making process.  It’s giving patients a choice.</p> <p>Now patients already have a degree of choice.  They can choose the hospital that will carry out an elective procedure.  Or at least they could if they were able to distinguish to any meaningful degree the quality of care offered by one hospital from another.  But whether you’re going in to have an in-growing toe nail removed or for radical cancer treatment, if you don’t know how good a particular provider is, how can you – or your GP – decide which to choose?</p> <p>And even if you look at the current overall hospital ratings, they won’t tell you how good their clinical outcomes are at the one thing that you’re most interested in – at the procedure you’re about to have.</p> <p>So while patients today theoretically have a choice.  In reality, it’s hardly a choice at all.</p> <p>So is it any wonder that although almost all GPs maintain that they always offer their patients a choice, according to research by the by Anna Dixon here at the King’s Fund, less than half [49%] of them recall being offered one?</p> <p>We need to offer choice where appropriate; but even more so we can make the framework for choice more robust.  If you could see not only how good a hospital was, but how good a specific department or even a specific consultant-led team was, wouldn’t that change things dramatically?</p> <p>That is when GPs and other clinicians can really draw a patient in to the decision making process.  For with the right sort of information, choice becomes meaningful.</p> <p>And patients will choose the care that offers the best results for them. </p> <p>Last month the National Cancer Intelligence Network published, for the first time, mortality rates 30 days following surgery for bowel cancer.  Across the country, the figure was 5.8%.  Not bad, perhaps.  But that national figure masked huge variation.  From just 1.7% to 15.6%.</p> <p>Now this doesn’t automatically mean that care at one place is necessarily better or worse than elsewhere.  As you know, there will be all sorts of factors at play.  But it does give clinical teams pause for thought.  To ask the question, is there more that we can do?  To look at those with the best performance and see if there are things that they are doing that we are not. </p> <p>Making this information available to the public will also have an impact.  Patients, with their doctor, will be able to make a more informed choice as to by whom they wish to be treated.  And given the choice between one hospital with a very high survival rate and another with a lower one, which would you choose?</p> <p><strong>Integration through competition</strong></p> <p>Now choice, real choice, means that providers will be sometimes, in effect, competing for patients.  They do now.  Strengthening information and accountability will encourage all providers, however good they may be, to raise their game and to offer patients the best possible care.</p> <p>No provider, whether from the NHS, charity or independent sector will be competing on price.  As we extend tariffs prices will either be fixed for all providers nationally or locally by commissioners.  The only way to distinguish yourself as a healthcare provider is to provide a higher quality service than everyone else.</p> <p>But at this point, some people start to question whether competition isn’t utterly at odds with that other essential ingredient I’ve mentioned – proper integration of healthcare. </p> <p>I would like to explain not only why this is not the case, but why competition can actually lead to a far greater degree of integration than would ever be the case without it.  And to do that I hope you will forgive me if we leave the realm of healthcare for a moment.</p> <p>We live in a complex world where we take for granted the minor miracles of integration that we see and experience every day.  Integration that is so seamless that we don’t even notice it.</p> <p>Let me take just one example.  I bet virtually everyone here today has a phone in their pocket or handbag.  Some of you will have more than one.  It might be a basic model where you can make calls and send texts and that’s about it.  Or it might be one of the latest smart phones that can do just about everything bar the washing up.</p> <p>Either way, you are enjoying the fruits of countless individual companies operating in a wide range of individual, highly competitive markets, all working together to deliver that one complex, ubiquitous product.</p> <p>Mining companies, designers, chip manufacturers, haulage companies, marketing agencies, precision engineers, logistics companies, data management, network providers, warehouses and, finally, the place that sold you the finished product. </p> <p>Each one competing fiercely for business at every step of the way.  Each one successful in large part because of the high degree of integration they can offer with the other parts of that supply chain.</p> <p>When organisations compete but don’t offer to integrate their services, the result is clear... they don’t get the business. </p> <p>It is in the interests of every provider to offer the greatest possible degree of integration.  Even with those they are competing directly against.  Vodafone and T-Mobile both rely on common standards.  Whether you have a Nokia, an iPhone or a Samsung, the same SIM card will work in all three.</p> <p>The same can be true of healthcare.  Only here we don’t call it a supply chain, we call it a care pathway. </p> <p>Of course, the NHS isn’t a mobile phone.  It’s infinitely more important than that.  If things go wrong on your phone, you can’t make a call.  If things go wrong in the Health Service, people’s lives are at stake. </p> <p>Modernisation isn’t about competition.  It’s about improving results for patients.  It’s about building quality services for patients.  It’s about extending information and choice.  It’s about competition as a means to an end, not an end in itself.  And it means ensuring that the service is patient-centred, not provider-centred.</p> <p>I know the clinicians in charge of commissioning will demand nothing less. </p> <p>Because it will be an essential element of every contract within the NHS. </p> <p>Because they will be rewarded by the outcomes they deliver and they will be better if they are deeply integrated within the wider pathway of care.</p> <p>So a hospital that doesn’t go out of its way to integrate its general surgery with community nursing teams and with local GPs will quickly run into problems.</p> <p>The community dialysis provider that does not link up with specialist community nursing, with hospital renal specialists or with social care organisations will find it very difficult to convince commissioners to pay for their services. </p> <p>And if nothing else, if they don’t prioritise integration, their competitors certainly will.</p> <p>And in those circumstances where the best care is be provided by commissioning a single provider across the whole pathway, that’s  allowed too.  The Bill doesn’t prevent that.  It will support that.  This is about doing whatever it takes to produce the best outcomes for patients.</p> <p><strong>Listening</strong></p> <p>If we agree that the whole point of the NHS is to provide the very best outcomes for patients, then I believe we must have a fully integrated NHS that is clinically led and that gives patients a real choice.</p> <p>I am very clear that this is what we must achieve, but I am also very open to views and ideas as to how we achieve it.  To my mind, nothing is more important than getting this right.  The law of unforseen consequences can play no part in NHS modernisation.</p> <p>That’s why we have paused after the Health and Social Care Bill has left committee to listen and reflect on what people are saying and to see if there are things we can do – substantive things – that will mean that our ambition is matched by the reality on the ground.</p> <p>The Bill is necessary not to give more power to the centre, but to give it away to clinicians.  You cannot have a clinically led system without the legislation necessary to give them that lead.  And if you want the NHS to be truly run from the bottom-up then you do at some point need the people at the top to let go the direct reins of power.  That is what the Health and Social Care Bill is about.</p> <p><strong>Conclusion</strong></p> <p>I don’t want the future of the NHS to be determined by me or any other politician.  I want it to be determined by the millions of choices made by millions of individual patients and by the healthcare professionals responsible for their care.</p> <p>By local NHS and social care organisations working with local authorities and patient groups to bring cohesion and integration to local patient services.</p> <p>And by the many thousands of clinical leaders in GP surgeries, hospitals, cooperatives and independent sector providers all across the country. </p> <p>The government will put the right people – clinicians – in charge.  We will make it clear what they need to do and how they will be held to account.  And we can do everything possible to support them in this difficult role.</p> <p>This is our vision for the NHS.  A vision of an NHS led from the bottom-up.  A vision that puts patient care above news headlines. </p> <p>A vision that I believe in and that I fully expect to deliver outcomes that are consistently among the very best in the world.<br /></p> None Andrew Lansley CBE MP The King's Fund Leadership Conference Department of Health 2011-05-18
<p>Check against delivery</p> <p>Good afternoon everyone. At the risk of seeming contrary on what’s traditionally the first day of spring, may I start by harking back to mid-winter.</p> <p>Because I want to begin by paying tribute to the vital and life-saving work that many of you did in delivering the specialist ECMO care during the Swine Flu outbreak.</p> <p>It is a striking achievement that, under such tremendous pressure, you managed to achieve survival rates that were as good as the very best specialised centres in the United States.</p> <p>I’d particularly like to mention Richard Firmin, who led the process from Leicester.</p> <p>The successful mobilisation of limited resources through cooperation and collaboration demonstrates what I want to talk about today.</p> <p>That is – the power that’s unleashed by professional groups working together as a community.</p> <p>By sharing information, combining resources, harvesting collective know-how and expertise to support patients.</p> <p>It’s something this Society has been demonstrating for many years now.</p> <p>Whether it’s in respect of survival rates in cardiac surgery or resection rates in lung cancer, the Society’s work follows a simple logic.</p> <p>Be open – and you improve safety.</p> <p>Communicate – and you reassure.</p> <p>Share knowledge – and you improve performance.</p> <p><strong>The value of information</strong></p> <p>A couple of centuries ago, the Duke of Wellington famously said ‘Publish and be damned’.</p> <p>Well, in recent years, you’ve proved the opposite: ‘Publish and be praised’.</p> <p>It is a motto I’ve held to throughout the seven years I’ve spent covering the health brief – and it’s now a clear motif in our modernisation plans.</p> <p>The conviction that through better information, stronger clinical auditing and a greater willingness to self-assess on the outcomes achieved, we can unlock higher clinical standards.</p> <p>A belief, frankly, that an open NHS is a safer NHS – and also, by definition, a more trusted NHS and a more empowering NHS.</p> <p>Because by putting information into the public domain, we give patients more control and more meaningful choice over how they’re treated.</p> <p>That’s why one of the first speeches I gave after getting this job was on the subject of outcomes and the information revolution.</p> <p>I want to make this a top order issue for the NHS, because I believe clinical auditing is such a powerful driver for clinical excellence.</p> <p>It does invite people to look at and compare their performance based on clinical parameters not tickbox rules and regulations.</p> <p>And it’s vital for improving accountability and public trust, which is something your report today quite rightly points out.</p> <p><strong>Cardiothoracic success</strong></p> <p>Over the last five years, cardio-thoracic surgeons have broken new ground in using outcome measurements to drive up clinical standards in the UK.</p> <p>You’ve shown that opening up your data and demonstrating variation in standards isn’t an admission of weakness, but a sign of strength.</p> <p>And the result is the steep improvements seen in cardiac care.</p> <p>Of uniformly high standards in mortality rates across all specialist cardiac centres in England.</p> <p>Of better survival rates than ever for older people undergoing heart surgery.</p> <p>Of quality improvements achieving real savings in bed days for procedures.</p> <p>According to today’s report, £5 million was saved on bed days for coronary artery bypass operations alone, set against an outlay of £1.5 million for clinical audits.</p> <p>Good quality information is also identifying the gaps – the areas for improvement across the system.</p> <p>We know there’s significant variation in waiting times for non-elective cardiac surgery.</p> <p>This is unacceptable for emergency cases, where delay can make a huge difference to a patient’s experience of care and the cost of the service.</p> <p>It gives the NHS a clear warning sign that this needs to be addressed.</p> <p>Thoracic surgery too is heading in the same direction.</p> <p>Some important work has been done to develop the risk models necessary for full clinical outcome reporting.</p> <p>From the data we do have, we know there is still significant variation in resection rates for lung cancer patients.</p> <p>It varies from under 5 per cent in some areas, to more than 25 per cent in others.</p> <p>It also varies by age. The proportion of patients who undergo surgery for lung cancer drops off after the age of 50 and virtually flat-lines once you reach 80.</p> <p>There may be good clinical grounds for this – but this information gives us cause to ask questions and find answers.</p> <p>And proper analysis based on outcomes will give us either the confidence that the right decisions are being made – or cause for action and redress if they’re not.</p> <p><strong>An 'Open Source' NHS</strong></p> <p>That’s why my message today is quite simple: where you lead, the rest of the NHS must follow.</p> <p>In the past, and in too many areas today, we still have a ‘closed circuit’ NHS, where clinicians hold information close to their chest.</p> <p>And yet you only have to look at how the world is changing around us to question that logic.</p> <p>Look at the huge potential opened up by new technology.</p> <p>Look at the exponential rise of the internet as an influence over people’s lives.</p> <p>And look at how open source standards and protocols have pushed the boundaries in IT and mobile telecommunications.</p> <p>They’ve pushed boundaries precisely because they’ve allowed experts to develop and improve a product together, through a free exchange of ideas.</p> <p>We need to apply the lessons of openness and transparency in health.</p> <p>If you like, we need an “open source” NHS as far as information is concerned.</p> <p>A health service that’s more transparent, more digitally adept and more willing to share knowledge across professional groups and with the public.</p> <p>That’s what I really mean by an information revolution: a free exchange of ideas, information and data to drive improvement and expand choice for the patient.</p> <p>Cardio-thoracic surgeons are pioneering it.</p> <p>Clinical audits must be at the heart of it.</p> <p><strong>Funding for Clinical Audits</strong></p> <p>That’s why in July’s White Paper, we said that we would extend national audits to more conditions and a wider range of interventions.</p> <p>Over the next year, we’ll make another £1.2 million available for up to four new national clinical audits.</p> <p>The National Clinical Audit Advisory Group, chaired by Professor Nick Black, will lead on advising us on which areas these audits will focus on.</p> <p>But we want topics that align well with the Outcomes Framework and have NICE Quality Standards in place.</p> <p>Because in essence, the clinical audit provides the missing piece in the jigsaw.</p> <p>The Outcomes Framework show us what we’re looking to achieve …</p> <p>The Quality Standard shows how we do it – what a high quality service looks like …</p> <p>And the Clinical Audit gives us the detail and the benchmarking necessary to achieve it …</p> <p><strong>Information for the public</strong></p> <p>This is vital for continuous professional improvement on the one hand.</p> <p>And, of course, it can also help us to give the public the information they need about their treatment.</p> <p>So we need to make this data accessible to the public. To make it something they can use to assess and shape decisions about their care</p> <p>I think the public portal that the Society has set up is excellent in this regard – a true pioneer of the kind of patient-friendly information I want to see across the NHS.</p> <p>I know there is still work to do on the long term funding of the portal – discussions about where it’s hosted, how it can form part of a more unified access point and so on. </p> <p>But that should not detract from the achievements so far – and neither should they prevent the cardiothoracic community pushing further ahead.</p> <p><strong>Building for the future</strong></p> <p>I think you have some firm foundations to build on.</p> <p>Funding for the Adult Cardiac Surgical Database is guaranteed for the next three years, and we are continuing to support national clinical leads who will help with the collection and analysis of audit data.</p> <p>Longer term, funding for clinical audits will be up to the NHS Commissioning Board to determine, but the path of our reforms means it’s likely to be a clear priority for commissioners.</p> <p>For instance, the data from the audits are vital for delivering outcomes in the Operating Framework, and I also expect audits will be used to revalidate consultants.</p> <p>So it’s no flight of fancy to suggest that all providers in the future will be required to have robust clinical audit systems in place as a condition of contracting for NHS services.</p> <p>Quite simply, without them, how else could a commissioner be certain they’re targeting their resources effectively?</p> <p>How can they be sure that taxpayer’s money is being used to achieve the very best outcomes for patients?</p> <p>It won’t happen overnight, but over time I want the whole NHS waking up to what you and others have already recognised – that good information and good analysis isn’t an add-on, but an essential component of a high quality service.</p> <p>Outcomes are one of these key purposes of reform. </p> <p>A focus on patients, with shared decision-making is another.</p> <p>The third purpose is empowered professionals.</p> <p>So, for me, the leadership which you have given and continue to provide is instrumental to the achievement of continuously improving healthcare in a modernised NHS.</p> <p><strong>Conclusion</strong></p> <p>In concluding let me say this.</p> <p>I know it’s uncomfortable to be the vanguard. I know the progress you’ve made is hard-fought. I know it occasionally ruffles feathers.</p> <p>But don’t let internal resistance put you off.</p> <p>I’m giving you a very clear green light as far as this Government is concerned: we absolutely want to see these sort of approaches applied and expanded across the NHS.</p> <p>Since I started off with the Iron Duke, let me end with the Iron Lady.</p> <p>Margaret Thatcher once said: “You may have to fight a battle more than once to win it.”</p> <p>As far as opening up the NHS, extending information and applying greater scrutiny to clinical outcomes goes, this is a battle worth fighting.</p> <p>And based on what I see coming out of this Society and its membership, it’s a battle you’re winning and I hope will continue to win.<br /></p> None Andrew Lansley CBE MP Society of Cardiothoracic Surgery Department of Health 2011-04-21
<p class="introText">Speech by Andrew Lansley, Secretary of State for Health, to NHS staff at Frimley Park Hospital in Surrey with the Prime Minister and Deputy Prime Minister</p> <p> </p> <p>There is no more important institution in this country than the NHS.  This is true for everyone, not least for me.  I am passionate about improving our NHS; for today and for generations to come.</p> <p>As David and Nick have said, there is widespread support for the principles of our proposals:<br />• For a patient-centred service with ‘No decision about me, without me’;<br />• For clinical leadership,<br />• And a relentless focus on what matters most, clinical outcomes and results for patients;</p> <p>But while there is agreement on the principles, people also have genuine concerns as to the detail.  So in the coming weeks we will pause, listen, reflect and improve with the professions and the public to make the Bill better in four areas. </p> <p>First, we need to make sure that we have the right sort of competition in the Health Service.  Not competition for its own sake, not cherry picking the lowest hanging fruit, not giving preference to the private sector over and above NHS or charities. </p> <p>Fair competition that delivers better outcomes for patients.</p> <p>Second, we need patients and the public to play an active role in the NHS.  Local decisions should not be made behind closed doors, but open to the genuine influence of the people they serve. </p> <p>Care should be integrated and designed around an individual’s needs.  The needs of the patient, not the convenience of the system, should come first. </p> <p>Third, commissioning should mean GPs coming together with their colleagues across the NHS – nurses, allied health professionals, hospital consultants – to design the best possible services for patients.  That is the idea.  The Bill must make this a reality.</p> <p>And finally, education and training.  The new NHS must build upon what works for the benefit of patients.</p> <p>Today heralds the first of a series of listening exercises and events with the Prime Minister, the Deputy Prime Minister and me.  This as a genuine opportunity to shape the future of the NHS.</p> <p>The NHS Future Panel, a team of top health professionals, will help lead the process and be chaired by Professor Steve Field, former head of the RCGP.</p> <p>And anyone can go to the Department of Health website to put forward their ideas on the four areas.</p> <p>By taking advantage of this natural pause in the legislative process, taking us up to late May or early June, we can be sure that we achieve what is our ultimate goal:<br />• a health service that is free;<br />• that is based on need and never a person’s ability to pay;<br />• and an NHS that, on what matters most – on outcomes for patients – is consistently among the very best in the world.</p> <p>I want to thank the more than 6,000 GP practices already taking the lead in improving local services and to thank the 90% of local authorities who are starting to bring a greater degree of local democratic accountability and coordination to the Health Service. </p> <p>I encourage everyone to take part in this and to help make the NHS as good as we know it can be.<br /></p> None Andrew Lansley CBE MP NHS Modernisation - Pause, listen, reflect and improve Department of Health 2011-04-06
<p class="introText">Andrew Lansley, Secretary of State for Health, speaks at HC2011, a conference for health and social care informaticians, ICT professionals and clinicians.</p> <p> </p> <p>Thank you Matthew [Swindells, Chair, BCS], Jim [Norton, President, BCS].</p> <p>I’d like to start by welcoming the work done by the BCS on the Information Revolution agenda.</p> <p>I can’t tell you how useful it was to have such forward-looking input – helping us to look to the future in terms of giving as many people as possible the ability to access information</p> <p><strong>Transparency and accountability</strong></p> <p>I want to begin with accountability.  A basic tenet of modern government is that it should be accountable to its people.  That it should be answerable for its actions and that there should be sufficient checks on it to ensure that it acts in the interests of the people and not in self-interest.</p> <p>The idea that for a government, or indeed any institution, to be truly effective it needs to be open to public scrutiny is not a new one.  However, the reality of this has been highly variable.  The extent of meaningful scrutiny has often been constrained by a lack of information, or by control of information by vested interests.  All that is changing as information access is rising exponentially.</p> <p>We live in an information age.  Information and data – once the preserve of the elite – is increasingly available for all.  Everything from what is happening anywhere in the world to real time market data.  Today, more information is available than at any other time in our history, sometimes for a price, but more often than not, for free.</p> <p>We have to be aware though. In economics, there is a ‘Gresham’s law’ that bad money drives out good.  People will get rid of poorer value currency and hold on to higher value currency.  If we are not careful, something similar could happen in information – the volume of freely available but poor quality data could drown out access to higher quality, useful, relevant data.  That is where a true information society should step in.</p> <p>Where information is a currency, and its value is understood, and appreciated.  By doing so, we can genuinely intensify accountability.</p> <p>I believe that real accountability, in all walks of life, but especially in public life and for public services, can only be achieved by being open and transparent about everything that we do; issues of national security or individual confidentiality apart.  That means not just having some privileged person able to police behaviour, but having the public able to scrutinise routinely.</p> <p>It is our task to ensure that not only are we transparent.  We should make information and data readily available, and also should ensure it is a good quality currency without seeking to control its exchange.<br />This kind of transparency is a founding principle of this Government.  For example, you can now go to the Number 10 website and, by clicking on the “Transparency” heading, see:</p> <p>• Details of everything the government spends above £25,000;<br />• A list of who does what in Whitehall and what they get paid;<br />• A list of current and up-coming government contracts;<br />• And a huge amount more besides.</p> <p><strong>A shift in thinking</strong></p> <p>Now this information will not be of use, or even of interest, to everyone, but whatever area you are interested in, you are now free to examine the data and to start asking awkward questions.  Holding us and future governments to account for the way we spend your money!</p> <p>This represents a fundamental shift in thinking.  Traditionally, as any fan of Yes, Minister will testify, governments of all colours have been somewhat backward at coming forward. </p> <p>But when we hide uncomfortable information, bury bad news and obfuscate the facts, we put our own interests before the public’s and we do them a terrible disservice in the process.</p> <p>In the NHS, poor performance can sometimes be hidden, excellent practice goes unnoticed and, in the worst case of all, someone like Harold Shipman is able to literally get away with murder for over 20 years.</p> <p>Openness and transparency is not easy.  It shows up our faults, it can sometimes lead to embarrassment.  But we are confident that, over time, it also leads to better decisions and better government.  And it is something that we are determined to see replicated across public services, within health and social care especially.</p> <p><strong>A mountain of data</strong></p> <p>The NHS, on any given day, produces a virtual mountain of data.  A million patients see hundreds of thousands of staff within hundreds of hospitals or GP practices and clinics across the country.  Huge sums of money are spent, countless thousands of tests are conducted, thousands of operations carried out and about 60,000 people in and out of A&amp;amp;E departments. </p> <p>And every single time that anything happens, a record is made.</p> <p>Instantaneously amassing and organising this data in years gone by would have been an impossible task.  Like King Canute holding back the tide.  But time, and technology, have changed that. </p> <p>Today, we can at least canalise the tide – and the potential benefits for patients are only limited by our imaginations.</p> <p><strong>The Information Strategy</strong></p> <p>This is what the Information Revolution is about – capturing the data and using the imagination and the creativity of clinicians, NHS staff and everyone here today to make the very best use of this incredible resource.</p> <p>As I said, getting the currency of information right means we should offer not just more information, but better information – more accessible, more relevant, more meaningful.</p> <p>It’s about turning that mountain of raw data into a coherent picture of quality.</p> <p>To measure and monitor the standard of NHS services.</p> <p>To hold professionals to account for their performance.</p> <p>And to bring the NHS fully into the digital age, by empowering patients and professionals through a free exchange of data and information.</p> <p>We consulted on our plans last year, and we’re currently reviewing what people have told us.</p> <p>I expect soon to publish the consultation response shortly, with an Information Strategy following shortly after that.</p> <p>The essential principles of our approach are clear.  We want a genuinely empowered and informed public, pushing up standards by exercising meaningful choice;</p> <p>We want an online presence for the NHS ranking among the best in the world for content and relevance.</p> <p>And we want to nurture and sustain a vibrant information ecology, taking in clinical audits and quality metrics, enabling clinicians to benchmark and improve the outcomes they secure.</p> <p>We’re mindful, of course, that the Information Strategy needs to learn from the past. </p> <p>We need to be clear as to the most appropriate roles for central government, for NHS organisations and for service providers from the private and voluntary sectors.</p> <p>And we need to think long term. The strategy needs to be robust, stable and flexible enough to meet the needs of the NHS for a generation or more, encouraging a more innovative and dynamic use of information to meet people’s needs. </p> <p>And there are big issues here:</p> <p>• Protecting privacy and confidentiality in an open world,<br />• The role of national standards in information sharing,<br />• The electronic recording of data throughout the patient pathway, in a way that allows it to be accessed readily by those who have a genuine need to do so,<br />• Developing a market place in information intermediation to drive innovation,<br />• Improved interoperability to connect systems together, and<br />• Better access to information for the public</p> <p>But get it right, and I believe a new NHS can emerge. </p> <p>• An NHS where patients not only have a choice, but the information and advice they need to make that choice. <br />• An NHS where we don’t just pay lip service to openness and transparency, but use the power of information to boost accountability and drive up standards.<br />• An NHS that routinely harnesses the massive amounts of aggregated patient data to drive forward clinical research in the fight against disease and ill health.</p> <p>This, surely, has to be the future to which we aspire: open, connected and digitally enabled.</p> <p>The question is how do we get there?</p> <p><strong>Harnessing the Care Record</strong></p> <p>A starting point is the effective capture, management and use of the huge volumes of patient data flowing through the NHS.</p> <p>This is a tremendous source of information – but most would agree that we haven’t yet come close to releasing its full potential. </p> <p>The single most important source of that data is the patient’s own care record, the data that’s recorded and updated as they progress through their treatment. </p> <p>Many real gains will come from being able to harness the full potential of this record.  To do that we need to improve the way this information is recorded, how it’s used and how it’s shared.</p> <p>When you visit your GP, you’ll see them typing up your notes while you’re still there in the consulting room.  But elsewhere things can be very different.</p> <p>Think of the inherent complexity of treating a typical hospital in-patient.  Multiple conditions, multiple diagnostics, multiple treatments.  Then multiply that complexity by a whole ward, add a gap between seeing a patient and writing up their notes and you start to see why it can be so difficult to keep a patient’s record 100% accurate.</p> <p>But what if a doctor or nurse could tap her lapel and record what they need to there and then?  Their voice could be translated into text for review and then added to the patient’s record. </p> <p>This is hardly beyond the realms of possibility and people are already using mobile devices like digital pens to improve and speed up record keeping.</p> <p>Better data, less form filling, superior care.</p> <p>And sharing this sort of success here at Healthcare 2011 or at last month’s Innovation Expo can really help to speed up the adoption process.</p> <p>And what if you could see and control your own data?  You would be free to look at, correct, even update it with things like your own wishes if the worst should happen. </p> <p>You could even choose to share it with those you trust, such as Cancer Research UK or the British Heart Foundation.</p> <p>While this sort of thing isn’t yet widespread, it is happening already. </p> <p>I mentioned Harold Shipman earlier.  Imagine the damage done in his area to the trusted doctor/ patient relationship.  Imagine being the doctor who had to come in and replace him.</p> <p>Well that doctor was Dr Amir Hannan.  Where Shipman was secretive and closed, Dr Hannan has been as open and transparent as possible and has slowly but steadily been able to rebuild that trust within his community.</p> <p>His patients have access to their own records online, they can email him, he has built online condition support groups and he has put information and transparency at the core of his care for patients.</p> <p>If transparency can heal the rift left by Shipman, just think what it can do elsewhere.</p> <p><strong>Data Sharing and Clinical Audit</strong></p> <p>And care records can be even more useful when anonymised and combined.  The potential to use this mass of data, the largest data set anywhere in the world, for research purposes are hard to overstate.  It could herald the start of a clinical revolution to mirror the information revolution. </p> <p>While there are, understandably, concerns over privacy – information must be accessed securely and legally and without causing harm – I believe these concerns are surmountable with a good dose of practicality and common sense.  They should not stand in the way of the very real potential benefits that data sharing can bring.</p> <p>For the last decade, cardiac surgeons have collected, analysed and published data on the outcomes of their care.  This benchmarking of their performance across the NHS has shed light on good and bad practice, encouraging all cardiac units to focus on self-improvement. </p> <p>The result?  Over the last five years, death rates have halved and are now 25 per cent lower than the European average.  You now have a greater chance of surviving cardiac surgery in England than in almost any other European country.</p> <p>At the very least, this sort of information makes clinicians stop and ask themselves if they really are as good as they could be.  And that can only lead to better care for patients.</p> <p><strong>Information for patients</strong></p> <p>Another area where the potential benefits are huge is more comparable information about hospitals for patients.  There are thousands of care providers in England.  When you go to yours, how do you know how good they are?  Are they the very best in the country?  Or the very worst?</p> <p>We already have a choice of which hospital can treat us, but how do we know whether one hospital is better than another?  At the moment, that’s a hard question to answer.  But in the future, it will be through published data about the quality of their health outcomes. </p> <p>Not polishing, not spinning, just publishing.  Letting good quality data tell the story and allowing a whole range of intermediaries interpret it.</p> <p>This will have two equally powerful effects.  First, providers themselves will see clearly just how well they are performing against their peers. </p> <p>And second, patients will be able to use this information to directly improve their own care.</p> <p>Let’s say that you – or your child, or your parent – have to go into hospital for some form of treatment.  With no information to go on, you will probably opt for your nearest hospital or at least the one that your GP refers you to.  But your GP won’t necessarily know any better than you whether it is the best place for you or not.</p> <p>But if you have clear, easy to understand information about the quality of the care that different providers offer – the outcomes they deliver – then the situation becomes very different. </p> <p>Do you really want to go to your nearest hospital when the care it provides is worse than ones further away?  Do you really put convenience above your own health?  Above your child’s health?</p> <p>It’s your choice.  Armed with this information, you will become an active participant in your own care.  There really will be no decision about me, without me.</p> <p>You can see it in everything from booking holidays to choosing a new mobile phone; when people have a choice and access to information they quickly become savvy consumers.  I am certain the same will happen for healthcare, surely the most important aspect of all of our lives.  And as the NHS provides everything for free, the choice will be one based solely on the quality of service and outcomes a provider can deliver. </p> <p><strong>Superfast Broadband</strong><br /></p> <p>The Information Strategy will spark a revolution in patient care.  It will create the structure within which the NHS can improve in leaps and bounds.  But even the most elegantly designed structure will collapse eventually if it is not underpinned by firm foundations. </p> <p>The UK has experienced an explosion in internet usage in recent years.  The majority of businesses, homes and now individual people are connected in some way.  Being a particularly technology-literate audience, you will know more than most just what an incredible impact this has had on our economy, our society and our home lives. </p> <p>But we are still at the beginning of this new industrial revolution and, like revolutions past, we need the basic infrastructure to be in place if we are to reap the rewards. </p> <p>First came the canals, then the railways, more recently the motorways and now it’s superfast broadband.</p> <p>This government wants to bring this to every community in the country.  To have the best superfast broadband in Europe by 2015.</p> <p>Much of this is set to happen as companies like BT and Virgin roll out more and more cable to the parts of the country where it makes commercial sense. </p> <p>But without government support, that will still leave as much as a third of the population beyond its reach.</p> <p>That is why, in last year’s spending review, we announced £530 million to help cover the entire population.  Not to fund the extension all together, but to make the sums add up for private investors.  To plug the gap.</p> <p><strong>Unlimited ambition</strong></p> <p>Now the role of government should be to ensure a good minimum – 40 meg or so, but why should the industry stop at 40?  Why not 400 or even 1,000? </p> <p>Some may argue that there is no need for most people to have services of such speed or capacity. <br />But I’m sure many of you will remember that people said the same thing 10 years ago – only then they said that nobody would ever need more than 1 mega bit per second! </p> <p>Or, to use another analogy, think of the M25.  When it was first designed, its planners wanted to build a motorway far wider than just three lanes.  But the Treasury said no.  They said there just wasn’t the  demand for such a huge road.  What a short-sighted mistake that was.  And we’ve been playing a hugely expensive game of catch-up ever since, much to the constant annoyance of anyone who uses it.</p> <p>To misquote Ray Liotta in ‘Field of Dreams’, “Build it, and they will come.”<br /></p> <p><strong>Telehealth and Telecare</strong></p> <p>But whatever the services of the future may be, there are real benefits that the internet is delivering today. </p> <p>Over 80% of patient interactions with the NHS are face-to-face.  Have you, or someone you know, ever been to see your doctor, for example to pick up some test results that came back negative, and wondered why you had to take half a day off work just for that?</p> <p>No other industry works in such a way, and by effectively using modern communications technologies, there is no reason why the NHS should either.  And moving just 1% of those face-to-face meetings online would save the Health Service around £250 million a year.</p> <p>There are huge potential benefits to taking more consultations online using things like high quality video conferencing and home-based monitoring equipment. </p> <p>• Rather than time-consuming visits to see a GP, the GP can come to you, virtually, in your own home. <br />• Rather than travelling long distances to talk with a specialist, they can talk with you instantly, including potentially with them having immediate access to vital signs or diagnostics <br />• And rather than having to make regular visits to see a nurse for routine testing, you can be trained to monitor your own condition, or have equipment installed that will do it automatically, and update your records remotely.</p> <p>We are in the process of concluding the world’s largest pilot of telehealth and telecare – the Whole System Demonstrator.  This is an incredibly exciting programme that will provide vital information on the effectiveness of the range of technologies that can help people remain independent. </p> <p>Increased use of technology will mean millions of people in years to come will be able to stay in their own home and avoid unnecessary hospital visits or being forced into residential care. </p> <p>For those in the pilot, it has already changed their lives.  One of the three main sites is in Cornwall, where one participant, Eddie, from Looe, has had a lung problem that not only meant he was house bound, he was also a regular visitor to A&amp;amp;E – attending 5 times in the 6 months before he joined the pilot.</p> <p>But by having telehealth equipment installed in his cottage, he can now monitor his own oxygen levels and blood pressure and take appropriate action when needed.  The confidence this has given him means he is now venturing beyond his front door for the first time in 5 years.</p> <p>Simple changes, and an extraordinary difference.</p> <p>Most of these services will work well enough with a good, reliable, current generation broadband service.  But widespread availability of superfast broadband will not only make it easier to roll these services out to the community, it brings with it the potential for entrepreneurs inside and outside the NHS to develop new services and explore new ways to serve patients and to save money.</p> <p>And there are significant gains to be made for community-based staff, giving them all the information they need whenever they need it. </p> <p>Just like in Kirklees in Yorkshire, where community matrons use hard wearing and secure laptops in their discussions with patients, to arrange for prescription changes and to cut out unnecessary visits for them and for their patients.<br />Openness of the market</p> <p>But just as we want to bring openness to the NHS, we also need to bring openness to the way we do IT in the Health Service.  The old way of centrally planned, fiendishly complicated billion pound contracts with a small number of providers just didn’t work.  One size does not fit all.</p> <p>So in the same way as we want to open the market for healthcare up to any qualified provider – whether from the public or private sector, a social enterprise or a charity – so do we want to open the IT market up to any provider, large or small, who can help deliver better care for NHS patients.</p> <p>I was at the NHS Expo earlier this month, and there was a real buzz about the potential of joining up data across the NHS.  There were dozens of companies each with exciting ideas about how they can help clinicians to improve patient outcomes. </p> <p>Large ones like Intel who were extolling the possibilities of secure ‘cloud-based’ computing for health, or Cap Gemini with their RAPA electronic patient alert system that notifies a designated worker, such as a GP or specialist, as soon as their patient walks into A&amp;amp;E.</p> <p>And smaller companies like Sandhill with their commissioning management software or NDL with their Blackberry app that helps community staff in the field to organise, record and synchronise their day on the road with the care records back at the surgery.</p> <p>There are so many organisations out there with so many ideas.  I want to give all of them the chance to prove themselves for the benefit of patients.</p> <p><strong>Conclusion – No decision about me, without me</strong></p> <p>Over the next few years, I look towards a modernised NHS.  Outcome focussed, clinically led and patient centred.</p> <p>By publishing outcomes data for all to see, we will change the culture of the National Health Service.  On the clinical side, providers will be held to account for the quality of the care they provide.  They will have the hard data to see how they are performing against their peers and the incentives to improve their performance.</p> <p>But an even greater culture shift will be for those who use the NHS.  For the first time we will open the door on the ‘secret garden’ philosophy that has hidden the performance of the NHS, and held it back since the Service was founded.</p> <p>We will give patients the information:<br />• that can reveal the true picture of local services,<br />• that can enable patients effectively to choose who to trust with their own care,<br />• that can involve them in the decisions to be taken about their own treatment</p> <p>For there truly to be “no decision about me, without me.”</p> <p>Thank you.<br /></p> None Andrew Lansley CBE MP British Computing Society - ‘No decision about me, without me: Information and Empowerment’ Department of Health 2011-04-05
<p>Together, with social enterprises inside the NHS, and working with the NHS, we can do something extraordinary in the years ahead.</p> <p>We can create, for the people in this country, the assurance that – whatever their means, whatever their needs – they will have access to one of the finest healthcare systems anywhere in the world.</p> <p>And the assurance that we can deliver for our country some of the best health, anywhere in the world.</p> <p>But if we’re going to do that, we need to empower people, we need to empower patients, we need to empower care users, we need to empower those who care for them.</p> <p>In doing this, I want social enterprise and employee ownership models to be a leading feature in health and social care provision.</p> <p><strong>Principles of reform</strong></p> <p>Healthcare, when all’s said and done, is about people.</p> <p>It’s about caring for people. And it’s caring about them.</p> <p>As David Cameron put it, the NHS isn’t a machine, it’s a living and breathing organisation.</p> <p>It draws its strength from the strong human relationships and interactions that exist within it and across it.</p> <p>People depend on the NHS, just as the NHS depends upon people.</p> <p>And so when we talk about the Big Society …</p> <p>When we talk about pluralism, or patient-centred care, or any of the language that goes with this debate …</p> <p>We’re actually talking about something very straightforward: strengthening human bonds, the relationships, and the vital connections which individuals and the service rely upon.</p> <p>And for the health system, I think that means doing three things in particular – three things that are central to our plans.</p> <p>First, to give people more choice over how and where they’re treated; give them more information to inform that choice.</p> <p>Let me be clear: a process of shared decision-making, between patients and care users, and those who care for them.</p> <p>What Tuckett described as ‘the meeting of experts’.</p> <p>In the health service we have experts who understand diagnosis and treatment, and patients are experts about themselves.</p> <p>So let’s bring those experts together.</p> <p>Let’s make sure that for everybody looked after by the NHS, the principle of ‘no decision about me, without me’ is a reality.</p> <p>Second, we have to empower communities so that local people have a greater say in how their health services operate for them.</p> <p>We’re doing this through the new HealthWatch organisations, the shift in commissioning to General Practice-led consortia and the increased role of local authorities.</p> <p>And third, we need to return power to the frontline professionals on a grand scale.</p> <p>Giving people control.</p> <p>Giving them permission to innovate and improve on behalf of the patients they serve.</p> <p>Focusing on outcomes, focusing on quality.</p> <p>And this is where social enterprise and employee ownership models come into their own.</p> <p>Because as good as the NHS is, I think it can be better.</p> <p>We have improved; we know we can improve further.</p> <p>To do that, we should look critically and openly at what we can do better, and at who can bring new ideas and new ways of working to the NHS and to healthcare.</p> <p>We have to compare results.</p> <p>We have to reduce the variation – variation that exposes poor performance and lack of productivity. </p> <p>And we have to foster the enterprise and innovation which is the hallmark of all successful organisations.</p> <p>Frankly, I don’t think it’s about public sector versus private sector vs voluntary sector.</p> <p>It’s about the characteristics of successful organisations.</p> <p>And I’ve seen some those characteristics in social enterprises.</p> <p>Take for example when I was in Tower Hamlets with WhizzKids, a voluntary sector organisation applying themselves in order to give great services, focussing on the people you’re serving.</p> <p>They designed what they did around the needs of young wheelchair users.</p> <p>And it wasn’t just that the wheelchair users got the service they need, when they needed it, but it cost 60% less than it had done under the previous arrangements.</p> <p>And for every pound spent on Whizzkidz services, you get up to £65 back in social value – because of the social, environmental and economic benefits of good wheelchair access for young people.</p> <p>There is very clear evidence of how the business model, the social enterprise model that you represent, really does deliver.</p> <p>Before the election, I helped to launch a study into the economic and business impacts of a social enterprise model, on behalf of the Employee Ownership Association together with John Lewis Partnership and Circle Health Partners.</p> <p>It demonstrated very clearly that where you have employee ownership and strong employee participation together, you get better results. More initiative and innovation. Better retention and morale. Higher standards and a strong commitment to excellence.</p> <p>And it’s that commitment to excellence which I believe must be at the heart of our NHS. Over those several years, I visited hundreds of hospitals and clinics over the last seven years.</p> <p>I talked to thousands of NHS staff.</p> <p>One message above all others came home to me.</p> <p>It was people saying:</p> <p>“Look, we could do our jobs much better if you gave us room to breathe …</p> <p>If there was less bureaucracy and political micro management…</p> <p>If we felt our voice was heard …</p> <p>If we didn’t have to jump through so many hoops to make good ideas happen…</p> <p>If only they would listen to us, we would do it much better.”</p> <p>Well, of course, the ‘they’ is now me. And I do intend to listen.</p> <p>And the first message I’ve heard is that people want to take greater ownership of the service they deliver, because they really feel they can deliver better for the patients and the care users they look after.</p> <p>So I want to give doctors, nurses and other health professionals the autonomy and discretion that their expertise and training deserves.</p> <p>I want to end the arrogance that suggests that the men and women from Whitehall – and still less we politicians – know better than professionals living and breathing the realities of healthcare day-to-day.</p> <p><strong>The value of social enterprise</strong></p> <p>So if micromanagement has been a malady in the NHS, then social enterprise models can be a cure.</p> <p>Why?</p> <p>Well, as someone put it me, being part of a social enterprise means you respond with “how I can” rather than “why I can’t”.</p> <p>Social enterprise is liberating. It’s inspiring. It projects a ‘can-do’ ethos which we need in a modern health service, and in modern public services.</p> <p>But, above all, it really delivers for people.</p> <p>It delivers because those most in tune, most directly in contact with a person’s needs, are put directly in charge of the services that meet them.</p> <p>It gives them the capacity to do things the traditional NHS simply couldn’t comprehend.</p> <p>And that is a change we’re seeing around the country.</p> <p>If you drive up the M1 to Leicester, you can visit Inclusion Healthcare service in the city.</p> <p>Not only does it operate as a successful GP-led drop-in centre for homeless people.</p> <p>It also works with other local agencies to run numeracy and literacy skills and computer training sessions for its clients.</p> <p>It’s doing more than returning people to health, it’s helping them return to employment too.</p> <p>Or head up the M6 and visit the brilliantly named Social AdVentures in Salford.</p> <p>Go and see its ‘Change4Life on Prescription’ programme, which works with community gardening centres to help people with depression and anxiety to spend time in the fresh air, honing their gardening skills.</p> <p>Or for a social enterprise on a grander scale, go across the Pennines to the City Health Care Partnership in Hull.</p> <p>There, more than a thousand front line health professionals have worked at arms length from the PCT since 2008.</p> <p>As well as giving staff a greater sense of belonging and control, it’s allowing the organisation to offer a small grants scheme for local voluntary and community groups.</p> <p>And so the health improvement work it supports isn’t formulaic, isn’t straight-off-the-shelf.</p> <p>It’s targeted and personalised at a neighbourhood level.</p> <p>It’s support for local people, designed and delivered by local people.</p> <p>And that makes all the difference.</p> <p><strong>Right to request</strong></p> <p>There are many more out there, doing similar things.</p> <p>All of them flourishing through the Right to Request programme, which has accelerated over recent months.</p> <p>As I’ve been able to announce since the election, more than 50 organisations inside the NHS are breaking away from PCT control and reinventing themselves as social enterprises.</p> <p>To give you a sense of scale, it means a tenth of the entire NHS budget for community services will be delivered by social enterprise in the years ahead. That’s nearly 25,000 staff.</p> <p><strong>Right to provide</strong></p> <p>However, the original Right To Request programme had a narrow base.</p> <p>It only covered community services, which is only one side of the coin as far as health services are concerned.</p> <p>We now want to broaden this out. To offer the same opportunities for the rest of the health and social care sector.</p> <p>Today, I’m publishing a new guide on the “Right to Provide” programme, the sister scheme for Right to Request.</p> <p>It formalises our commitment to allow any group of people within the NHS to set up as independent, employee-led organisations, and it opens up potential on a much greater scale.</p> <p>We want to attract the people who know things can be done better, and who have the skills and expertise to make it happen.</p> <p>One example would be a group of professionals involved in diabetes care, who might want to come together to deliver a multidisciplinary service within one organisation.</p> <p>It's the opportunity to break down the professional silos, and the organisational silos, and redesign organisation and delivery around the needs of patients.</p> <p><strong>Financial support</strong></p> <p>So we do want to sow the seeds of social enterprise more widely.</p> <p>But as any gardener will say, the best blooms only come when you nurture and nourish the seedlings.</p> <p>We need make sure any new organisations get the best possible start, and that the environment is conducive to future growth.</p> <p>That’s why I’m pleased to say we will be putting at least £10m this year into the Social Enterprise Investment Fund.</p> <p>The Fund has helped more than 400 organisations to date, giving them the springboard to self-sufficiency.</p> <p>We’re making the funding available to help many more get themselves up and running over the next 12 months.</p> <p><strong>Any qualified provider</strong></p> <p>We’re also going further in allowing social enterprises to gain a strong foothold in the NHS.</p> <p>In recent years, there’s been a tendency for the NHS to be a secret garden, where ideas don’t come out and new providers don’t come in.</p> <p>We need to make sure that we use all of the enterprise, innovation and expertise that we can, to deliver the best possible care for patients. I don’t want to see social enterprise and voluntary groups left out in the cold.</p> <p>We will not give preference to incumbent NHS providers.</p> <p>Where competition has existed in the past, it’s been lost in a kafka-esque world of bureaucracy that people have to journey through.</p> <p>So I want to change this – to simplify, to streamline, to throw open the doors to any organisation that can improve quality and effectiveness in the health service.</p> <p>Now, in the past we’ve talked about “any willing provider”. What we’re saying now is “any qualified provider” can do so.</p> <p>It’s a subtle change, but it’s more than just semantics.</p> <p>The terminology reflects our commitment to put quality at the heart of choice.</p> <p>“Any qualified provider” means an end to the complicated and costly tendering processes that blocked many from providing services.</p> <p>In their place, most organisations will undergo a simple, once-only qualification process for providing health services.</p> <p>Once you’re qualified, once you’re on the list, the power is where it should be.</p> <p>Not with administrators or managers running tendering process or trying to allocate patients to organisations.</p> <p>But with patients and their GPs, or their referring physician, choosing the best service for them – and doing so always on the basis of quality, and never on the basis of price. Price will have been established through national and local tariff arrangements. So at the point of referral, the issue is only one of quality.</p> <p>It’s a simpler, fairer, more open way of working.</p> <p>I expect people won’t understand change.</p> <p>They always scaremonger and mutter darkly about backdoor privatisation, or the break-up of the NHS as we know it.</p> <p>It is not that.</p> <p>The NHS will continue to be absolutely based on its founding principles, of a comprehensive service available to all based on their needs.</p> <p>It will be not more fragmented than in the past, but less fragmented.</p> <p>Less fragmented because it will be designed increasingly around the needs of patients, bringing more opportunities for integrating services.</p> <p>And in that context, NHS providers have the chance to succeed, because we will give them the opportunity to be more enterprising and more innovating.</p> <p>I think that inside the NHS we have an immense number of people and organisations potentially that themselves can embrace the social enterprise model.</p> <p>And I don’t think we’ll see radical changes in the shape of provision, but I do hope we will see really positive change in the relationship between people and the service that is provided to them.</p> <p>Public services should constantly be open to the test: are they delivering the best quality care.</p> <p>What we want is quite simple. A fair playing field for all providers to compete – always on quality, not on price – to make the NHS the very best it can be.</p> <p>And if you want my personal hunch, it’s not private businesses that stand to benefit most from this. It’s actually the voluntary sector and social enterprises with pre-existing relationships with patients and communities.</p> <p>They’re the ones who will have the greatest potential in these arrangements– and ultimately the greatest potential for patients.</p> <p><strong>Conclusion</strong></p> <p>So let me conclude with a final thought.</p> <p>People love to pour scorn on the Big Society, to be cynical about it and say it’s a sound bite. They say it lacks definition.</p> <p>We’ve always known – David has always known – that we didn’t invent the big society in May last year, we’ve embraced the Big Society. It has existed. It does exist.</p> <p>The point is to give people greater opportunity in the future.</p> <p>What we’re doing in the health service really demonstrates that. We’re showing tangible commitment by this Government to improve public services by embracing new providers.</p> <p>We see social enterprise and employee led models from outside the NHS and from within the NHS, alongside charities and voluntary groups as the key players.</p> <p>Vital for shaping the future.</p> <p>Vital for securing better outcomes.</p> <p>Vital for strengthening NHS values, never to undermine them.</p> <p>We know these organisations can work. Social enterprise is an obvious business model for a social market.</p> <p>We know they can deliver – for patients and staff alike.</p> <p>With your help, I think we can make social enterprises a mainstay of health and social care in the years ahead.</p> <p>Tremendous possibilities lie ahead. Exciting times. And challenges, many challenges.</p> <p>But I believe that together we can overcome those challenges and realise those ambitions.</p> <p>The best possible health service, the best possible care, for the people whom we all look after.<br /></p> None Andrew Lansley CBE MP speech to the Voice 11 social enterprise conference Department of Health 2011-03-30 speech to the Voice 11 social enterprise conference
<p>My message is quite simple really. As Ken said, we can and must do better.</p> <p>Janice’s story is tragic in so many ways.</p> <p>It was tragic for the young man himself, when you think about the desperate way in which he ended his life.</p> <p>It’s tragic for the family coming to terms with what happened, the terrible grief that comes from the death of their son under these circumstances.</p> <p>But it’s tragic on a broader level too.</p> <p>Tragic in terms of what these stories say about the performance of our public services.</p> <p>They dramatise, in the most desperate way, what happens when you have a divided system.</p> <p>Now I’m not going to stand here and say ‘everything is awful’ because actually I think there’ve been some important developments in recent years.</p> <p>The relationship built between the NHS and the National Offender Management Service, in particular, shows real promise for the future.</p> <p>As do the excellent advances in prison IT –absolutely fundamental for connecting services and sharing information when someone moves between prisons.</p> <p>But if this whole campaign – your campaign –  demonstrates one thing, it is that we can’t just tinker around the edges.</p> <p>We do need wholesale and deep-rooted change in our public services.</p> <p>We need to unify systems and unite professionals involved in offender care.</p> <p>We need to streamline and scrap excess bureaucracy.</p> <p>We need to align health, social care and criminal justice around the shared pursuit of better outcomes.</p> <p>Above all though, I think we have to reflect on a harsh, perhaps unpalatable, truth for our society and public services.</p> <p>Because when people with severe but manageable mental health problems end up in custody, it’s actually a judgement on all parts of the system.</p> <p>It shows both the formal and informal structures of care and support have broken down and failed to protect them.</p> <p>And in facing up to this truth, we cannot and must not fail them again once they’re within the criminal justice system.</p> <p>So yes, public safety comes first.</p> <p>Yes, in some cases, custody will be the only option.</p> <p>But true justice for the most vulnerable is about drawing them into treatment, not pushing them away from the support they need.</p> <p>Ken and I agree wholeheartedly about this, and  officials across our two Departments are working together in partnership to make it a reality.</p> <p>We now have a genuine cross-Government strategy for mental health – launched in this very building earlier this year – which has some very clear messages.</p> <p>- That people should get the same quality of healthcare services in prison as they do in the community.<br />- That we have to do more in early intervention, to support children and young people before they reach crisis point.<br />- And that, across all age groups, we need diversion services to be a cornerstone of better care and support for offenders with mental health problems.</p> <p>Which is why, in this year, we will be putting £3 million into up to 40 diversion sites for adults, and £2 million for up to 60 sites for young people.</p> <p>This is to kick start progress. It will help us to understand what works best to shape rapid progress to achieve, as Ken said, a national diversion scheme from 2014.</p> <p>We’re also doing all we can to simplify and streamline the commissioning process.</p> <p>The NHS will continue to be responsible for health care in prisons.</p> <p>But it will be the national NHS commissioning board, rather than Primary Care Trusts individually, who take the lead and judge performance against indicators in the NHS Outcomes Framework.</p> <p>What does that mean? It means greater consistency in commissioning. Clearer expectations around standards. Stronger clinical leadership to make sure policies are built on evidence.</p> <p>But it also means respecting that different areas have different circumstances.</p> <p>So the Commissioning Board will work closely with GP-led Consortia to understand and respond to their local and regional pressures.</p> <p>And local authorities will support this too. They will take a key role as shapers of community health – again helping to bring people together to support local needs.</p> <p>Finally, we will continue to work with the Home Office very closely, and stimulating closer working between the local NHS and the Police, and criminal justice agencies.</p> <p>As well as improving health outcomes for detainees, this can help us to free up vital police time for other things.</p> <p>So the message couldn’t be clearer.</p> <p>We are listening carefully to what you’re telling us.</p> <p>We are determined to bring a new impetus to improving offender health and wellbeing.</p> <p>We do need to do better, to prevent future tragedies.</p> <p>And, with your help, I believe we can.</p> None Andrew Lansley CBE MP speech to the Women's Institute 'Care Not Custody' reception Department of Health 2011-03-28 speech to the Women's Institute 'Care Not Custody' reception
<p class="introText">Andrew Lansley, Secretary of State for Health, addresses Healthcare Scientists.</p> <p>CHECK AGAINST DELIVERY</p> <p>Since its foundation, the National Health Service has improved and saved the lives of countless numbers of men, women and children.  The lion’s share of credit for this has always gone to the doctors and nurses who, most of the time, are the public face of the NHS. </p> <p>But as every one of them will readily admit, healthcare is not an individual pursuit but a team effort.</p> <p>One of the most important members of the NHS team, but one that often little known to the public, are healthcare scientists. </p> <p>So I want to start by paying tribute to all of you who do so much to make the National Health Service what it is.</p> <p>To the microbiologists, clinical biochemists and toxicologists who analyse and interpret the body and its fluids.</p> <p>To the embryologists who help to create life.</p> <p>To the audiologists, cardiac and respiratory scientists who diagnose and assess the impact of disease on the main organs of the body.</p> <p>To the engineers, the physicists and the technicians who design, build and operate some of our most advanced technologies.</p> <p>To the people who work in NHS Blood and Transplant, who deliver  a service so vital for the success of so much that happens within the NHS.</p> <p>To the people in the Health Protection Agency who help to protect us from infectious diseases.</p> <p>To all healthcare scientists, all of you working hard to further our understanding of medicine, to improve the quality of treatment and to help make people’s lives better... thank you.</p> <p>The incredible range of stories told in last year’s book, ‘Extraordinary You’, highlighted just the tip of this iceberg of the talent that exists in the NHS.</p> <p>When healthcare scientists come forward and tell their stories, people quickly comprehend the true depth of their contribution to the Health Service.</p> <p>So I was so pleased to see that Professor Nick Stone from Gloucester was one of the key speakers at the recent NHS Innovation Expo, talking about his exciting work to harness the potential of biophotonics</p> <p>Across the country, it is healthcare scientists as much as any other group who make the National Health Service as successful, as innovative and as effective as it is.<br />But despite its successes, there is still so much the NHS can do, and needs to do, better.</p> <p>We need to have more diagnostics in the right place at the right time to deliver the outcomes that people expect from the NHS –reducing mortality and improving morbidity</p> <p>We also need more diagnostics to keep the country safe from the constant challenges of evolving infections – from the latest flu outbreak to bacteria such as e-coli O-157.</p> <p>We also need you – the healthcare science workforce – to deliver the very specialist treatments that we are so good at pioneering. </p> <p>Healthcare scientists combine the research skills of pure scientists with the patient-focus of front line NHS staff.</p> <p>And you have the collaborative skills we need, so often working with academic teams and companies large and small to deliver a track record of innovation that is the envy of the world.</p> <p>Science and scientists already drive many of the advances made in medicine.  But I believe your role will become even more important in the coming years.</p> <p><strong>Clinical Leadership</strong></p> <p>It may sound odd coming from a Health Secretary, but I don’t believe I should be the one running the Health Service.  I’ve been responsible for health policy, first in opposition and now in government, for many years now. </p> <p>I have met with and listened to countless doctors, nurses, healthcare scientists and other healthcare professionals.  I am passionately committed to the NHS and like to think that I have a deeper understanding of it than most of my colleagues. </p> <p>But I’m not a clinician. </p> <p>When it comes to making decisions about how to improve services for COPD or asthma, how to reduce emergency hospital admissions or to improve the diagnosis and treatment of cancer, I have little to add.  So how ridiculous that I am the one in charge.</p> <p>I think that the role of the Health Secretary should be to set the strategic direction for the Health Service, to focus it on achieving what matters most for patients – health outcomes – and then holding it to account for those outcomes.</p> <p>It should be the health professionals themselves who lead the NHS from within.  I want to leave the NHS to get on with delivering better healthcare as only it know how.</p> <p>As General Patton once said, “Don't tell people how to do things, tell them what to do and let them surprise you with their results.”</p> <p>And so, even before the Health Bill makes its way through Parliament, real power is shifting away from Whitehall and down to the front line. </p> <p>Down to clinicians who will lead on designing and commissioning local health services, and down to providers free to run themselves in a way that they feel can best improve care for patients.</p> <p>This process, of devolving responsibility to the lowest level will, I believe, unleash an explosion of creativity and innovation.  And it is a process in which scientists will play a big part.</p> <p>This is why of the regional networks, led by a Senior Lead Scientist and working closely with Sue as Chief Scientific Officer, are so important.  They will help to ensure that healthcare scientists have a clear voice, build strong links within their local communities and engage with GPs and other clinical colleagues at a local level. </p> <p>They will help to make sure that your skills, your abilitiesyou’re your experience help shape the new NHS.</p> <p><strong>Clinical Commissioning</strong></p> <p>General Practice-led commissioning is not about GPs making all the decisions.  It’s about clinicians of all sorts coming together to decide the best way of dealing with particular health problems. </p> <p>Decisions will be made locally about how best to design, organise and improve services.  These decisions won’t be as clinically robust if healthcare scientists are left out of the loop.</p> <p>You can add tremendous value when it comes to local commissioning decisions.</p> <p>This is another area where your knowledge, expertise and application can add real value to local commissioning decisions.</p> <p>The Audiology report, ‘Shaping the Future’, launched later at this conference, shows how scientists – keeping a strong focus on the patient – can help to redesign pathways to increase the quality of care and experience for patients while delivering efficiencies for the NHS .</p> <p>This work shows how delivering care closer to home, delivering services in the community and delivering new models of care, such as direct access to healthcare scientist-led clinics, can transform the quality of services to patients.</p> <p>Likewise the work that will be presented here on improving cytology services, reducing turnaround times to just two weeks, is a massive step forward in the quality of care that women can expect to receive, while at the same time delivering efficiencies in the service</p> <p>I've asked Sue, as Chief Scientific Officer, to work with the emerging consortia to help them to better understand and unlock the true potential of diagnostics and scientific services.  And I am sure that you will all be supporting this work locally  <br /></p> <p><strong>Providers</strong></p> <p>But as you know, commissioning is only one part of our plans to modernise the Health Service.  We will also open out the provision of healthcare to any willing provider.</p> <p>Now I know that some of you worry that any willing provider is shorthand for private companies coming in and doing everything on the cheap.  Undercutting the NHS and delivering poorer quality care for patients.  This just isn’t the case.</p> <p>Any willing provider means that different providers – from the NHS, the independent sector or social enterprises, will compete against each other on the quality of the service they can offer. </p> <p>Locally or nationally, the prices are fixed.  One organisation cannot undercut another, because everyone will get paid the same pre-determined amount.  The only way to differentiate yourself will be to do a better job that of your rivals.</p> <p>Any willing provider is not a race to the bottom on price, but a race to the top on quality.  And healthcare scientists will be essential in this race – you focus on quality through your training, your culture and through the way you deliver in practice.  You will be an important part of measuring and monitoring that quality for the commissioning of NHS services.</p> <p>And you will be equally as important within individual providers.  The Health Bill will grant hospitals the freedoms they need to innovate and improve without the bureaucratic roadblocks of PCTs and SHAs breathing down your necks.</p> <p>If you, your department or your team has an idea for how you can deliver better patient care, how you can work more efficiently, how you can improve health outcomes, then you will can go ahead and do it.  You will be free to innovate, to use you skills and your imagination for the benefit of patients.</p> <p><strong>Leadership</strong><br /></p> <p>These changes more than anything else, require leadership.  They require people to stand up and be counted.  People like you.</p> <p>Everyone in this room has something they can bring to the table.  Be it expertise, experience or new ideas.  But it will be wasted if do not join in.</p> <p>So where local commissioning decisions are being made, make sure you are part of that conversation. </p> <p>If you’re based in a hospital, make sure your ideas for how to improve the service you provide are heard.  Knock on doors.  Don’t be afraid to make a nuisance of yourselves, you’re just the sort of nuisance the NHS needs!<br />Spin Outs</p> <p>And if you have an idea that you are passionate about and that you think could be of real benefit to the whole of the NHS, why not think about doing what David Gow did. </p> <p>In 2002, David set up TouchBionics, the NHS’s first spin-out company.  As a medical engineer specialising in prosthetic limbs, he was frustrated at how the benefits of his advanced research were not helping many actual patients.  So he patented his ProDigits device and has now supplied hundreds of these to patients around the world.</p> <p>This sort of thing is going to get an awful lot easier.  Especially as the way we pay for NHS services will move from being based around activity – how many of a particular named procedure you carry out – to one based on the overall quality of the outcome.</p> <p>Currently, if there is not a tariff for a new procedure or a new piece of technology, then commissioners are less likely to pay for it.  But as we move to the new system, it doesn’t matter how you achieve a particular clinical outcome, only that you do. </p> <p>So if there is a new technology or new procedure or new approach that will lead to better results, or more cost effective results, then there will be nothing to stop it from being available throughout the NHS.</p> <p>Science and engineering leading to new ideas and innovation resulting in better care for patients. </p> <p>When it happens, it’s brilliant.  I want it to happen all the time.</p> <p><strong>Research</strong></p> <p>But it’s not only on the front line that we need to see an increasing role for healthcare scientists.  Britain has long been recognised as a centre for scientific research and excellence.  And the future of our economy, let alone the future of the Health Service, depends on maintaining this reputation.</p> <p>This workforce has a real focus on research and innovation, a strong patient focus and a desire to constantly improve quality.<br />Since 2008, the Chief Scientific Officer’s Research Fellowships, run in conjunction with the NIHR, have help to build the capacity and capability of health scientists, supporting the enormous potential within this professional group for the benefit of patients.</p> <p>But I know there is so much more we can do.</p> <p>Earlier this month, I announced £775 million of funding over 5 years through the NIHR to promote translational research and development. </p> <p>A major increase in resources dedicated to delivering, through science and discovery, major benefits for patients.</p> <p>The funds will be available to any NHS/ university partnership, and collaboration with industry and charities will also be a central part of this. </p> <p>This money will drive innovation focussed upon some of our greatest health challenges – diseases such as dementia, cancer and heart disease.</p> <p>This is a second wave of this funding.  In the past, it’s supported:</p> <p>• new stem cell technologies to cure blindness by replacing damaged eye cells with healthy ones;<br />• the use of MRI scanners to diagnose autism with 85% accuracy; and<br />• a new blood test to diagnose Alzheimer’s disease.<br /></p> <p>When you think of the measures we are having to take across government to put our public finances in order, I hope you will agree that this represents a tremendous commitment.  We really are putting our money where our mouth is.</p> <p>And we have already made some real and meaningful progress, including:</p> <p>• £20 million last year (2009/10) and this year (2010/11) to support the Regional Innovation Funds, which have generated nearly 2,000 applications this year with funds 10 times oversubscribed;<br />• The £2 million Challenge Prize Programme to reward ideas that tackle big health and social care challenges facing the NHS now and in future;<br />• The NHS Evidence website, full of easy to use, reliable and trustworthy clinical evidence;<br />• The 5 Academic Health Science Centres and the 17 Health Innovation and Education Clusters;<br />• The Legal Duty to promote innovation, helping to embed innovation as ‘core business’ for the NHS; and<br />• Over 8,500 delegates attended this year’s Healthcare Innovation Expo, the largest event of its type in Europe</p> <p><strong>Conclusion</strong></p> <p>This government is committed to science.  I am committed to science and science in health.  I want its intellectual rigour, its creativity and its insight to drive improvements in patient care.  To improve the NHS for the benefit of all. </p> <p>We are proving this commitment not only through the money we are investing – though that is considerable – but by giving you the power and the opportunity to use your expertise to improve patient care.</p> <p>This is a real opportunity to make a difference.  An opportunity to fulfil your potential within your careers and within your organisations. </p> <p>But it will not be easy.  It will take strength and leadership.  It needs you to make the personal decision to get involved, to work with your fellow clinicians locally and to move your participation up to a higher level. </p> <p>As General Patton said, you know what needs to be done, now go out there and surprise me.<br /></p> None Andrew Lansley CBE MP National Healthcare Science Event Department of Health 2011-03-21
<p>I find myself in an interesting and unusual position. </p> <p>First, I am part of a coalition government – the first since the War – elected in difficult times, with a single overwhelming task that has been forced upon us – to dig the country out from under a mountain of debt and return our public finances to strong and sustainable footing.</p> <p>This in itself will require leadership and determination on a grand scale.  Perhaps not what you might expect from a coalition government, but none the less, that is what you’re getting.</p> <p>But neither I nor any other member of the government, from either party, entered politics for this reason. </p> <p>Despite what the reputation of politicians, we generally enter politics because we want to make our community, out country or even the whole world a better place, and we feel strongly that we have something to offer personally.</p> <p>Speaking for myself, I entered politics because I believe that public services can be so much better than they are.  I felt so strongly about this that I left my previous career as a civil servant to stand up for what I believe in Parliament.</p> <p>You may remember that prize winning documentary from the 1980s, Yes, Minister?  I am one of the very few who have been both Bernard and Jim Hacker!</p> <p>In the same way that our economy has been transformed by the spirit of enterprise, I believe that our public services be rejuvenated by harnessing the passion, creativity and ingenuity of our many public servants.</p> <p>For many years now, the focus of my political life has been the National Health Service.  I have seen for myself the incredible things its people are capable of.  Excellent care, first class treatment, incredible results. </p> <p>But I have also seen how the system can get in the way of those people.  Stamping on rather than supporting their ideas, strangling them in red tape rather than clearing the way for innovation, drowning them in a sea of bureaucracy rather than freeing them to act.</p> <p>Now that I am in a position of influence, I feel very deeply that I must do everything in my power to help the NHS to be as good as I know it can be.  To help the people of the NHS achieve their full potential</p> <p><strong>What is leadership?</strong></p> <p>But before I talk about leadership within the NHS, I would like to briefly look at leadership in general.</p> <p>In essence, I think it’s about setting out a clear vision and purpose that others can follow.  It’s about engaging people to that purpose and maintaining an unflinching focus on fulfilling that vision.</p> <p>The American theologian and academic, Theodore Hesburgh, once said, “The very essence of leadership is that you have to have vision.  You can't blow an uncertain trumpet.”</p> <p>For without that clarity, those who follow, those who implement, those who are entrusted to make that vision a reality, will face an impossible task. </p> <p>A failure of management can often be traced back to a failure of leadership.  For if the end goal is not properly thought through, if the logic of the argument is flawed or based on a false premise, then no amount of effort will ever make it work.</p> <p>Leadership is therefore more than an act of will; it is an act of thought.</p> <p>To a large degree, I believe that is one of the fundamental problems of the National Health Service.  It is based on the false premise that something as huge and complex as the nation’s health, that an organisation that employs more than a million people and treats over a million people every 36 hours, can best be managed from the centre.  That all we have to do is find the right combination of guidelines and targets, control a little tighter, mandate a little more and all will be well. </p> <p>I simply don’t buy that.</p> <p>General Patton got it right.  He said, “Don't tell people how to do things, tell them what to do and let them surprise you with their results.”</p> <p>The role of the Health Secretary should not be to tell you all how to do your jobs.  How arrogant and how ridiculous that notion is. </p> <p>The role of the Health Secretary, for the NHS at least, should be to set the objectives and then let you surprise me with the results.</p> <p>The high-level objectives for the NHS will come in the form of the Outcomes Framework, setting a clear national direction, constantly improving outcomes for patients.  By making clear what success looks like it will be obvious whether a particular part of the NHS is achieving it.</p> <p>But beyond that, I believe that leadership should come from within.  For beyond the high-level goals set out in the Outcomes Framework, the question remains - how to achieve those aims? </p> <p>This is where the Health Secretary, the Department of Health, the Strategic Health Authorities and the Primary Care Trusts, however skilled and well intentioned they may be, can never be as good or as effective as local clinicians.</p> <p>Clinicians able to identify the needs of their local populations; to recognise the roadblocks to better patient care; and to act to put things right.</p> <p>It is clinicians, from both primary and secondary care, tertiary and community care working together and with others in their local authority and in social care who can design and deliver better care for patients.</p> <p>Just last Friday I was talking to Dr Liz Robin, Director of Public Health here in Cambridge.  She was telling me how, by inviting GP Commissioners into the discussions of the PCTs Senior Leadership Team, they had already “improved the overall quality of the decisions taken.”</p> <p><strong>Leadership vs. management</strong></p> <p>This is clinical leadership, and I want it to be the future of the Health Service. </p> <p>But do not confuse leadership with management, something we have always had a great deal of in the Health Service.</p> <p>Management and administration are vital, but they should exist to support the decisions of leaders.  Effective management is about making sure that objectives are realised. </p> <p>In a moment I will talk a little about how our plans to modernise the NHS – through commissioning and the any willing provider reforms – hope to unlock the potential of the NHS and the people within it. </p> <p>But better care is about more than structures and mechanisms, it’s about people. </p> <p><strong>National Leadership Council</strong></p> <p>If we are to have clinical leadership then we also need strong clinical leaders. </p> <p>The National Leadership Council is working to develop those clinicians who will need to step up under the new system and take on greater responsibility for local services.  It already started to run a coaching programme for GP consortium leaders and now offers 120 leadership fellowships, which focus on practical improvements as part of their development.</p> <p>The clinical leaders of today and tomorrow will be essential in deciding the future direction of the Health Service.<br />• On the future of education and training,<br />• On achieving everything that is possible through commissioning,<br />• And on the continual development of quality standards and the outcomes framework.</p> <p>Your voices are needed more than ever, but now, they will be heard and they will be acted upon because you will hold the power to decide.</p> <p><strong>Chief Residents’ Programme</strong></p> <p>But perhaps more important than decisions and debates taking place at the national level, is what’s happening in individual Trusts.</p> <p>It’s appropriate that I’m here talking at your ‘Leadership Forum’, itself a clear sign of your commitment to clinical leadership, for in many ways Cambridge – as you might expect – is leading the way.</p> <p>And not only when it comes to embracing clinical leadership, but also from pushing the boundaries of medical science through your Comprehensive Biomedical Research Centre.  Where among many other things, you’re extending what is possible for cancer patients through your new Cancer Centre or leading research into combatting osteoporosis or arthritis.</p> <p>But the forward thinking does not stop there.  One particularly interesting initiative is your new Chief Residents Programme, run with the Judge Business School.  By bringing the future leaders of the hospital together with some of the greatest leadership minds in the country, you will ensure that your best clinicians are also your best leaders.</p> <p>But as well as the 10-day, stripped down mini-MBA from the Judge, it is the practical projects here within the Trust which make the real difference.</p> <p>• Things like improving the induction for juniors;<br />• making sure that every doctor is fully engaged in patient safety<br />• and, just to show how quickly the world changes, what to do if a consultation that went badly was filmed and ended up on YouTube?!</p> <p><strong>Example – Addenbrooke’s Renal Pilot</strong></p> <p>I was at the Healthcare Innovation Expo last week, an excellent showcase not only of some of the most advanced technology available but of some of the best and most forward thinking within the NHS.</p> <p>New thinking about how to organise services, how to work across organisational boundaries, how improve clinical outcomes, improve efficiency and, often, how to do all of these things together.</p> <p>There was even an example that sprung from the Chief Residents’ Programme here at Addenbrooke’s.  I think they call that serendipity.</p> <p>Some of you will know this, but for some time the Trust had been aware that junior doctors have been ordering unnecessary diagnostic tests. </p> <p>So, led by renal consultant and clinical IT lead, Dr Afzal Chaudhry – who I think is here today – and with the support of a company called Care FX, a small pilot was established to test the idea. </p> <p>Basically, if two of a patient’s three previous blood tests were normal, the doctor would be asked if they were sure they had a clinical need for going ahead with the test. </p> <p>If they did, then of course they could still order it, but if they were only doing it for the sake of it, then the system would automatically cancel the test.  A simple prompt to the doctor to stop and think before acting.</p> <p>Where prompted, this pilot on the 5 most common renal tests, led to a 22% fall in the number of tests carried out.  And fewer unnecessary tests mean fewer needles being put into patients. </p> <p>An uncomfortable experience for most, but for some it can be agony and blood tests can quickly lead very small babies to need a transfusion.</p> <p>Fewer tests also means fewer bottles and labels produced and disposed of on the ward and in the lab, and more time freed up for the tests that really do matter.</p> <p>The pilot also yielded a great deal of valuable data on the clinical behaviours of doctors at the moment decisions are made.</p> <p>Now, this was more of a ‘proof of concept’ than a wide spread trial, but the results were so telling that whatever decisions the Trust makes regarding the upgrading of its IT systems, it wants to make sure it can take these benefits forward.</p> <p><strong>Modernisation</strong></p> <p>Doctors spotting a problem and being free to solve it.  This is clinical leadership in action and I hope that as we modernise the NHS, we will see a good deal more of it.</p> <p>For our plans for the Health Service are about one thing and one thing only – giving patients health outcomes that are consistently among the very best in the world. </p> <p>We will do this through an unswerving focus on outcomes, by giving patients more control over their own care, including involving them in the decisions made about their own treatment, and by putting clinicians in the driving seat of the National Health Service.</p> <p>I want to talk today about two principal aspects of our plans:<br />• The impact of clinical leadership on the design and commissioning of local health services, and<br />• also the impact of our provider side reforms for organisations like Addenbrooke’s.</p> <p><strong>Commissioning</strong></p> <p>First, commissioning.</p> <p>For many years now, I’ve travelled around talking to clinicians the length and breadth of the country.  The one thing I would here time and time again was, “I wish they would let me get on and do the things I know will deliver better care for my patients”. </p> <p>Well ‘they’ is now me, and I am determined to give people the freedoms they have asked for.</p> <p>I know that people in the health services and in all of our public services have an incredible capacity for creativity, for innovation and for success if only they have the freedom to act and make things happen. </p> <p>General Practice-led commissioning will, for the first time, make the people who hold the purse strings and the people who make the clinical decisions, one and the same.</p> <p>But do not think that because commissioning will be general practice-led specialists will be somehow left out of the loop. </p> <p>Because, by paying the NHS for the quality of the outcomes it delivers and not simply for the amount of activity it undertakes, the focus will be on the pathway of care rather than on what one particular institution can do.  More than ever, integration will be the name of the game.</p> <p>Clinicians from general practice will need to come together with clinicians from secondary and tertiary care, with those from community care and their colleagues in local authorities, to design and commission services that lead to the very best outcomes for patients in their area. </p> <p>When these conversations take place, the focus very quickly becomes the patient and not the institution.</p> <p>These conversations are already leading to exciting new developments</p> <p><strong>Example – diabetes care pilot</strong></p> <p>Here in Cambridge, doctors from Addenbrooke’s have been working with their colleagues in general practice in East Cambridge and Fenland with dramatic results. </p> <p>By investing in community care to improve glucose control in diabetics, inpatient admissions have been reduced, almost immediately, by 40%.</p> <p>Another important aspect of this work has been enlisting patients in the active management of their own condition. </p> <p>Community nurses spend time teaching people how they can do more through things like diet and self-testing, to improve their quality of life and to avoid the worst aspects of their condition.</p> <p>By working together, you have produced massive improvements in patient outcomes – especially when the result of many of those prevented outcomes would have been amputation.</p> <p>But you’ve also saved money through far fewer expensive hospital treatments.  Money that can be better spent elsewhere. </p> <p>Across Cambridgeshire, GPs are keen to roll this approach out.  Based on the experience of this pilot, it could save the NHS in Cambridgeshire around £5 million a year.  And if you extrapolate up for the rest of England, that could mean a huge benefic for patients and an annual saving of around £400 million.</p> <p>I know that Dr David Simmons, the lead clinician for the pilot, is writing a paper which I’m sure will create a great deal of interest around the country and far further afield when it comes out.</p> <p><strong>Providers</strong></p> <p>But our plans for transforming the commissioning of services are not uniquely radical.  We will also bring real change to the provider-side of the NHS:</p> <p>• opening up the provision and delivery of healthcare to any willing provider,<br />• publishing far more, and far more meaningful information about the quality and outcomes of particular providers,<br />• and, with every NHS Trust a Foundation Trust, we will also redefine what it means to be a Foundation Trust.</p> <p>We will never alter the values of the National Health Service – the best available treatment, based on need and not the ability to pay, free at the point of delivery.  But as long as these values remain, then we should do everything we can to make sure that patients receive the very best standards of care.</p> <p>If our goal is to have outcomes as good as the best in the world, then we should do everything we can to help patients and their doctors to choose the best available care, whoever provides it.</p> <p>In the coming months, we will publish the results of our consultation on an information revolution.  Armed with a clear picture of just how good a particular institution, department or, possibly, consultant-led team really is, patients and their doctors will be able to choose the best and most appropriate care for them.</p> <p>And because the money will follow the choices of the patient, how good a particular institution is will really matter. </p> <p>Some say that people don’t want choice, but think about that for a moment.  What would you do if you could see that the treatment you would receive – or your children or your parents would receive – in your local hospital was significantly worse than one further away?</p> <p>What is more important to you when it comes to your own or your families health – short term convenience or the quality of healthcare?</p> <p>And think about how quickly we have all become used to choice in every area of our lives.  People may not be used to having control over their own care now, but it won’t take long and there will be no going back.</p> <p>For some institutions, any willing provider will, quite rightly, be cause for concern.  If you are not as good as you know you should be, if you compare poorly with others, then you will start to see patients choose to go elsewhere.  You will have a huge and very real incentive to improve, and to do so quickly.</p> <p>Here good quality clinical leadership will be the only way of addressing whatever issues you face within your organisation.  For no amount of management-led cost cutting or administrative change will help.</p> <p>It will take clinicians to assess the problem and come up with a solution that improves outcomes for their patents.  And if the outcomes improve, so too will the financial situation of a Trust.</p> <p>But for those who provide excellent care, for those who can demonstrate that they deliver the best outcomes and the best patient experience then the rewards will be significant. </p> <p>As we give more powers to Foundation Trusts, places like Addenbrooke’s will be able to take the funds that come from excellence – both through patient choice and through a new tariff that rewards providers based on the quality of care delivered – and reinvest those funds in even better care.</p> <p>That will mean more funds for you to improve further and expand your services.  Perhaps even to open a new branch of Addenbrooke’s somewhere else?  Why perhaps even an Addenbrooke’s Oxford!</p> <p><strong>New relationships</strong></p> <p>Some may want to take advantage of the removal of the private income cap to generate still more funds to invest for NHS care.</p> <p>Some hospitals are already looking at expanding their private practice, at opening new branches both here and abroad. </p> <p>Moorfields Eye Hospital, for example, has opened a branch in Dubai.  Again, the money raised from this venture feeds directly back into improving their NHS operation in London. </p> <p>John Pelly, Moorfields's chief executive, has said: "Without profits [from our commercial business] our ability to invest in our clinical services would be seriously constrained.”</p> <p><strong>Example – NHS Bexley</strong></p> <p>Others are already looking at working more closely with specialist private providers to deliver better, more cost-effective care to NHS patients.</p> <p>Another example on display at the Innovation Expo, was how, over the last year, Bexley NHS Care Trust in Kent has significantly improved their cardiac care by working with a private company – the European Scanning Centre in Harley Street – who own perhaps the world’s most advanced CT scanner, the £2 million Aquilion ONE.</p> <p>Patients in Bexley get access to the very latest technology without the need for a significant capital investment and, working with the provider and local cardiology consultants, they have been able to redesign the entire cardiac pathway. </p> <p>This has significantly improved care for patients in the area while saving an average of £1,500 per patient.</p> <p>There will be no limit to the potential improvements that the best hospitals in England can make.  So the question for you today is, what do you want the future to look like? </p> <p>Cambridge University Hospitals Trust already has a reputation for excellence on which to build.  But it will be up to you, to the clinicians supported by management, to grasp the nettle, to set your direction and to meet whatever goals you set.</p> <p><strong>Conclusion</strong></p> <p>Strong clinical leadership is not about turning a doctor into a bureaucrat. </p> <p>It’s about equipping the people who understand and have the closest relationships with patients with the skills and the authority to lead.</p> <p>It’s what any organisation that wants to deliver the very best outcomes for its patients needs. </p> <p>I hope that if I were to return to address you in 4 years time, it really wouldn’t matter who was in the post of Health Secretary, as far as the NHS was concerned.  It would matter a great deal when it comes to public health, but for the NHS, I hope that it will be you who are very much running the show.</p> <p>Clinicians in Cambridge have long been at the forefront of commissioning and working across boundaries.  And I have high hopes that when full responsibility is devolved to the local level and when the unnecessary layers of management bureaucracy – the PCTs and the SHA – are stripped away, the people of Cambridgeshire – who I have the honour to represent – will benefit from some of the very best care in the country, indeed, anywhere in the world.</p> <p>Thank you.</p> None Andrew Lansley CBE MP Cambridge University Hospitals NHS Foundation Trust’s Leadership Forum Department of Health 2011-03-17
<p><strong>Check against delivery</strong></p> <p>It’s a pleasure to join you today to discuss the future of nursing, and the key role of leadership in a modern NHS.</p> <p>It is a theme that Florence Nightingale herself would warm to … [personal content excised]</p> <p>Florence was a formidable and remarkable woman, whose strong views helped to shape the nursing profession as it stands today.</p> <p>Passionate about evidence. Insistent on the highest professional standards. Wholly devoted to the patients’ best interests.</p> <p>Famously, the first question Nightingale asked on arriving at the front line hospitals of the Crimea was ‘Who’s in charge?’</p> <p>And that’s where I want to start today. It is, of course, a question carrying as much weight today as it did 150 years ago.</p> <p>And it chimes with many of the concerns people have expressed to me.</p> <p>Concerns about how we provide consistent, and consistently excellent, standards of care.</p> <p>About whether nursing, and senior nurses, will have the influence they need within the new commissioning and management systems.</p> <p>About whether we’ll be able to recruit and retain enough high quality nurses across the Service to improve standards of care.</p> <p>Frankly, about whether the leadership and commitment is there – nationally, regionally and locally – to support the nursing profession through the changes that lie ahead.</p> <p>It’s these very concerns I want to address today.</p> <p><strong>The value of nursing</strong></p> <p>For me, a modern NHS means nurses, midwives and allied health professionals having more opportunities to shape and improve how things work.</p> <p>As David Cameron said: “nurses are the backbone of the NHS”. In truth: backbone, and muscle, and eyes and ears.</p> <p>The single largest profession within the Health Service.</p> <p>The people who spend most time with patients.</p> <p>Who define the person’s experience of care, explaining, informing, comforting and supporting people through their treatment.</p> <p>A group who, like GPs, are uniquely placed to understand and advocate on behalf of the patients and the families they support.</p> <p>And it’s this ability, to see the whole care pathway for a patient, that we need to harness more effectively in the future.</p> <p>Nurses, midwives and their colleagues in the allied health professions give us something extremely valuable.</p> <p>They give us the human perspective.</p> <p>They understand the ins and outs of the communities and populations they serve.</p> <p>A health visitor’s value, for instance, doesn’t just lie in the support they provide – important as that may be.</p> <p>It also lies in the insights they can bring, the connections they can draw, the relationships they can build with other parts of the system.</p> <p>The same is true of district nurses, community nurses or ward sisters – all of them uniquely placed to identify trends, to spot problems and to suggest creative solutions.</p> <p>And in a world where we’re increasingly in the business of managing complex long term conditions, the role of other professionals … speech and language therapists, podiatrists, physiotherapists, occupational therapists … all of them are crucial for delivering a full and effective programme of care.</p> <p><strong>Quality</strong></p> <p>So when we talk about quality, about outcomes, about continuous improvement, the role of the nursing profession is paramount.</p> <p>At this point, let’s not for a second forget the High Impact Actions that were developed by the nursing and midwifery professions.</p> <p>Eight actions that show the difference good nursing can make, in reducing both distress to patients, and cost to the NHS.</p> <p>It is the kind of modern-day addendum to Notes on Nursing that Florence Nightingale would surely have championed.</p> <p>She would have approved of the other aspect of quality: clear measurement and tracking of performance.</p> <p>Something that is supported by the Quality Indicators – again developed in partnership with the profession – which will ensure higher standards across the board.</p> <p><strong>Nurse-led change</strong></p> <p>This demonstrates what happens when nurses and midwives have the freedom and responsibility to drive up standards and drive through change.</p> <p>Leading improvements, as they have, for instance, in Newham.</p> <p> <br />Where nursing and support staff successfully reduced pressure ulcers in local nursing homes – saving money and reducing pain and distress for residents.</p> <p>Or in my constituency of Cambridge, where children’s nurses now take responsibility for discharging patients.</p> <p>We’re now seeing a much quicker discharge. Much  greater continuity of support for children and families treated there.</p> <p><strong>Commissioning</strong></p> <p>So we need a culture within the NHS that enables nurses and midwives to make their expertise and experience count. How do we achieve it?</p> <p>Many in the room are concerned about General Practice-led consortia.</p> <p>Well, my view on this is quite simple.</p> <p>We know we will need nursing input in the new commissioning arrangements.</p> <p>Frankly, we need lots of it.</p> <p>We’d be mad to ignore it.</p> <p>We do expect nurses, midwives and the allied health professions to be fully involved in how Consortia go about their task.</p> <p>We want the Consortia to listen to them  To involve them. To engage them. To learn from them.</p> <p>And, crucially, to apply this insight and knowledge in how they build and shape care pathways.</p> <p>Why, then, don’t we insist on a formal nursing presence within GP consortia?</p> <p>If this engagement is so important, you may ask, then why isn’t it mandatory?</p> <p>Well, I think the danger with any mandatory arrangement is it can quickly become tokenistic.</p> <p>Through the Health and Social Care Bill, we have put a clear duty on consortia to involve nurses, midwives and other professionals in decisions.</p> <p>But I’m not going to prescribe precisely how they do this.</p> <p>That’s exactly the sort of top-down direction we’re trying to get away from.</p> <p>And in fact, if you look around, the appropriate structures are evolving naturally in the pathfinder areas.</p> <p>In Warrington, for instance, they’ve formed a Clinical Cabinet that brings GPs, nurses and other clinicians together to discuss local commissioning strategy.</p> <p>Other consortia will do things differently. But be in no doubt: all will be expected to involving nursing and midwifery expertise in their decisions.</p> <p><strong>National leadership</strong></p> <p>The same is true for the national and regional commissioning arrangements led by the NHS Commissioning Board.</p> <p>Again, I’m very clear that there should be a senior nursing presence at the heart of national policy development.</p> <p>I’m delighted Chris is staying with us as Chief Nursing Officer until October.</p> <p>We will then be appointing a Chief Nursing Officer for the new NHS Commissioning Board, and a Director of Nursing for the Department of Public Health.</p> <p>Why? Because nursing will be integral to decision-making at the highest levels within the new national structures.</p> <p>A clear sign that we see nurse leadership as vital for developing and executing effective health policy.</p> <p><strong>Financial challenge</strong></p> <p>That leadership is even more necessary as we devote more of our resources to front-line care and, in order to meet rising demand, must use resources much better.</p> <p>I know many are concerned about the financial environment and the implications for nursing capacity.</p> <p>I’m afraid this is no time for sugar-coating.</p> <p>We are entering the toughest period in the NHS’s history.</p> <p>It is a time of unprecedented financial challenge.</p> <p>It would have been whichever party was elected.</p> <p>For whoever was standing here as Health Secretary, the same realities would exist.</p> <p>To balance the demands and pressures of rising costs and an ageing population.</p> <p>To make sure more money reaches the frontline, rather than being caught up in back office functions.</p> <p>And to meet David Nicholson’s challenge, of finding an unprecedented total of £20 billion in savings over four years.</p> <p>But knowing that resources will increase by £10.7 billion over that period; and all of the savings will be reinvested in the NHS, mean we can meet the challenge only if we focus on what really matters.</p> <p>To promote innovation.</p> <p>To prevent disease, not just seek to cure.</p> <p>To raise productivity.</p> <p>And to raise quality, by putting patients at the heart of care and making results for patients the driver of caring and care.</p> <p>To achieve this we must have the resources at the front-line. And the team and staffing we need.</p> <p><strong>Workforce development</strong></p> <p>Our new workforce consultation set out how we will achieve this:</p> <p>It’s about giving more direct power and responsibility to providers.</p> <p>It’s about improving the co-ordination of training and continuous development through the new Health Education England body.</p> <p>And it’s about making sure there’s consistent sector-wide leadership and oversight for workforce development.</p> <p>Our modernisation plans give us a unique chance to step back.</p> <p>To think about what the modern nursing workforce needs to look like.</p> <p>To make sure decisions are made locally and based on local priorities.</p> <p>In a tough financial environment, the challenge for senior nurses and midwives will be finding new ways of structuring teams, of matching levels of skill with levels of need.</p> <p>And yes, that may mean using support staff in new ways to support patients and free up nurses and midwives to concentrate on more complex cases.</p> <p>It’s what they’re doing in Derby, for instance, where assistant practitioners help patients regain their independence and confidence ahead of discharge.</p> <p>Or in Lincolnshire where support staff act as a familiar face and a point of contact for patients between the hospital and home.</p> <p>And in addition, the consultation allows us to think about the new skills and expertise that modern nursing entails.</p> <p>We all know the business of nursing and midwifery is more complex today.</p> <p>More multi-disciplinary working.</p> <p>More complex, long term conditions.</p> <p>More overlapping, complicated issues to unravel and resolve.</p> <p>The new education standards will mean that more nurses, at point of registration, will have the knowledge and skills to bring services together for patients.</p> <p>They will qualify with degrees, and be able to take on leadership and management roles within their organisations.</p> <p>And it’s important that the best nurses and midwives don’t hide their light under a bushel.</p> <p>We want to encourage a strong culture of mentoring and support, passing on knowledge to support the next generation and to ensure continuous improvement in standards.</p> <p><strong>Conclusion</strong></p> <p>Let me finish by going back to the theme I started with: the memory and legacy of Florence Nightingale.</p> <p>Because if there’s one word that Nightingale has become synonymous with.</p> <p>One word that sums up the essential, timeless quality of nursing …</p> <p>It’s compassion.</p> <p>Whatever the professional challenges and whatever the financial situation, we have to value, honour and protect the compassion and comfort that good nursing brings.</p> <p>Yes, we need a modern NHS.</p> <p>Yes, we need a more productive NHS.</p> <p>But what matters more than anything is that we have a compassionate NHS.</p> <p>This is not something you can measure, still less mandate from above.</p> <p>It depends on all of us in this room, as leaders of the system, to instil and champion those values we hold dear.</p> <p>No matter how tough things are.</p> <p>We do need change in the NHS. And change will bring improvement.</p> <p>But through your leadership, I know we can achieve it whilst preserving the fundamental principles that the Health Service depends upon.</p> None Andrew Lansley CBE MP speech to the Florence Nightingale Foundation Conference Department of Health 2011-03-11 speech to the Florence Nightingale Foundation conference
<p><strong>CHECK AGAINST DELIVERY</strong></p> <p>I would like to welcome you all to the 2011 Healthcare Innovation Expo.  People have come from across the country and around the world to witness for themselves the future of healthcare.  And that future is right here under this roof. </p> <p>The Expo is an exceptional showcase for some of the most exciting technologies and techniques in modern healthcare, and I am sure you will all find a wealth of creativity and innovation that you can take back to your own organisations.</p> <p>For well over twenty years, I have stood up for the benefits of enterprise and innovation.  I believe these can energise our public services every bit as much as they have done the private sector.  Not in any way to inhibit the values of public service, but to empower public servants to deliver better care more efficiently.</p> <p>The NHS and the UK has a long history of innovation, from Ian Donald who pioneered the use of ultrasound in the 1950s to the Sanger Institute in my own constituency in Cambridgeshire, which developed the first working draft of the human genome in 2000.</p> <p>The creative spark that kick starts the long and often difficult journey from initial idea to widely adopted treatment is a precious and delicate thing.  We need to do all that we can to encourage that creativity within the NHS and to grow and propagate the ideas that clinicians and others have for the benefit of their patients.</p> <p>The modernisation of the NHS will encourage innovation in three main ways:<br />• By placing the patient at the centre of decision making about their own care – so need drives innovation;</p> <p>• Through a resolute focus on improving health outcomes; so that the drive for results drives innovation;</p> <p>• And by placing power in the hands of local clinicians while getting rid of the huge and wasteful bureaucracy that can so often strangle and frustrate innovation; so health professionals themselves drive innovation by their knowledge and drive for continuous improvement.</p> <p><strong>Patients first</strong><br />The worlds most successful businesses – people like Apple or Virgin or Tesco – all have one important thing in common.  They all start with an unwavering focus on the wants and needs of their customers.  The same should be true in public services.</p> <p>To create a health service that is truly excellent, our starting point must always be the individual patient.  We have passed the point where one size fits all.  The future is about personalising care.  About tailoring treatment to maximise outcomes.  And here I mean several things. </p> <p>At one end of the spectrum it’s about making the most of the latest technologies, of developments in genetics and genomics to improve the diagnosis and treatment of rare conditions or to tailor drug treatments to an individual person. </p> <p>At the other, it’s bringing together clinicians with their colleagues in social care to build personalised care and treatments packages for patients with complex long term conditions.</p> <p>And for everyone, it’s making sure that the patient is always a central part of the decision making process about their own care.  Making sure that, in all cases, there really is no decision about me, without me.</p> <p>By involving the patient in their own care in this way, a new perspective is brought to view. </p> <p>A consultation room becomes the meeting of two experts: the clinician being the expert on the treatment and the system; the patient the expert on themselves and their own wants and needs. </p> <p>And evidence from the UK and around the world shows that care and treatment that involves the patient produces better health outcomes, a better patient experience and in many cases, better value for money.</p> <p><strong>Outcomes</strong><br /></p> <p>Another change will be a focus on driving up the quality of care the NHS provides, not just the amount of care it delivers.</p> <p>The Outcomes Framework, which we published in December, sets the direction for the Health Service and will soon be the main means for holding the NHS to account for the quality of its care.</p> <p>The Framework as a whole and its constituent parts, set the direction for the NHS over the coming year, the health outcomes we want to achieve.  What it does not do is tell people how they should achieve them. </p> <p>That isn’t the job of the Department of Health, that’s the job of the clinicians who actually look after patients every day.</p> <p>The Outcome Framework was developed after consultation with the public, with NHS staff, patient groups and others.  We’ve included some areas purely because they received such strong levels of support.  The only problem is that, as yet, there are no clear indicators to measure against them.</p> <p>So, for two outcomes included in this year’s Outcomes Framework –<br />• for improving recovery from stroke and improving children’s and young people’s experience of healthcare,</p> <p>and for four more that I expect to see in future Outcomes Frameworks – <br />• for improving health outcomes for those with learning difficulties,<br />• for children with long term conditions,<br />• for children and young people with mental illness<br />• and for enhancing the quality of life for people with dementia,</p> <p>we need your help.</p> <p>Outcomes will be the “must dos” of the national NHS. They must be the hard-headed drivers of change.  We need indicators that not only measure the rate of improvement but that also shepherd all developments within a particular field to a clear goal.</p> <p>So, I am today launching a competition to find those indicators over the next 12 weeks.  If you have ideas, we want to know about them.  If you’re working on something that might help, tell us.  The details of how you can become a part of marshalling the combined resources of the NHS for the benefit of patients are now on the Department of Health website. </p> <p>We will align every payment, every incentive, every structure behind those outcomes.  One way will be through the tariff, the way we will pay for the vast majority of NHS services.</p> <p>The tariff will not be about providing a particular type of treatment, but for delivering a particular quality of outcome.  This in itself will be a powerful driver of innovation within the Health Service.</p> <p>I was at Bart’s cancer centre last week, seeing their planned new Cyber-knife, a new technology that could provide better care for patients that would also be, as it happens, be more cost-effective than surgery. <br />But at the moment, services are constrained from innovating up-front, because there is no specific tariff to pay for it.</p> <p>But by paying for specified outcomes rather than particular treatments we can free commissioners, in the shape of the new GP consortia, to pay for what in their judgement and the judgement of the patient will provide the best outcome.  If that is the new Cyber-knife, then there is nothing that will stand in their way.</p> <p>The result will be more money flowing towards the best, most innovative treatments.  Just like those promoted here at the Expo.</p> <p>We are opening up the Health Service to any provider who can deliver NHS services at or above stringent NHS quality standards and at NHS prices.  As patients gain control over their own care, as they get to exercise choice over what, where, when and by whom they are treated, providers will compete on the quality of care that they provide. </p> <p>Some worry that providers will compete on price, but with fixed national or local tariffs, this simply can’t be the case.  At the point of referral or choice, quality will be the only consideration, because price for all providers will be tariff based. Competition will be based entirely on quality.</p> <p>It will no longer be enough for a provider to presume that just being the closest hospital will be enough, not when patients can see quite clearly how well they’re performing – or not performing – relative to others. </p> <p>It will no longer be enough for a provider to rely on doing things the way they always have done, because they’ll be competing against other providers for their patients.  Other providers who might well be offering better care.</p> <p>This will drive competition based on the quality of care a provider can offer, the outcomes of their treatment and the experience of the patient.</p> <p>The role of government is not to enforce innovation – that’s impossible – but to create an environment that promotes it, that supports it and that spreads its benefits as widely as possible.</p> <p>In the past, the NHS has been as successful as it has been despite the system, not because of it.  Our plans to modernise the NHS will change that.</p> <p>Excessive bureaucracy often tolls the death knell for innovation – so we will strip it out.  We will replace top-down direction from Whitehall, from regional Strategic Health Authorities and from Primary Care Trusts with bottom-up, clinician-led, local decision making. </p> <p>Consortia of GPs, working with their clinical colleagues across primary, secondary and community care, local authorities and their local communities will design, plan and commission clinically-led health services as they see fit.</p> <p>When you start to bring together clinicians from across the NHS to talk about how best to design new services for patients, institutional distinctions quickly fall away.  Instead, the conversation becomes one of how best to improve the patient’s pathway of care, linking up all the different parts of care in an integrated way. </p> <p>By breaking down the walls that divide clinicians, we will start to mine a rich seam of ideas and creativity based around improving outcomes for patients.  Ideas that could never have come through a system of central command and control.</p> <p>We will start to see the results of this very soon.  Already, there are 177 Pathfinder Consortia, covering 35 million people, around two thirds of the population of England.  These pathfinders are leading the way to the new system, taking up the reins in their local areas, fighting for their patients.</p> <p>As well as a shake up at the commissioning level, we’ll do the same with providers.  Finally, long after the last government promised to do it, all NHS Trusts will become Foundation Trusts, free to compete in the business of being the very best. </p> <p>And as I said before, we will open up the provision of NHS services to any organisation that can provide NHS quality care at NHS prices.</p> <p>And as the money really will follow the patient, the quality of clinical outcomes that a provider can offer will determine their future success. </p> <p>That will depend on always being ahead of the game, on always giving their patients the very best healthcare and the very best experience of the NHS.</p> <p><strong>Research Funding</strong><br /></p> <p>Beyond being clear about what outcomes we seek, but then getting out of the way, there is another very important role for government.  We can do everything we can to make sure that the UK continues to be one of the best, if not the best place in the world to conduct cutting edge clinical research.</p> <p>On Monday, I announced £775 million of funding over 5 years through the National Institute for Health Research to promote translational research and development. <br />A major increase in resources dedicated to delivering, from science and discovery, to benefits for patients.</p> <p>The funds will be available to any NHS/ university partnership, and collaboration with industry and charities will also be a central part of this. </p> <p>This money will drive innovation focussed upon some of our greatest health challenges – diseases such as dementia, cancer and heart disease.</p> <p>This is a second wave of this funding.  In the past, it’s supported:<br />• new stem cell technologies to cure blindness by replacing damaged eye cells with new healthy ones;<br />• the use of MRI scanners to diagnose autism with 85% accuracy along with a genetic test for autism; and<br />• a new blood test to diagnose Alzheimer’s disease, and a new blood pressure watch</p> <p>When you think of the measures we are having to take across government to put our public finances in order, I hope you will agree that this represents a tremendous commitment.  We really are putting our money where our mouth is.</p> <p><strong>NHS Global<br /></strong></p> <p>For as Lord Howe will say in more detail tomorrow when he stands where I am now, the NHS is more than a means for improving the health of the nation.  It is also an engine for economic growth.</p> <p>The National Health Service, the world’s largest state funded provider of healthcare, also has a world wide reputation for healthcare.  Equity, excellence and innovation - a reputation I can only see improving in the coming years and a reputation that we can use to help put Britain back on the path to prosperity.</p> <p>Many of the freedoms we are giving providers – the autonomy, the ability to borrow and invest, to innovate and expand, the removal of the cap on private income – also present opportunities for growth here and abroad. </p> <p>Some NHS organisations are already reaching out, exploring new opportunities, seeking new collaborations. </p> <p>Moorfields Eye Hospital, with their new facility in Dubai, and Imperial College, with their diabetes clinic in Abu Dhabi, are pioneers, seeking new commercial opportunities for the NHS – providing new revinue streams to fund better care for NHS patients. <br /></p> <p>And some Trusts with well-developed international reputations, such as Great Ormond Street, already treat international private patients here in England.  Private money that is invested back into the NHS to provide ever better care for NHS patients here in Britain.</p> <p>These are just some of the many opportunities that exist for NHS providers.  Others might include collaboration with global centres of excellence, data management, designing best practice guidance, accreditation systems, NHS technology and offering advice to other providers.  The only limit is our imagination.</p> <p><strong>Conclusion</strong><br /></p> <p>Of course, it’s not only the innovation itself that is important.  The speed with which it is adopted makes all the difference in the world.  New ideas need to have their moment in the spotlight, to be discussed, debated and adopted across the country.</p> <p>That is why this Innovation Expo is so important.  It provides that spotlight.  It brings people from the public, private and voluntary sectors together to share their ideas about how we can improve patient care and improve efficiency. </p> <p>So wherever you have come from, whichever organisation you represent, I hope that you enjoy your time here at the Expo. </p> <p>If you are from a provider of NHS services, I hope that you take the ideas and technologies that you see here over these next couple of days and spread the word.  Think about how you can use them for the benefit of your organisation and your patients.</p> <p>And if you are here to help those providers, if you have a new technology or technique, then I wish you the very best. </p> <p>We have under one roof the future of healthcare.  That doesn’t happen every day.  I hope you all make the most of it!<br /></p> None Andrew Lansley CBE MP Healthcare Innovation Expo Department of Health 2011-03-09 speech to the Healthcare Innovation Expo
<p>I think it’s clear to everyone that this government is deeply serious about putting our public finances in order.  Having lived beyond our means for so long, we can’t afford to continue as we were.  But the scale of our ambition goes far beyond just fixing the economy. </p> <p>I didn’t enter politics to cut the deficit.  I am in politics because I am a public servant, but also because I have my own ideas about how we can deliver world-class services.  Recognising that I had those views and I had to stand up and be elected on them. <br /></p> <p>For well over twenty years, I have stood up for the benefits of enterprise and innovation.  I believe these can energise our public services every bit as much as they do the private sector.  Not in any way to inhibit the values of public service, but to empower public servants to deliver more, more effectively.</p> <p>We face enormous pressures on costs – an ageing population, obesity and alcohol abuse.  Expensive new drugs and technological innovations like genetics, nanotechnology and robotics.  People expect to receive the latest and the best treatment, and so they should. </p> <p>But unless we fundamentally change the way we do things, we won’t be able to do this.  Unless we modernise, every year the relative costs of running the Health Service will go up.  Demand will grow, the bureaucracy will expand and inefficiencies will become ever more entrenched.</p> <p>There is no “easy option.”  Sticking with the status quo and hoping that a bit more money will be enough to meet the challenges ahead is a complete fiction.</p> <p>We need modernisation.  We need to do more to reduce the demands on the NHS through a far greater emphasis on public health.</p> <p>We need to open up the NHS to make it more competitive, more responsive and more transparent, cutting out waste and bureaucracy. </p> <p>And we need a modern, successful NHS and to pay providers for the results they achieve for patients.</p> <p>The typical 1940s patient might have been a young man with TB or Polio, best suited to hospital treatment.  But today that typical patient is more likely to be elderly with multiple conditions and with as many social care needs as healthcare ones.  But the NHS keeps treating them in hospital, which may not be at all the best place. </p> <p>Indeed, as the Health Ombudsman’s report tragically illustrated, it can sometime be the worst place.</p> <p>The challenge for the modern NHS is to reflect and meet the needs, the expectations and the ambitions of today’s society.</p> <p><strong>NHS Modernisation</strong></p> <p>There are many ways in which we aim to do this: </p> <p>• We want to give patients far more control over their own care.  Giving them the choice over what happens to them and by whom, as well as where it happens.  There really should be no decision about me, without me.</p> <p>• We will publish far more and far more relevant information on the quality of care being delivered by different providers.  So that patients and clinicians can see clearly who is providing the best – and the worst – care.</p> <p>• We will allow NHS services to be provided by any organisation that can deliver NHS standards of quality at NHS prices.  For why on earth should we stand in the way of patients receiving the best care just because it is not an NHS organisation providing it?  On that basis, we would stop Macmillan nurses caring for cancer patients. </p> <p>• We will give NHS providers the freedom to run themselves as they see fit, not as one particular tier of bureaucracy or another decides they should. <br /> <br />• We will empower clinicians to take the lead across all aspect of NHS care.  It is not my job to tell clinicians how to care for patients.  They are they experts, they are best placed to make those decisions.  And they are best placed to design integrated local services in collaboration with their colleagues across primary, secondary, community and social care.  Managers should be there to support the decisions of clinicians, not the other way around.</p> <p>• And to drive all of this, we will change the way that we pay for NHS services.</p> <p>And it is this last point – how we pay for things – that I would like to focus on in particular.  For many people, particularly those in the press, have tended to focus almost exclusively on the structural changes we are making, especially those around GP-led Commissioning. </p> <p>But what may actually make the biggest difference to the care that people receive will be how people behave within the system.  And to support the national focus on outcomes and quality, we need to align incentives.  The outcomes framework will lead this. </p> <p>• Commissioners will be accountable for outcomes and quality.<br />• They will contract for services using the new quality standards. <br />• The regulator will regulate and inspect against real quality criteria. <br />• Information on outcomes will focus health and social care providers on results. </p> <p>And the pricing system should align directly with this.  It is vital that what is rewarded is the best care, not just throughput or a simple process target.</p> <p>I want every incentive and every reward to align with the single goal of improving outcomes for patients.  Better survival rates; a faster, fuller recovery; more prevention; and the effective management of long term conditions. </p> <p>At the moment, this is far from the case.</p> <p><strong>Payment By Results</strong></p> <p>We have a system in the NHS misleadingly called ‘Payment by Results’.  But organisations aren’t paid for results.  They are paid for activity.  They are rewarded for processes and ticking boxes, for doing stuff and not actually for delivering the best possible patient care.</p> <p>PBR currently pays per procedure.  If what you want is just lots and lots of activity then, as you would expect, it has. </p> <p>The ‘more the merrier’ was the idea.  Only it isn’t very merry.  Providers get paid with little regard as to the quality of a procedure, or the end result for the patient.  From the organisation’s point of view, there is scant incentive to improve.</p> <p>And because providers are paid after the event, they don’t have the up-front funds to invest in better prevention.  Instead they are forced to be reactive and prevented from being proactive.</p> <p>You also have some quite perverse incentives.  If a hospital provides a poor service and discharges a patient only for them to bounce back a couple of weeks later through A&amp;amp;E, the hospital is not penalised for it.  It’s rewarded! </p> <p>It’s paid for putting right what it should have done in the first place.  And if the same happens again, then they get paid a third time.  And a fourth. </p> <p>Take maternity services.  Within antenatal care, the more visits or scans a provider can record, the more money they are paid.  It’s actually in the best financial interests of the hospital to provide care on a purely reactive basis, dealing with problems as they arise rather than planning care to prevent them from happening in the first place.  The hospital benefits.  The mother does not.</p> <p>Another example - previously, because there wasn’t a specific tariff for interventional radiology procedures, if a woman had uterine fibroids there was a financial incentive for the hospital to perform a hysterectomy, a far more invasive and sometimes traumatic procedure. </p> <p>The problem was that because of the way the tariffs were set up, the hospital would not have been able to cover the full costs of interventional radiology, where as they could be confident of covering the costs of the hysterectomy.</p> <p>Or take cataract operations.  Although the NHS Institute and Royal College of Ophthalmologists’ guidelines say that best practice would include combining the initial outpatient consultation with the pre-operative assessment into a single visit – far more convenient for the patient – and just a single post-operative out patient appointment, the tariff didn’t reflect this. </p> <p>Instead, it would just keep paying out for every pre- and post-operative appointment.  The focus wasn’t on providing the best and most convenient care for the patient but on making things easier for the provider.</p> <p>The current system is the wrong system.  By rewarding treatment over prevention, activity over the quality of outcomes, patients suffer.  This cannot be right.</p> <p>That is why we are changing the tariff – the way we pay for care.  I want commissioners of care, be they PCTs, the new GP consortia or the NHS Commissioning Board, to genuinely pay for results.  To reward those who improve health outcomes.  For the financial incentives to finally catch up with the rhetoric of a demand for ever higher standards.</p> <p><strong>Dialysis</strong><br /></p> <p>For example, the new tariff for haemodialysis rewards services that apply best clinical practice by paying significantly more for dialysis sessions that are delivered through so-called ‘definitive access’ than for those that are not. </p> <p>This treatment is better for patients because the faster flow rates result in more effective and efficient dialysis and it is much safer due to a reduced risk of infection.</p> <p>The tariff has been set so that if patients receive their dialysis in this way, the more the provider is paid.  So, as well as rewarding those who provide the best treatment, it also provides a strong incentive for those that are yet to bring their service in line with best practice to do so.</p> <p>These changes are about getting the right financial system in place to support the very best patient care and to offer greater patient choice and control.</p> <p><strong>Pathways</strong><br /></p> <p>As soon as you bring clinicians together from primary, secondary and community care to design an ideal service, those institutional distinctions quickly fall away.  Instead, what becomes important is the patient’s pathway of care. </p> <p>So instead of a hospital looking at what it does in isolation, clinicians start to look at what is in the best overall interests of the patient and where their services can best fit in to that pathway. </p> <p>I want the way we pay for NHS care to support and encourage this.</p> <p><strong>Maternity</strong><br /></p> <p>Take the example of maternity again.  The current system pays for activity, encouraging a reactive approach that increases the chances of interventions.  Paying for a ‘Pathway’ could turn this on its head. </p> <p>Newly expectant mothers will first see a midwife to discuss her options.  A home birth, midwife-led, in an obstetric unit.  She would discuss her birth plan and what pain relief she would prefer.</p> <p>Whatever she decides, she should be supported every step of the way by an integrated system of care, from a networked service, with clear quality standards that help to achieve the results she wants – a health baby, a healthy mother and a good experience from the first antenatal appointment to the last time she sees a health visitor.</p> <p>The Midwife will also carry out an initial risk assessment in which she will take into account all relevant factors:<br />• does she have any underlying health problems?<br />• Has she had any previous problems with childbirth? <br />• Does she have any mental health issues or require any social care? </p> <p>Depending on the results, the provider would receive a fixed amount up front, possibly for the entire maternity pathway – or possibly split into separate payments for antenatal, birth and postnatal care – based on the potential medical and social needs of the mother. </p> <p>It is then in the interests of the provider to work as pro-actively as possible with that woman, to plan and manage her care and to prevent the need for any avoidable interventions. </p> <p>For the greater the concentration on the smooth management of the pregnancy and on good clinical outcomes the more money can be saved by avoiding unnecessary interventions.  The money saved can then be used to improve their maternity services still further. </p> <p>The quality of the mother’s experience and the health outcomes for her and her baby are both improved.</p> <p>And because the money is paid up front, providers will have the funds to invest in the prevention services they can’t necessarily afford when they are only paid for things after the event.</p> <p><strong>Bureaucracy-light</strong><br /></p> <p>This sort of quality based payment also strips out a great deal of bureaucracy.  For as long as a provider meets the NICE quality standards, it doesn’t matter how they do it.  There will be no more telling providers how they should schedule antenatal appointments – that level of detail will be left for midwives or obstetricians to decide based on the patient’s own personal circumstances. </p> <p><strong>Year of Care<br /></strong></p> <p>Cystic Fibrosis is another example, this time based on a “Year of Care” pathway.  Building on the work of the Cystic Fibrosis Trust, it sets out all aspects of the support that an individual will need over the course of 12 months, depending on the severity of their illness. </p> <p>With this sort of payment it is easy to build in quality components.  The things that should happen.  Some patients will have more complex needs, and their payment will be higher, but it is all focussed on the most clinically appropriate care, whether that is delivered in the home, a GP surgery or in a hospital.</p> <p><strong>Best Practice Tariff</strong></p> <p>You can also provide a similar incentive for more discrete episodes of care.  There are already a few so-called ‘Best Practice Tariffs’ and we will soon introduce more.  18 in 2011/12.  One will be for TIAs, or mini-strokes. </p> <p>Here, payment will be aligned with NICE quality clinical guidelines, so providers can be paid more for delivering a service that meets these standards, and less for one that doesn’t.  In the case of treating a patient with a suspected mini-stroke, the emphasis is on preventing a full, acute stroke.  Things like an immediate specialist referral, identifying those at higher risk within 24 hours and getting an MRI scan for those high risk patients within 24 hours of diagnosis.</p> <p>Payments based on the historic average cost of a treatment can’t hope to keep up with often fast-paced developments in care.  Where NICE clinical guidelines support the introduction of a Best Practice Tariff, we won’t wait for the cost data to catch up.  For example, in 2011/12, we’ll introduce Best Practice payments for some minimally invasive techniques in interventional radiology, using a reasonable estimate of the costs involved.</p> <p>I know that it can sometimes feel like the NHS is drowning in a sea of best practice guidance sent from on high.  In the past, the guidance has often been sent with no money to implement it, no incentive to enact it.  It’s then often seen as yet another burden to endure, another rod for the backs of already over-stretched clinicians. </p> <p>But by aligning best practice, NICE clinical guidelines and improved patient experience with the way that care is paid for I am confident we will see a significant improvement in clinical outcomes.</p> <p><strong>30 days after discharge</strong></p> <p>And in this way, we can also address the issue of hospitals discharging patients with inadequate support in the community only for them to turn up a few weeks later in A&amp;amp;E. </p> <p>Hospitals will remain responsible for a patient for 30 days after discharge.  Responsible for arranging any social care, any rehabilitation or reablement. </p> <p>And unless there is good reason for it, if they are readmitted during this time, then the hospital will have to pick up the bill themselves.  The commissioner won’t pay a penny.</p> <p>Again, this is a powerful incentive to make sure that the pathway of care is properly integrated and that, for example, a hospital cannot wash its hands of a patient just because they’re no longer lying in one of their beds.</p> <p><strong>Risk Stratification</strong><br /></p> <p>In many cases, the different levels of risk are reflected in a different level of tariff.  This means the commissioner of that care, be it the GP Consortia or the Commissioning Board, is further encouraged to provide care that is the most appropriate for that patient. </p> <p>A good example is the new tariff for multi-professional outpatient clinics for patient needing dialysis.  By paying more for patients with complex needs to see a multi-professional team – for example a doctor and a psychologist or social worker – patients are given more choice and control and are able to move to their chosen treatment pathway more quickly.</p> <p>The incentive is always to provide care that is integrated along the care pathway, aimed squarely at delivering the best clinical outcomes and tailored to the individual clinical and social needs of the patient and not on the organisational convenience of the institution.</p> <p><strong>Leadership</strong></p> <p>I said at the beginning that one of the ways we will modernise the NHS is by placing more power in the hands of clinicians.  The changes to the way we pay for NHS services, far from being just an arcane and technical change to a pricing mechanism, is a vehicle for clinical empowerment.</p> <p>It empowers providers to innovate and rewards them for improving the quality and efficiency of the services they provide.  And it empowers commissioners to influence the services their providers deliver and to gain as much value for money as possible. </p> <p>But as is always the case, with greater power comes greater responsibility.  Clinicians within consortia and providers will now have to grasp the nettle and lead those organisations.  They will need to look at how they operate now and see how they can do so differently in the future.  They will need to work with their colleagues across patient pathways to see how they can deliver not the best secondary care or the best primary care, but the best overall patient care.</p> <p>Now more than ever, the NHS needs leadership.  It may sound odd coming from a Secretary of State for Health, but I don’t believe that in the future, modern health service, a politican should be in control.  Leadership should come from within the NHS . </p> <p>The leaders we need are:</p> <p>• clinicians – designing the best care pathways for their patients. <br />• managers – working with their clinical colleagues to realise that change. <br />• local councils – ensuring that local healthcare joins up with other services like social care and public health.<br />• And patients – holding local services to account and playing an active and informed role in their own care.</p> <p><strong>New GP Pathfinders</strong><br /></p> <p>I am very glad to see that more and more clinicians are grasping this nettle.  Today we are announcing the next group of General Practice-led Pathfinder consortia.  As of today, a further 40 consortia will begin the journey to taking full responsibility for local health services, working with providers along the various care pathways to deliver the best outcomes for patients.  This brings the total to 177 across England, covering 35 million people, over two thirds of the population.</p> <p><strong>Conclusion</strong></p> <p>The modernisation of the Health Service represents a massive shift of power away from me, away from Whitehall, to the front line, releasing the untapped creativity and talent of the NHS for the benefit of patients; realising the enterprise and innovation which NHS staff have by the bucket-load.  They are our brightest and best.  We should treat them as such.</p> <p>Modernising the way we pay for NHS services is a powerful tool for clinicians to drive forward clinical practice. </p> <p>Along with far greater transparency, with increasing patient control over their own care and with clinical leadership to the fore at every step of the way, I know that a modern NHS will be one that delivers outcomes for patients and their families that are truly among the best in the world.</p> <p>Thank you.<br /></p> None Andrew Lansley CBE MP Nuffield Trust Annual Health Strategy Summit'NHS modernisation and the way we pay for care'2 March 2011 Department of Health 2011-03-02 speech to the Nuffield Trust Annual Health Strategy Summit
<p>The title of this conference, 'Maximising Quality, Minimising Cost', can be interpreted in different ways by different people. </p> <p>Some may wish to place the emphasis on one part over another.  To say that what really matters, given the state of the public finances, is to cut costs, and as long as we can keep quality above a minimum standard, then that should be enough.</p> <p>Others may insist that it is quality alone that matters; that any attempt to reduce costs will inevitably lead to poorer care.  That while we should pay lip service to greater efficiency the only real way to improve care is to spend more money on it. </p> <p>Still others may take a more “steady as she goes” view; that things aren’t so bad, that there isn’t a great deal that can be improved anyway and so we should be content with the status quo. </p> <p>They are all wrong.</p> <p>Our plans to modernise the NHS are not primarily about cutting costs.  They are about increasing productivity, improving efficiency and enhancing value for money through competition.  They are about achieving far more with what we have.  Introducing the dynamism of competition and contestability to drive up standards and to drive out cost.  But most of all, they are about achieving health outcomes that are among the best in the world.</p> <p><strong>Money alone is not the answer</strong></p> <p>Since 2001, improvements in the NHS have been principally driven by massive annual increases in the budget.  In the beginning this was justified as we could all see that the NHS was underfunded.  We now have new hospitals and GP surgeries and with more, better paid staff. </p> <p>But over time, for politicians at least and others joined in, throwing ever increasing amounts of money at the NHS somehow became the only way to improve quality.  Only it didn’t as productivity fell, we closed the gap in spending with other European health systems, but not the gap in terms of results.  A policy statement was seen as meaningless if it did not come with a large additional budget attached. </p> <p>This was always going to be unsustainable, and we’ve now reached the end of that particular road.</p> <p>While we will continue to increase the NHS budget year on year, and by £10.7bn over the life of the Parliament, the scale of those increases will be far smaller than in recent times. </p> <p>If doing things in the same way as we have done before is not possible, now must be the time for change. </p> <p>For if we do not, if we do not adopt a resolute focus on productivity and efficiency, if we do not do everything we can to herald a new era of innovation and creativity, the future is one of poor standards and relatively poor outcomes.  And I for one will not allow that to happen.</p> <p><strong>Bureaucracy</strong></p> <p>In the short term, there are many things we can do that will save serious amounts of money within the Health Service.  Most obviously, by abolishing the excessive layers of bureaucracy, saving £5 billion in total by the time of the next election, even allowing for the running costs of the service to be taken back to the 2004 level.</p> <p><strong>QIPP - Quality Innovation Prevention and Productivity</strong></p> <p>But beyond the obvious, there are even greater gains to be had from directly improving the quality of care.  As I said, many assume that better care costs more.  But as the work on the ongoing QIPP programme has already demonstrated time and again across the Health Service, this is not the case. </p> <p>More accurate diagnoses, fewer treatment errors, fewer complications, faster recovery and less invasive treatments.  All things you would list under a heading of “better care” and all things that can dramatically reduce the cost of that care.</p> <p>And most cost effective of all is to keep people healthy and out of hospital in the first place.  So our modernisation of healthcare will include:</p> <p>• Putting as much effort into preventing disease as we do to cure it. <br />• Treating people in the right place, at the right time, first time.<br />• Treating people wherever possible in their homes and in their communities rather than in hospital. <br />• And safely reducing the length of a patient’s stay in hospital while ensuring that they are only discharged when they are ready to move on and do not come back a few weeks later.</p> <p>This is not rocket science.  People have been talking about it and working on it for years, such as the Modernisation Agency, NHS Institute for Innovation and Improvement and now the QIPP programme.  So why has it not happened at pace and at scale when the benefits both to patients and to the NHS budget are so plain? </p> <p>The answer?  Because there was no incentive to do so. <br />• Why should GPs engage in the reform of local care pathways if they have no real power to change things? <br />• Why should a hospital help to treat more patients in the community if it means receiving less money in the future? <br />• How can PCTs intervene on public health when so much of what can have an impact lies beyond their area of responsibility?</p> <p>The Health Service is full of talented, highly skilled people dedicated to the welfare of their patients.  People who are full of ideas and passion.  The people are not the problem.  The system is the problem. </p> <p>The system that tells people what to do, that restricts their room to manoeuvre, to create, to innovate.  If we are to see the gains we all want, if we are to see dramatic improvements in quality combined with greater efficiency, then we need an NHS that can unleash that creativity for the benefit of patients. </p> <p>An NHS where providers of healthcare compete based on the value of the service and the care they provide.</p> <p><strong>Value-based competition</strong></p> <p>So what do I mean by this?  What is “value”?  Well here I would like to draw on the work of another of our speakers, Professor Michael Porter, who set out the idea of value-based competition in his excellent book, Redefining Health Care. </p> <p>I am sure he will explain far better than I can.</p> <p>But put simply, value is about results.  It’s the results that a particular provider delivers at a medical condition level. </p> <p>So how good is one hospital’s diabetes care compared to another’s?  How good is their COPD care or their hip replacement surgery?  When providers of NHS care compete on the outcomes they achieve for patients, everybody benefits. </p> <p>For this to work, these outcomes must be measurable and transparent.  And where this happens, the results we know can be dramatic.</p> <p>According to a recent study by the European Association for Cardiothoracic Surgery, patients undergoing heart surgery in England have a greater chance of survival than in almost any other European country. <br />In the past 5 years, death rates have halved and are now 25% lower than the European average. </p> <p>This stunning improvement was not down to a government target.  It was the direct result of the collection, analysis and publication of outcome data by cardiac care professionals.  I remember first talking to Sam Nashef at Papworth 15 years ago about the audit and transparency they were leading in cardiac care. </p> <p>It was their idea and their professional pride that drove competition between – and cooperation among – them and forced up standards so dramatically, firstly through audit and then through publishing data.  They should be lauded for the results and I want to see similar results across every facet of the NHS. </p> <p>Under our plans to modernise the Health Service, providers that deliver excellence will benefit from more referrals and more patients choosing their service.  Those that don’t will have a strong incentive to change and improve.</p> <p>Providers will benefit when and precisely because patients benefit. </p> <p><strong>Liberating clinicians</strong></p> <p>That is why we will empower doctors, nurses and all other health professionals to lead the NHS from the front-line. </p> <p>We’ll change the default in Health Service decision-making, so that it’s GP-led commissioning – the people who see patients every day – and their clinical colleagues across the NHS, social care and local government, who decide what and how services are provided.  Not detached and bureaucratic tiers of NHS or Department of Health management. </p> <p>We’ll give patients choice at every possible point along the way and we’ll give them the information and support they need to exercise that choice. </p> <p>The money will follow the patient and it will flow to the very best providers.  The public aren’t fools.  If they or their GPs can see for themselves how one hospital will give them a far better standard of care than another, even if it’s further away, most people will go for the best care.  To pretend otherwise is just patronising.</p> <p>And we’ll invite Any Willing Provider to deliver care, competing with others based on the value of the care they can deliver.</p> <p>They will be free to experiment, to take risks, to innovate, even to fail.  Free to use their professional judgement and experience to provide the best possible care for their patients.</p> <p>We will allow staff to ‘spin out’ of the NHS and set up independent social enterprises if they want to.  Giving patients and commissioners real choice.</p> <p>For example, from April, over 60 new Social Enterprises and up to 16 new aspiring Community Foundation Trusts will start to provide commity based health services.  Many acute and mental health Founation Trusts will also take on responsbility for providing local community services. </p> <p>And we’ll finally deliver on Tony Blair’s promise to make every NHS Trust a Foundation Trust – a real Foundation Trust with real independence.  Free to organise themselves and to compete with others to provide the very best patient outcomes.</p> <p>This is a genuine opportunity for all providers to deliver clinical excellence and to be rewarded for it.  As the money flows to the best providers, they will be able to develop and grow their services.  The State will no longer stand in the way of spreading excellence.  Instead we will do everything we can to encourage it.</p> <p>The challenge for Chief Executives, freed from central control, will be to lead their organisations in a spirit of openness and collaboration. </p> <p>The challenge for senior healthcare professionals will be to stand up and be counted, to put their heads above the parapet and take decisions jointly with management to improve the services they offer.</p> <p>The reward for meeting these challenges will be a more vibrant, dynamic and entrepreneurial NHS.</p> <p>Our reforms are finally bringing the power of competition and cooperation to healthcare.  Not a free-for-all race to the bottom, but striving  for quality, for excellence and for efficiency.</p> <p>Some raise concerns that this will lead to variation and divergence across the country.  But despite the best efforts of a top-down system, variation exists already.  You will have seen from the Atlas of Variation that we published last year, that there is wide and unacceptable variation in care across the NHS.  The presence of variation is not wrong in itself where it is as a result of the needs of local people.  The difference will be that future variation will be because local communities have chosen that variation.  It will be the very opposite of the postcode lottery.</p> <p>Of course, because of the nature of competition, some providers will perform better than others.  Some patients will gain more than others.  But does that mean that those others lose out?  Will they receive worse care than they do now?  I believe not.</p> <p>The evidence is that where there is effective competition, all producers are driven to raise their game, so that even those providers that are less successful also improve, and that those served by them also receive a better service.  As the saying goes, “competition is a tide which lifts every boat.”</p> <p>And this is far from some sort of laissez-faire approach.  Every effective market requires strong and independent regulation.  And a social market even more so.  This will be the role of our co-hosts today, Monitor.  They will have the vital job of ensuring effective competition and a level playing field, acting in the interests of patients and the tax payer. </p> <p>And the Care Quality Commission will ensure that the high standards of safety and quality that we expect from the NHS are consistently delivered.</p> <p><strong>Tariff</strong></p> <p>And there will be other incentives to improve.  One will be through the tariff.  In 2011-12, the overall National Efficiency Requirement will be 4%.  2% of which will be embedded within the tariff, through things like:</p> <p>• The setting of all tariffs below the average of reported costs; and<br />• better targeting of long stay payments;</p> <p>There will be an increasing number of best practice tariffs to<br />promote excellent care:</p> <p>• To help reduce unexplained and unwarranted clinical variation,<br />• To increase day case rates where appropriate, and<br />• To reduce lengths of stay in hospital.</p> <p>And there will be changes to the rules to reduce unplanned emergency readmissions. </p> <p>But from 2013/14, prices will no longer be set by the Department, but by Monitor and the NHS Commissioning Board working together.  In certain circumstances, when the system is ready, where patient choice is not the driver of output-based competition, and where Monitor and the NHS Board are confident that it will not harm service quality, they will be able to set a maximum rather than a fixed price for services as the Operating Framework last year and this year allowed, encouraging price competition where it is deemed appropriate.</p> <p>Some people’s instant reaction to the very mention of competition on price is to recoil in horror.  To talk of quality inevitably going out of the window as commissioners put saving money over improving quality. <br /></p> <p>But think for a moment who those commissioners are.  They are GPs, they are nurses, they are clinicians of all types.  People who all share a professional and, when the Health and Social Care Bill becomes law, a legal duty to ensure the highest levels of care for their patients.  There will not only be a professional incentive but also a quality incentive through the quality premium, where clinical leaders will be incentivised to deliver the best outcomes for their patients.</p> <p>If I were to trust anyone to make the right decisions, these are the people I would trust.</p> <p>And more than that, Monitor, in its new role as economic regulator, will be watching closely to make sure that price competition is working to improve quality as well as efficiency.</p> <p><strong>Conclusion</strong></p> <p>So let me conclude, I don’t want anyone to be misled about our plans to modernise the National Health Service – as some are trying to do so.  The focus of everything we do will be on improving health outcomes. </p> <p>We will do this:</p> <p>• by liberating clinicians and their colleagues to re-design the Health Service from the bottom up;<br />• by making them responsible for the budgets they spend; and<br />• by creating a dynamic social market based on choice, competition and transparency. </p> <p>The inevitable results of this approach will be two-fold: firstly, increases in productivity over the coming decade, contrasting with the loss in productivity of the last decade and outcomes that are consistently among the very best in the world.  And that is our vision.</p> <p>Thank you.<br /></p> None Andrew Lansley CBE MP Monitor and UCL Partners Conference'Maximising Quality, Minimising Cost'24 January 2011 Department of Health 2011-01-24 speech to Monitor and UCL Partners Conference
<p>It’s a pleasure to be here in Birmingham at the new Queen Elizabeth II hospital. </p> <p>I remember being shown the plans and model of this wonderful new building several years ago.  What a pleasure now to see it; and to have the opportunity also to visit the military wards.  I’m very impressed to see what you’ve achieved here.<br /></p> <p>Every single day, those in our military risk their lives in foreign lands to keep us safe at home.  For those who are injured, their war does not end.  Instead the front line shifts from the battlefields of Helmand to the wards of this hospital . </p> <p>Injuries suffered on the front line are complex and can require many years of care and rehabilitation.  In the last decade, thousands of serving personnel have been treated here for serious injuries and other medical conditions.  So it makes sense that we place this new centre here at the Queen Elizabeth II Hospital, where we can learn the most and deliver the most for military patients. </p> <p>The horror of major trauma is not restricted to the battlefield.  It is a major issue for civilians too.  Every year around 20,000 people in England and Wales experience major trauma.  Of those, more than a quarter will die and more than half will face life with a serious or permanent disability. </p> <p>Now, the nature of the injuries experienced in battle will differ from those suffered on the streets at home.  Military patients who come into contact with IEDs and fire-arms tend to experience trauma at the more severe end of the spectrum.  The NHS can learn a huge amount in terms of trauma care for blast injuries and ballistics. </p> <p>Surgeons and nurses returning from the front line will have deep specialist knowledge.  Knowledge that is of value to our major trauma centres. </p> <p>But civilians also have to deal with complicating factors that the military does not.  Things like hypertension or diabetes.</p> <p>So military and civilian trauma care is not the same.  Each has much it can learn from the other. </p> <p>I remember at Papworth a couple of years ago, I was at a celebration of Europe’s first successful heart and lung transplant. </p> <p>This great achievement is an excellent example of what can happen where disciplines from basic research, immunology and, ultimately, the surgery come together. </p> <p>With this, as with all new developments, courage and the ability to adapt and to innovate is required by the institution, by doctors and by the patients themselves. </p> <p>But what’s as important, is that the new developments and spin-offs that come out of the understanding of complex patients are disseminated throughout the NHS and the military.  So that the benefits of new techniques and procedures can be felt by all.</p> <p>This unit has the potential to push forward medical and surgical practice in the same way as they did at Papworth.  Pushing the boundaries of what is possible, keeping alive people who would previously have died, making what today is cutting edge, commonplace.</p> <p>Already, benefits of this sort of cross-fertilisation have helped soldiers to survive injuries that once would have proved fatal.  And many of the management strategies developed in combat have improved civilian care when it comes to gunshot wounds, natural disasters or terrorist attacks.</p> <p>But to date, much of this work is opportunistic and uncontrolled.  This centre will bring focus and rigour as we attempt to translate our experiences in Afghanistan into real benefits to the civilian population at home.</p> <p>The Government has confirmed its support for health research in the strongest way possible in the recent Spending Review.  It is a part of our determination to secure long-term improvement in treatments and outcomes through innovation.  Annual real terms increases will ensure that NHS patients will benefit from the most innovative medical research and technologies. </p> <p>This £20 million centre, a joint venture between the Departments of Health and Defence, the Queen Elizabeth Hospital and the University of Birmingham, will make a real difference to the lives of many people, military and civilian.</p> <p>It will, for the first time, bring together trauma surgeons, research scientists and many others from the military and the NHS. </p> <p>It will help us to expand our knowledge and practice in haemorrhage control, to develop new resuscitation strategies and to test and develop new devices. </p> <p>It will help us to push forward in the vital area of infection control.  To stop people dying from an infection before they have a chance to recover from their injuries.</p> <p>It will help us to focus our research on the early phase of injury and translate it into novel therapies and interventions for pre-hospital and early in-hospital trauma care.  Those precious early moments that can make such a difference to the survival and recovery of a patient.</p> <p>Those in our Armed Forces who have made sacrifices to defend our country deserve the very best – as do their fellow citizens back home.  This Government is committed to giving them both first class treatment and support.  This Centre will be an important part of that support.</p> <p>So let me finish by congratulating you, University Hospitals Birmingham, the University of Birmingham and all those involved in this Centre.  The substantial funding devoted to this initiative is a reflection of your dedication and expertise, your past achievements and a promise of the future successes that lie ahead.</p> <p>Thank you, I wish you all the very best as you take this exciting work forward.</p> None Andrew Lansley CBE MP Launch of the National Institute for Health Research (NIHR)'s Centre for Surgical Reconstruction and MicrobiologyThursday 20 January Department of Health 2011-01-20 speech at the launch of the National Institute for Health Research (NIHR) Centre for Surgical Reconstruction and Microbiology
<p>Check against delivery</p> <p>Anyone who steps foot in a John Lewis or Waitrose this Christmas is likely to leave it with the knowledge that employee ownership works.</p> <p>For the John Lewis Partnership, it works on the shop floor, where morale is high, staff turnover low, and customer satisfaction among the best in the business.</p> <p>And it works at the board room too, where profits exceeded £300 million last year, meaning that every partner sharing a £150 million bonus pot.</p> <p>Of course, John Lewis isn’t alone. Across the corporate world, employee engagement and staff ownership are increasingly seen as attractive models for business.</p> <p>Earlier this year, a report from the Cass Business School gave academic credence to commercial reality. It found companies owned by their employees are more resilient and more agile in the face of economic challenge.</p> <p>It works for the private sector. Can it work for the public sector?</p> <p>Well, we think there’s a lot to be said for employee-owned organisations in health and social care.</p> <p><strong>A hearts and minds business</strong></p> <p>Healthcare, like retail, is a hearts and minds business.</p> <p>Good care is built on a strong relationship between clinician and patient. Where clinicians are motivated and armed with the capacity to improve services then you get better results.</p> <p>And we know from the experience of places like Sandwell that where you increase staff empowerment, you also get better staff morale.</p> <p>In Sandwell, for instance, they saw a dramatic fall in staff absence and a huge improvement in staff turnover as a result of corporate change.</p> <p>So the evidence is clear. The more we can strengthen the bond between the individual and the organisation, and the more we free up health professionals to innovate then the better for everyone.</p> <p>And that insight lies at the heart of my proposals for the NHS.</p> <p>I came into office with a very clear sense of how the Health Service needed to change.</p> <p>After a decade of micro-management, we needed a clear and consistent policy of decentralisation. To devolve decision-making. Escaping from the view that change can only happen through Government edict.</p> <p>And, in the NHS White Paper, we set out our plans.</p> <p>For an NHS where patients are given more choice and information, so that there is ‘no decisions about me, without me’</p> <p>Where clinicians are liberated, free to exercise their professional judgements, and shape the way their organisations run from the grassroots.</p> <p>And where the focus is not on bureaucratic process or Whitehall mandates, but on the task of securing the best outcomes for patients.</p> <p>Foundation Trusts are central to this. I’ve made it clear we want all trusts to become Foundation Trusts within three years, and we’ll help them to do so.</p> <p>Now some have questioned whether they’re social enterprises in the strictest definition.</p> <p>Let’s avoid that debate today.</p> <p>What matters is that FTs continue to live and breathe the principles and values that make social enterprises so compelling.</p> <p>I mean the principle of social purpose, of engaging with communities and investing any surpluses to improve care and broaden services, rather than distributing proceeds externally.</p> <p>And the principles of independence and freedom – that by freeing themselves from Whitehall interference, FTs can empower staff to make the right decisions for their patients, thereby unleashing the creativity and collective endeavour that’s so key to 21st century healthcare.</p> <p>And so, for instance, we want to build on the potential for service line reporting, where clinical leads in a department get the financial information they need to take full control of their team.</p> <p>We are still consulting on the future of Foundation Trusts. There have been many good, constructive responses to the consultation, which we’re now considering. And we’ll be announcing our intentions very shortly.</p> <p>But certainly I can tell you this now. We want to give Foundation Trusts more freedom. And we want to embed core principles that are consistent with social enterprise models.</p> <p><strong>Right to request</strong></p> <p>So, a simple aim, a consistent agenda. Promoting greater staff leadership, better employee engagement, and a clear and consistent social purpose.</p> <p>Foundation Trusts are one way of doing this for the acute sector – and as more Trusts take on foundation status, so we will see the character and vigour of social enterprise becoming an increasingly prominent part of the NHS’s DNA.</p> <p>And in the primary and community care sector, we’re pursuing a Right To Request programme, where staff can make a request to the PCT to form a social enterprise.</p> <p>And today we announce the third wave of organisations that will be making that transition.</p> <p>Thirty-two more NHS organisations will now become social enterprises through this programme – more than doubling the number who made the transition under the first two waves.</p> <p>It reflects a new pace and urgency to this reshaping of NHS services. The last Government was hesitant, and towards the end openly hostile, towards independent sector involvement in healthcare.</p> <p>We take a different view. We see this type of independent provision, not as an ideological threat to public services, but as a practical means of supporting the ethos and values that sustain the NHS.</p> <p><strong>Value of social enterprises</strong></p> <p>And the clinical leaders involved in Right to Request express the potential far better than I can.</p> <p>They talk of how social enterprise “unlocks goodwill, improves morale, helps to promote exemplary care”.</p> <p>Or how it “keeps staff on board and raises the aspirations and personal responsibility of staff and service users.”</p> <p>And how it generates ‘social value’. That by engaging more deeply with the local community, you can start to find new ways of filling gaps and meeting the needs of the most vulnerable.</p> <p>And in size and scope, the range of organisations involved is vast. Turnover from £100,000 to £100m. From just four to three-and-half thousand staff. Covering a full range of services, including whole provider arms and individual services. From drug treatment services in Wakefield to homeless healthcare in Leicester, to family nurse partnerships in Derby.</p> <p>It’s another addition to a growing family. Alongside the Right to Request organisations, there are also about 6,000 social enterprises involved in delivering health and social care services – all of them pushing the boundaries and exploring new ways of delivering support.</p> <p>Open Door in Grimsby is a typical example. It’s a 24/7 service supporting some of the most vulnerable and excluded people in the community. Drug users, sex workers, homeless people.</p> <p>It encourages them to come in, to see a doctor, to get treatment, without barriers, without boundaries, without judgements. There’s no CCTV, no locks on doors, no suspicion. A genuinely open culture that puts people at their ease.</p> <p>But it goes further than this. One of the big issues facing all of these service users is their financial security. Many of them can’t open a bank account because they don’t have a fixed address.</p> <p>So the other thing Open Door does, through its relationship with a major high street bank, is provide clients with the opportunity to open a bank account.</p> <p>Not a conventional service you’d expect from a health organisation. But it makes a big difference. As the very name of the organisation suggests, it opens doors for the service user. Allows them a way forward in their lives.</p> <p><strong>Promoting social enterprise</strong></p> <p>And that’s the sort of lateral thinking we need.</p> <p>If we want to make the breakthroughs in preventing illness and reducing demand on acute services, then we need to start challenging conventions about what a health or a care organisation does.</p> <p>We’re already making a move in the NHS to a payment system which demands that services look out across the whole community.</p> <p>That means health services will need to think not just about initial treatment, but the whole outcome of treatment, including rehabilitation and long term recovery.</p> <p>And you can only do that if you have flexibility and variety in the system, if the latitude is there for organisations to look beyond old models of care.</p> <p>That’s why our ambitions stretch beyond Right to Request.</p> <p>There is now a clear, unambiguous policy shaping NHS commissioning.</p> <p>No more preferential status for any one type of organisation. Instead, genuine diversity and plurality. A system that gives any willing provider a fair chance of competing for NHS contracts.</p> <p>Too often this policy has sparked frenzied accusations of ‘privatisation by stealth’ in the NHS.</p> <p>Yet as social enterprises up and down the country show, you strengthen, not undermine, NHS values and patient choice by opening the door to diversity and plurality.</p> <p>So, from my point of view, we’re determined to press on, to open up new opportunities for social enterprises and to extend Right to Request style models to other parts of the health and care system.</p> <p>A new Public Health Service, rooted in the principle of local, community-based action, will lend itself to social enterprises – as will the proposals we’re working on to improve mental health.</p> <p>And the vision for social care that we’re publishing tomorrow will advocate plurality and partnership in a sector that is already a rich and fertile ground for social enterprise.</p> <p>Only a few days ago, I announced plans for new Social Work Practices.</p> <p>These will give greater freedom and control for a profession that has been particularly hard-hit by the bureaucracy and micro-management of recent years.</p> <p>Pilots will look at how social workers could form independent organisations, contracted to local authorities, and working across health and social care to secure better outcomes for service users.</p> <p><strong>Dealing with barriers</strong></p> <p>So where next? Well, we still need to break down the barriers to entry. We know there are tricky issues around funding, around tendering processes, around transfer of employee rights.</p> <p>We are looking across Government to find the right solutions. Francis Maude will be telling you more about this tomorrow.</p> <p>But today, I can announce that I’m adding an extra £4.4 million to our Social Enterprise Investment Fund.</p> <p>This will be used to support Right To Request organisations through transition, as well as helping to set up other social enterprises from outside the NHS.</p> <p>The bottom line is we need innovation. We need to mobilise the workforce and carry people with us in delivering the reforms we’ve set out.</p> <p>Social enterprise is a powerful and proven model for change.</p> <p>It’s something I passionately believe in, and I look forward to working with you to expand the sector and derive more benefits for patients and service users in the months and years ahead.<br /></p> None Andrew Lansley CBE MP Guardian Social Enterprise Conference Department of Health 2010-11-16 speech to the Guardian Social Enterprise Conference
<p class="introText">INTRODUCTION<br /><br />I’m quite taken with the title of your conference: Building the Present, Shaping the Future.<br /><br />When it comes to the future, there are three kinds of people. Those who let it happen. Those who make it happen. And those who wonder what the hell happened.<br /><br />We have to be very much in the second group – not the victims of events, but the architects of solutions to help us triumph over circumstances. <br /><br /><br /><br />THE PRINCIPLES OF REFORM<br /><br />To do so, we need a clear strategy based on strong values and clear principles.<br /><br />For the NHS, through the White Paper, we set out those principles:<br /><br />First, a patient-centred NHS. Patients not just as beneficiaries of care, but as active partners in its design and delivery. <br /><br />Shared decision-making. Patients feeling that invariably, when they encounter the health service, it’s a case of ‘no decision about me, without me’. <br /><br />This is a principle not just for the health service, but a principle for the public service.<br /><br />Second, an outcomes focus for the health service. Striving to achieve results for patients, not straining to meet arbitrary targets set by politicians. <br /><br />Again, a principle for the public service – to focus on results. <br /><br />And a third principle for the NHS and for public services: the devolution of decision-making, close to those who are responsible for the service delivered and wherever possible into the hands of those who are the service beneficiaries. <br /><br />For us, in the NHS, giving much greater freedom and discretion for clinicians to drive change within their own organisations.  <br /><br />And I think across social care those principles are equally clear:<br /><br />A focus on prevention. Keeping people as independent as possible, for as long as they feel able, by providing earlier support.<br /><br />On protection. Protection from harm and abuse. Reassuring people that support will be there and lifting the fear that everything they’ve worked for may be lost, simply because of the care needs they develop, on what sometimes seems to be an arbitrary basis.<br /><br />A principle of partnership. Ensuring that individuals, carers, families and communities work together with local services, balancing family and community action with state support.<br /><br />And the principle of personalisation. Giving people control of their own care, so they can choose the services that best meet their needs.<br /><br />All of those principles come from core values that are at the heart of this coalition government.  The beliefs that support and sustain all of us involved in public services. <br /><br />Values of fairness – caring for each other, and the social solidarity that both the NHS and our care services represent.<br /><br />Of freedom – giving all of us greater freedom through those services to take more control of our lives; to feel ownership of the services, and their results.  <br /><br />And responsibility – for our own health; responsibility of families and communities for the health and wellbeing of our community; and importantly, businesses demonstrating their corporate social responsibility<br /><br />Those values become all the more important as we look to the future.<br /><br />We now need to bring these values and principles into a vision of how our care services will meet the pressures and demands facing us.<br /><br />Because care is at a crossroads. Demography is literally remoulding society and it is transforming demands on public services. <br /><br />More older and more vulnerable people - for example falls are costing the NHS a billion pounds this year.<br /><br />More cases of dementia – around 750,000 today, predicted to double over the next thirty years.<br /><br />And more people living with serious long term conditions.<br /><br />Only last week, new data told us that people over 75 spent in total an extra 1.5 million days in hospital last year – nearly 50% more bed days than ten years ago.<br /><br />A BIG SOCIETY APPROACH<br /><br />It’s clear that investment is only part of the solution. <br /><br />We can’t continue putting more and more money in to meet ever-increasing demand.<br /><br />We need a more sustainable way forward.<br /><br />A new outlook.<br /><br />A Big Society approach to caring for our ageing population.<br /><br />An approach that shifts power from the state to people and communities. <br /><br />That means giving real freedom and flexibility for the social care profession to find new ways of supporting people. <br /><br />Ways that draw upon the innate relationships and sources of support that lie underused within our communities.<br /><br />It will require a double devolution of power. From Whitehall to Town Hall. And then from Town Hall to the citizen.<br /><br />Stimulating a shared sense of responsibility between the State and the individual for meeting care needs.<br /><br />There’s no shortage of experience or knowledge about how we can make this happen.<br /><br />Technologies like telecare and telemedicine are already increasingly used to help people stay safe in their own homes. <br /><br />When I was in North Allerton, talking to North Yorkshire County Council, they told me about their programme of telecare services. This was established over three years ago.<br /><br />They put it very simply: “For every hour someone is on the floor, it’s an extra 24 hours in hospital.”<br /><br />They’ve shown the investment paid off. North Yorkshire has saved over a million pounds – more than a third reduction in costs, achieved by postponing entry into residential care or reducing the homecare support required.<br /><br />The best councils are also testing new commissioning practices to support people differently. <br /><br />Building new connections with the voluntary sector to bring greater flexibility and variety to care.<br /><br />For example the community network organisation Shared Lives, which is helping micro-enterprises to secure local government contracts.<br /><br />One of their most colourful stories was about an older lady who wanted to keep her flock of geese when moving into new supported accommodation. <br /><br />I think if we can accommodate a flock of geese we can accommodate most requests…<br /><br />Or the advocacy and advice provided by SupportNet in Nottingham –helping people to use their Direct Payments to make new friendships, to improve disability access on local public transport and forming lunch clubs and exercise classes. <br /><br />Direct payments and personal budgets are not just about people making decisions themselves, it’s about opening up new opportunities for people to be helped to make decisions – individually and collectively in local neighbourhoods.<br /><br />As one local resident put it in Nottingham– it’s all about “getting people to care about each other.”<br /><br />So we need a care system that reflects that principle; which uses those new kinds of design.<br /><br />And I’ve been very encouraged to see a kaleidoscope of community and user-led organisations emerging around the country – all of them determined to do care differently.<br /><br />But how do we make this systematic – not just good examples but good practice across the country? <br /><br />How do we blend enlightened commissioning and the enterprise of the voluntary and independent sectors to collectively open more doors and create new possibilities for older people and for people with disabilities?<br /><br />PARTNERSHIP FOR DEMENTIA <br /><br />Well, it means new priorities, new ways of thinking and new ways of working. <br /><br />Partnership on a new scale.<br /><br />We know the benefits of that. But with some very worthy exceptions, they’re too often unrealised.<br /><br />Dementia is a case in point. <br /><br />A third of people with dementia who go into hospital from the family home never return home. They end up being discharged into a care home. <br /><br />Also on dementia, as Sube Banerjee has told us, 1,800 people die each year because of the inappropriate use of anti-psychotic drugs. <br /><br />Many of them are prescribed these drugs as the first response to behavioural difficulties, before other and often effective, solutions are considered.<br /><br />If we can get all the key people – care homes, GPs, mental health professionals, social workers, all working in partnership, we can do much better. <br /><br />Better for them, better for the taxpayers, better for our communities.<br /><br />And thanks to the leadership of the Alzheimers Society the Dementia Declaration already has 45 organisations signed up from across the public and independent sector. This is a powerful model for the future.<br /><br />Each of these organisations came forward, worked together, to pledge support to reduce anti-psychotic use and improve support for people with dementia.<br /><br />That’s the kind of social movement that will drive change. It’s a Big Society response to this challenge. <br /><br /><br />PARTNERSHIP FOR CHILDREN’S HEALTH<br /><br />Children’s health is another area where we know we need to do better, and where we can do better if we have health and children’s services working together more effectively. That is what Ian Kennedy’s report told us just a few weeks ago.<br /><br />If we prevent just five children going into foster care, we can save £135,000 a year in care costs alone, and we give those children more stability and a better chance of doing well at school.<br /><br />Or if we improve breastfeeding rates by just 10 per cent, you stop nearly 4,000 cases of gastroenteritis and 1,500 cases of asthma a year. That would save about £7 million a year.<br /><br />Spot serious behavioural problems in just 10 children and you save society two and a quarter million pounds over their lifetime.<br /><br />Prevent one case of conduct disorder, the most common form of child and adolescent mental illness; you save £150,000.<br /><br />This is in the context where half of all mental health problems are capable of being identified before the age of 14 – so if we can boost child mental health we can transform over time the mental health of the nation.<br /><br />So we are investing in 4,200 new health visitors to help us support families and provide services where they suit the family best – at home, through their GP surgeries, through Sure Start Children’s Centres and other non-traditional settings.<br /><br />Last week, I announced that we will double the number of Family Nurse Partnerships, so that we can both achieve the universal service that health visitors should be and the very targeted service for the most at risk families that Family Nurse Partnerships presents.<br /><br />And we’ve also launched a consultation document on the future of children’s health – and how we can bring services together to secure better outcomes. <br /><br />I know that many colleagues here from across children’s services in local government will be actively involved in that.<br /><br />And I very much agree with Marion Davies when she said yesterday that “Now is not the time to retreat into professional silos but to build on the benefits of local partnerships.”<br /><br />We’ve known that for a long time. <br /><br />Integrated working is an old message with a new urgency. <br /><br />We need to implement change in the way that makes it a reality around the country.<br /><br />SPENDING REVIEW<br /><br />Last month’s Spending Review confronted many painful necessities, including what I know will be painful reductions in grants to support local government services.<br /><br />The potential impact on social care services was a very serious issue for us. <br /><br />There were real concerns that depleting social care would mean drastic reductions to eligibility for care support and would overwhelm the NHS with emergency admissions. <br /><br />We recognised those issues. We made crucial choices; and we secured a vital settlement for social care.<br /><br />That was something that was achieved across Government. It wasn’t just the Department of Health, not even just DH and the Department for Communities and Local Government working together. <br /><br />It extended to the Treasury, to Number 10, to the Deputy Prime Minister. <br /><br />To take one example of a key individual involved, in Paul Burstow, care services and adult social care is a devoted advocate of care services and care support. <br /><br />Somebody who has understood it for years; somebody who believes in it; and somebody who is very well-placed not only in our Department but beyond to argue the case for social care. <br /><br />He’s done it very effectively already, and I know when you listened to him on Wednesday you realised what a powerful advocate you have got inside Government.<br /><br />Paul took you through the numbers on Wednesday, and I want to reinforce the points he made then. <br /><br />The Spending Review is a strong platform upon which to base our planning for the future.<br /><br />It’s a platform for change, a platform for improvement, and it is a bridge to the long-term care funding settlement which is being mapped out by Andrew Dilnot and his team. I don’t think there’s anybody better than Andrew Dilnot to be leading that work too.<br /><br />I know there are questions being asked – such as “will the extra money get through?”<br /><br />Let me take you through it.<br /><br />Next year, there will be an additional £800m provided over and above the social care settlement, through the NHS, to support social care.<br /><br />£150m of that, next year, will be spent on reablement – in addition to the £70m which we announced last month that will be available this financial year.<br /><br />That will be backed by the new rules whereby NHS Trusts, from next april, will take responsibility for their patients for 30 days after discharge.  This is part of the focus on outcomes: the outcome of treatment is not that a patient is discharged from hospital, it is that they are discharged in a fit state, with support in order to then resume their activities of daily living at home. That’s what we’re aiming for – that responsibility. <br /><br />After care will no longer to be an after thought for the NHS – it will be integral to the outcomes we want to see.<br /><br />Hospital Trusts will need to work with you on reablement support to make sure these readmissions don’t happen; to make sure that outcome is being achieved.<br /><br />But I know there has also been some discussion at this conference about the NHS money for social care beyond reablement. <br /><br />For the remaining NHS money provided to support social care next financial year - nearly £650 million next year – there will be very clear instructions through the new Operating Framework to be published next month. <br /><br />This will set out specific Primary Care Trust allocations that they will transfer to Local Authorities for spending on social care services to benefit health, and to improve overall health gain.<br /><br />PCTs will work with you to agree where the money should be spent, with a shared analysis of need and common agreement on what outcomes need to be met.<br /><br />I know that you need certainty in order to plan and work together effectively.<br /><br />So in December we will set out allocations for next year, and we will set out indicative allocations for the year after.<br /><br />That money provided to support social care will be <br />divided up using the social care allocation formula so it will properly direct funding to where it is most needed.<br /><br />I think this is the clearest statement ever given by a Government that health and social care should be complementary, not conflicting. Integrated, not in silos. Cost-sharing, not cost-shunting. One system pulling together, not two pulling apart.<br /><br />Let me just walk you through the whole of that settlement, to reinforce what Paul said on Wednesday. <br /><br />I think we have been very clear: firstly that we have taken the ringfence off many of those grants that have been provided to you and continue to be provided to you. <br /><br />• Adult social care grants representing over £1.3bn next financial year [rising to £1.4bn by the end of the Spending Review], without a ringfence [the grants will be rolled into formula grant]<br /><br />• Learning Disability Transfer and Health Reform Grant together, of the order of £1.3bn next year, allocated on the basis of the Learning Disability requirements, but without a ringfence. So that is an unprecedented de-ringfencing of resources from the Department of Health to Local Government as part of that partnership.<br /><br />• In addition to all of that is a total of £800m next year [through the NHS to support social care]. It’s very front-end loaded: it rises to £1bn in 2014-15 (and in the year prior to that it’s £1.1bn). It very rapidly rises because we recognise that you have needs that are going to have to be met next year, and a lot of financial pressure next year.<br /><br />All of this represents a real opportunity to press on with reform. <br /><br />To redesign care services for the future.<br /><br />NHS WHITE PAPER<br /><br />And that’s precisely what the proposals in the NHS White Paper and the forthcoming Public Health White Paper will help us to achieve.<br /><br />The NHS White Paper had a clear aim to bring real, local democratic accountability to health care for the first time in 40 years.<br /><br />John Ransford yesterday talked about how local government is good at shaping place and community leadership. I entirely agree.<br /><br />That is why I want to make sure that joint Strategic Needs Assessments really give us the basis for local integrated strategies embracing health services, public health, and social care. <br /><br />That Health and Wellbeing Boards be a magnet drawing the key people together around the table to build on common ground; to have a shared sense of place and a focus on delivering the best results.<br /><br />I know many of you are keen to get going with these arrangements. <br /><br />Some authorities are already working up their own plans for integrated working. So thank you for the all of that enthusiasm you’re already showing, and which was evident in the many responses we received to the White Paper consultations.<br /><br />I want now to work with you to find the right way forward. <br /><br />That’s why I can tell you that in coming weeks, we’ll be inviting local authorities to establish trailblazers, a collection of pioneering local authorities to show how these arrangements will work in the future.<br /><br />The early implementers of health and wellbeing boards will link with General Practice-led commissioning pathfinders to ensure we can get the right relationships in place. <br /><br />And in particular I hope that will, in a number of places across the country, enable us to see how all of these new arrangements lock together in order to deliver benefits - and bring benefits sooner rather than later.<br /><br />But, in truth, whether one is an early implementer of these arrangements or not, I can already see the benefits coming through. <br /><br />Pretty much everywhere I go across the country people are not only talking to one another, but starting to put in place new relationships, new behaviour, and new ways of working: all designed to influence positively the current commissioning and service design arrangements, in order to secure better results, particularly in light of the financial circumstances that we face.<br /><br />PUBLIC HEALTH WHITE PAPER<br /><br />All of this paves the way for a Public Health White Paper, and a new approach to preventing illness and supporting health in our communities. <br /><br />As you know, from 2013-14 onwards, public health improvement will be entrenched within local government, as part of your responsibilities.<br /><br />There will be locally led plans, with local budgets and local powers.<br /><br />Strengthened responsibility and partnership.<br /><br />A health premium recognising deprivation and rewarding success.<br /><br />Directors of Public Health providing new levels of expertise within local authorities – working with other local leaders to bring a new coherence to health, social care and public health together. <br /><br />And, underpinning all of this, a new way of measuring success and gauging progress.<br /><br />Not through targets or inputs that distort decisions, but through a framework of outcomes that make sure the decisions you make are relevant and successful in making progress.<br /><br />Outcomes are the common currency that will bring services together. So I am clear that we need to connect across public services. We need the framework of outcomes for the NHS, the framework of outcomes for public health, and the framework of outcomes for social care to mesh together.  <br /><br />We will shortly be publishing a consultation on how we develop the framework for outcomes for social care, to make sure this reflects exactly those objectives and your views about how those outcomes are best measured for your communities.<br /><br />TRUST AND OPTIMISM<br /><br />The essence of the Big Society is trust and optimism.<br /><br />Through these changes, we are going to trust people in our public services, more; and trust local government to deliver for its communities. <br /><br />And it’s optimism too. Being optimistic about the resourcefulness and resilience that resides in every community.<br /><br /><br />We need to believe in people again. To support and value the contributions they make. To show leadership and advocacy in embedding change within and beyond our organisations.<br /><br />That kind of change for carers, for example – and we will be announcing plans in the next few weeks that will recognise and support the efforts of carers more fully.<br /><br />And positive change for professionals too – to give them that greater sense of ownership of the professions that they are proud to be part of.<br /><br />SOCIAL WORK PRACTICES<br /><br />Social work has been a particular victim of a decade of micro-management.<br /><br />Borne down by the paperwork. <br /><br />Reduced to managing processes rather than achieving results. <br /><br />So we need to rediscover social work’s original purpose, to re-professionalise social work, to give  them the skills they need, and the autonomy and discretion they are qualified to exercise.<br /><br />So today, I’m also announcing plans for new Social Work Practice pilots to give greater freedom and control for the profession. <br /><br />These pilots will explore how social workers can form independent groups, contracted to local authorities, working across health and social care to secure better outcomes for service users.<br /><br />We have the benefit of example: the pilots already in place for looked after children are very impressive. <br /><br />They’ve cut bureaucracy. They’ve improved flexibility. They’ve given social workers more time to concentrate on children and young people themselves.<br /><br />We hope to achieve similar benefits for adult social services – cutting the paperwork, and improve the services.<br /><br />CONCLUSION<br /><br />So what does the future then hold for all of us in adult social care?<br /><br />Some might agree with the Frenchman Paul Valery. <br /><br />“The problem with the future,” he said, “is that it isn’t what it used to be.”<br /><br />We would all like there to be a tide of money that can float us off any dangerous rocks and reefs. <br /><br />I can fully appreciate the anxiety over what lies ahead. <br /><br />But local government has a strong record on rising to new challenges. <br /><br />It has an enviable history in health protection and improvement – stretching right back to the earliest days of public health, when the great advances in public health were actually civic actions led by local government. <br /><br />So this is our chance, for you to take back that kind of freedom and power. To that extent, the future might actually be like what it used to be.<br /><br />A chance to lead for your communities.<br /><br />A chance to write a new chapter in the history of health improvement. <br /><br />The future is in your hands. Don’t let it just happen to you. Let’s make it happen for you and your communities.<br /><br />Let’s focus on outcomes; let’s work together across health and social care; let’s deliver the quality and level of support which fully provides for the young, the old, the disabled, and the most vulnerable.<br /><br />We know that any government, any society, any local government, is measured by the way in which it responds and cares for those who are the most in need and the most vulnerable in society.<br /><br />We can do better, we can achieve this, but only <br />if we work together. Health and local government, working within their communities, with local and professional leadership. Working together. Let’s make it happen.<br /><br /><br /></p> None Andrew Lansley CBE MP Secretary of State for Health's speech to the NCAS conference Department of Health 2010-11-05 speech to the NCAS Annual Conference
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117589.jpg" alt="Secretary of State for Health Andrew Lansley" /> </div> <p>One question that I am often asked is “why GPs?”  Now I’m sure that most of you could give me an answer.  But it is a fair question.  Why should the government – the taxpayer – entrust the vast majority of the NHS budget and commissioning decisions to General Practitioners? </p> <p>Well, for a start, we already entrust that money to unelected managers within Primary Care Trusts, and nobody seems too concerned about that.  The fact is, I think that GPs can do a much better job.  Primary care deals with most health problems for most people most of the time.  With around 300 million consultations every year, no-one knows patients better.  And you are the only group of NHS professionals with a population responsibility, so vital in improving the health of a nation. </p> <p>Professor Barbara Starfield, from the John Hopkins Bloomberg School of Public Health in Boston put it better than I could when she said, “There is lots of evidence that a good relationship with a freely chosen primary-care doctor, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs.”</p> <p>We also know that when specialists care for problems outside their main area of expertise, the results are not as good as with primary care. Since most people with health problems have more than one ailment, it makes sense to have a primary-care practitioner who can help decide when specialist care is appropriate.</p> <p>But it is not enough to have excellent general practice.  To a large degree, we have that already.  No, we must go further and empower general practice to organise, to coordinate and to innovate beyond the confines of the practice. </p> <p>As its name suggests, our White Paper is about “liberating the NHS”.  We will free you from top-down targets and liberate you from the dead hand of Whitehall and local micro-management.  And we’ve already made a start, removing targets such as 48 hour access to a GP.</p> <p>And up to a point, you already influence commissioning decisions by how you manage and refer your patients and by deciding which medicines to prescribe.   But it’s only up to a point.  I want you to go much further.</p> <p>Many of you are already taking the lead and starting to design local services directly – improving patient outcomes and often reducing costs. </p> <p>In Northamptonshire, the Nene Practice Based Commissioning Group – whose Darin Seger won an award for clinical leadership yesterday – has developed a peer review scheme that has dramatically cut referrals to their local hospitals.  In 6 months, the scheme prevented some 900 outpatient referrals to orthopaedics.  This not only improved patient care, in its first year it also saved over £600,000.</p> <p>In Croydon, GPs have worked with senior clinicians to start a one-stop GP-led service for women with menstrual problems.  As a result, waiting times to see a senior consultant have reduced dramatically from 10 weeks to just 2, with fewer than 10% of patients needing secondary care.  And their work is being recognised.  They have been nominated for two of this year’s Practice Based Commissioning Awards.</p> <p>I want to build on this by giving the responsibility to shape the majority of NHS services. </p> <p>Another question I’m asked is what exactly do I mean by GP Commissioning?  Does this mean, as some have caricatured, that I want GPs to turn into accountants?  To put down their stethoscopes and pick up a calculator?  Becoming more like administrators than doctors?  No.</p> <p>We already have more than enough managers – an extra 20,000 over the last decade – so there are people we can harness to that task.  What I want from you is your leadership, your judgement derived from years of clinical practice, your status within your community, and the knowledge of your patients. </p> <p>GP Commissioning will not turn GPs into managers, but it will require you to be leaders.  Some may want to lead their commissioning consortia.  Others will show their leadership in developing clinical networks. Both are vital. </p> <p>You will lead but you will not be alone.  The NHS Commissioning Board will be there with support and advice.  The Commissioning Board is not some new form of central control.  It is not the Department of Health under a new name.  It will hold you to account for the outcomes you achieve for patients and for managing NHS resources effectively. </p> <p>But it will not interfere with how you achieve these objectives or how you run your consortium.  It is there to support you, not tell you what to do. </p> <p>One form of that support from the Commissioning Board will come in the guise of Commissioning Packs, the first of which we launch today.  I don’t want the job of designing clinical care pathways to get bogged down in a swamp of bureaucracy.  This is where the Commissioning Packs can help.</p> <p>The packs aim to show Consortia how they can design services that will give patients the best outcomes and use money effectively.  To reduce the time GP consortia spend on things like procurement and administration.</p> <p>The first Commissioning Pack, for cardiac rehabilitation, and developed with the British Heart Foundation, is now available.  Dr Paul Zollinger-Read, Chief Executive of NHS Cambridge and a practicing GP, describes the pack as, “central to the development of a high quality, comprehensive and patient-centred service.  No doubt [it will] prove an important tool for new GP-led Commissioning Consortia.”  Other similar Commissioning Packs will soon follow.</p> <p>Of course, consortia can buy-in the support they need for the day-to-day management of commissioning, be that from a local authority, from other NHS services, a private company or elsewhere.  But Commissioning Packs may help to reduce the level of outside management help you need – there will certainly be no need to reinvent the wheel across hundreds of consortia. </p> <p>GPs have helped to design the packs and I expect them to evolve as GPs take on greater responsibility for commissioning.  This is exactly the sort of practical help and support you can expect from the NHS Commissioning Board.</p> <p>So, in practical terms, GP Commissioning means getting together with your colleagues across the local NHS to thrash out how you’re going to run the things locally.  To decide what good integrated diabetes care looks like; what a good asthma service will provide, how pre- and post-operative care can best be organised; what a more integrated urgent care service looks like. </p> <p>And for those patients with complex needs – patients with severe mental health problems, the socially excluded, patients with multi-morbidity – areas where GPs can sometimes feel unsupported, commissioning allows you to pull in the support you need to provide better care for your patients and to prevent unnecessary admissions. </p> <p>It’s the hard-headed, difficult stuff of designing the best possible care pathways for your patients. </p> <p>Members of the National Association of Primary Care are among the most enthusiastic supporters of the White Paper and I thank you for it.  You understand the incredible potential of GP Commissioning, of local accountability and of patient choice.  In the coming years, your support, your enthusiasm and your leadership will help us realise this incredible potential.  Not only of primary care, but of the whole National Health Service.</p> <p>But this isn’t just about giving power to GPs.  Just as much, it’s about handing power to patients and carers.  There is a vast amount of research that clearly demonstrated what every one of you will know instinctively.  That a patient’s treatment is always better and often cheaper when they are more than just a passive recipient of care, but an active participant in it. </p> <p>I want the fundamental relationship between doctor and patient to develop and become more of a partnership – jointly making decisions about the individual patient’s care.  “The meeting of two experts,” as Tuckett would say.  Some patients will want to lead the way and come to you pre-armed with firm views of what they want.  Others will be wholly dependent on your guidance.  All deserve the very best.</p> <p>Many of you will already treat your patients as partners.  Involving them in decisions, giving them as much choice as is possible within the bounds of appropriate treatment.  This should be the case for everyone.</p> <p>In the coming years, we will give patients real control over when, where and by whom they are treated.  They will be central to all decisions about their after care, often spending their own budget in the way that suits their own needs rather than the needs of the system. </p> <p>And because you cannot make an informed choice without proper information, we will arm patients with a wealth of clear, easy-to-understand information so that they and their GPs can choose and shape their care.  Of course, everyone would like the hospital around the corner to be the best in the country.  But the fact is, it may not be.  People are not stupid.  When they can see which hospital, which department, even which Consultant-led team is offering the best care, they will vote with their feet. </p> <p>And we will not only give them more information, we will give them control over their own data.  The new Summary Care Record will hold only the essential medical information needed in an emergency: medication, allergies and reactions.  If people don’t want this information shared, we will make it easy for them to opt out.  If they want more information stored, it will be their choice, based on explicit consent, with clear information. </p> <p>Personal choice, long spoken of, will finally become a day-to-day fact.<br />Genuine choice, with money following the patient, will stimulate innovation, increase productivity and provide far stronger incentives for providers to improve the quality of their services and to make them more personalised. </p> <p>And people will be able to go further.  They will be able to help shape not only their own care, but local services too.  Strong local democratic accountability will be essential to GP Commissioning.  Patients will have a strong voice in local decision-making through Local Authorities and HealthWatch, a new patient champion.  For the first time, local people will have real powers of scrutiny over local health services.</p> <p>GP Commissioning also opens up the potential for working closely with local authorities to jointly commission services, even for the pooling of budgets to tackle local priorities.  For example, by working closely with the local authority and social care providers, far more can be done to help older people or those with a disability to live independently.  Reducing their reliance on the NHS by avoiding things like hospital admissions.</p> <p>Power in the hands of GPs.  Power in the hands of patients.  All working with and accounting to local authorities and the local population.  The White Paper represents an end to the top-down management of the NHS.  It is a fundamental turn-around of the traditional culture. </p> <p>But this removal of power, this end to micro-management, does not stop at Parliament Square.  The responsibility for designing and shaping NHS services will not lie with the Department of Health.  But neither will it lie with SHAs or even PCTs.  That responsibility will be yours. </p> <p>I will not dictate what consortia should look like.  Decisions about your size, organisation and structure are for you and your consortium.  You are the ones who know your patients.  You are the ones with the clinical training.  You are the ones with the wealth of invaluable experience.</p> <p>Unfortunately, I have heard rumours of some PCTs attempting to corral GPs into particular groupings, or even “rejecting” GPs proposals as to the size of consortia they wish to form.  Let me assure you, they do not have this power.  PCTs have an important role to play.  But it is to support you, it is no longer to control you. </p> <p>The White Paper places a new emphasis on the importance of public health. <br />How can we be satisfied in making the sick well when we have the opportunity to prevent people from becoming sick in the first place?  The public health approach is better for individuals, better for communities, better for the country and far better for NHS budgets.  And I would like to thank the NAPC for your clear support in this area. </p> <p>The big killers of today are not the communicable diseases of the past.  They are heart disease, diabetes and stroke.  Diseases that are as much to do with lifestyle as anything else.  And diseases that we can avoid if we alter, often in just a small way, the way we live our lives. </p> <p>Again, GPs are perfectly placed to make a real difference in their communities.  Giving advice and information in the consultation room.  Working with community nurses, social care providers and the local authority to make prevention every bit as important as cure.  Your input will ensure that services are clinically led, put patients first and focus on improving clinical outcomes.</p> <p>Relationships with your professional colleagues will be essential.  Your local specialist community nurses will be there to help you design the best community services, just as hospital consultants will be essential for designing specialist pathways before, during and after a period in hospital.  Local authorities will be crucial for helping you integrate health with other local public services to maximise outcomes.</p> <p>Johnny [Marshall, Chair, NAPC] has described the White Paper as “a unique opportunity to raise the bar in the commissioning and delivery of care for patients.”  I must say, I agree with him.  But it will only happen with the commitment and support of everyone in general practice.  And for that to happen, I need your help.</p> <p>In response to the White Paper consultation, there has been widespread support for the principles, including for general practice-led commissioning. At the same time, there have been apparently conflicting responses to the timetable. Some have said it is too rapid, and that we must iron out every variable first. Others have said it is too slow and they are keen, and even ready, to make progress.</p> <p>The conclusion we draw is that we can and should support those who want to make early progress and, in doing so, give the wider commissioning community the basis on which they will have the confidence to join in.</p> <p>So, today, I invite GP-led commissioning consortia to put themselves forward to their PCT and SHA as ‘pathfinder’ consortia. There will be no complex approvals process. Simply show that you have local GP backing, strong clinical leadership, engagement with your local authority and are fully signed up to the Quality and Productivity agenda locally.</p> <p>Early pathfinders, nominated from the end of October, will be supported to form a National Learning network. We want to see pathfinder consortia established with the support of their PCT and SHA. Early pathfinders will be able to participate in a formal evaluation process run through my Department’s Policy Research Programme. I hope that, countrywide, there will be local learning networks in place before next April, so that 2011-12 can be a year of substantive development of consortia relationships, engagement, leadership and identification of preferred support arrangements.</p> <p>I will look to all PCTs to offer opportunities for GP clusters or pathfinder consortia to be active participants in commissioning decisions and budgetary responsibility during 2011-12.</p> <p>No one should feel they lack support to make progress now, if they are ready; and no one should feel they have to take on responsibility without learning and support available.</p> <p>For seven years, I’ve heard “why don’t they listen? We know we can do it better”. Now is your chance.</p> None Andrew Lansley CBE MP Secretary of State for Health's speech to the National Association of Primary Care's Annual Conference Department of Health 2010-10-21 speech to the National Association of Primary Care&#39;s Annual Conference
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117589.jpg" alt="Andrew Lansley, Secretary of State for Health" /> </div> <p class="introText">(As delivered)</p> <p>Just three months ago, I published the White Paper, “Equity and Excellence: Liberating the NHS”.  It is an ambitious plan for reform.  It is focused around three key purposes:</p> <ul> <li>to put patients first – to make real that, in the NHS, patients feel that ‘no decision is made about them, without them;<br /></li> <li>Secondly, to focus on outcomes, not inputs and processes, and to build a culture of evidence and evaluation.  To ensure that healthcare uses innovation and evidence to provide quality care, and is accountable for improving outcomes;<br /></li> <li>And, thirdly, that in order to deliver the best care, we must empower the NHS staff whose responsibility it is to give that care.  And, in particular, to take decision-making close to patients, and, therefore general practice, better to combine clinical decision-making with use of resources.</li></ul> <p>In short, to trust you.</p> <p>If the White Paper is about anything, it is about these purposes and that trust.  It is about making “the system” reflect and support the essential human relationships that exist within it.  Not to act as a barrier, but as a conduit.</p> <p>Our ambition is clear: for the health outcomes in this country to be amongst the best in the world.</p> <p>Today, the NHS has some of the best people and the best facilities in the world.  But the fact of the matter is, when it comes to what is really important – to outcomes – we lag behind.  Survival rates for cervical, colo-rectal and breast cancer are among the worst in the OECD.  We are on the wrong side of the average for premature mortality from lung cancer, and heart and respiratory disease.  And you’re more than twice as likely to die from a heart attack here in the UK than you are in France.<br /> <br />Patients deserve better.  The NHS can be better.  And with the reforms we have set out in the White Paper, it will be better.  I know there is a wide range of opinion regarding the White Paper.  There always is when you try to do something substantial and challenging.  But I have been encouraged by the widespread acceptance of the principles of our reforms.  If we keep those purposes clearly in view, I am convinced we can work positively together to deliver them.</p> <p>I have been responsible for health, in opposition and now in government, for nearly 7 years now.  For a politician, that’s a very long time.  And in that time I’ve visited most hospitals in the country and as many GP practices.  I’ve spoken to numerous doctors, nurses and other health professionals about just about every facet of the Health Service.  I’ve learnt a lot.  But I’m not a doctor.  And when all is said and done, despite all that I have learned on the way, I know that you, working together with your colleagues across the NHS, can organise the NHS from the bottom-up far better than I ever could from the top-down. </p> <p>One question that I am often asked is “why GPs?”  Why should the government – the taxpayer – trust the vast majority of NHS commissioning decisions and the NHS budget to General Practitioners?  Well, with around 300 million consultations every year, no-one knows patients better. And you are the only group of NHS professionals with a population responsibility, so vital in improving the health of a nation. </p> <p>Professor Barbara Starfield, from the John Hopkins Bloomberg School of Public Health in Boston put it better than I could when she said, “There is lots of evidence that a good relationship with a freely chosen primary-care doctor, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs.”</p> <p>Primary care deals with most health problems for most people most of the time.  Its priorities are to be accessible; to focus on individuals; to offer comprehensive care for all common problems; and to coordinate services when care from elsewhere is needed.</p> <p>We also know that when specialists care for problems outside their main area of expertise, the results are not as good as with primary care. Since most people with health problems have more than one ailment, it makes sense to have a primary-care practitioner who can help decide when specialist care is appropriate.</p> <p>But it is not enough to have excellent general practice.  To a large extent, we already have that.  No, we must go further and empower general practice to organise, to coordinate and to innovate beyond the confines of the practice. </p> <p>As its name suggests, our White Paper is about “liberating the NHS”.  Setting you free, not pulling you ever more under the control of the state, as the previous government did.  I value your status as contractors, independent from the state.  It is that independence which enables you to be the collective decision-makers on behalf of your patients and population; if you were all salaried GPs, then inevitably, the bureaucracy would control you and you could not be leaders.</p> <p>So, we will free you from top-down targets – and have already started the job with the Operating Framework.  And we will liberate you from the dead hand of Whitehall and local micro-management. </p> <p>To an extent, this change is less radical than often represented; it is in truth one of degree.  You already influence commissioning decisions by how you manage and refer your patients and by deciding which medicines to prescribe.   You decide what is best for your patients based on the options available and your own clinical judgement of what would be best for them.  Within limits, your referrals and patient choice drive service configuration.  But only up to a point, and too often it does not. So, I want you to go further and create the choices.</p> <p>Some of you are already going further and starting to design local services directly.</p> <p>In Northamptonshire, the Nene Practice Based Commissioning Group has developed a peer review scheme that has dramatically cut referrals to their local hospitals.  In 6 months, the scheme prevented some 900 outpatient referrals to orthopaedics.  This not only improved patient care, in its first year it saved over £600,000.</p> <p>In Croydon, GPs have worked with senior clinicians to start a one-stop GP-led service for women with menstrual problems.  As a result, waiting times to see a senior consultant have reduced dramatically from 10 weeks to just 2, with fewer than 10% of patients needing secondary care.  And their work is being recognised.  They have been nominated for two of this year’s Practice Based Commissioning Awards.</p> <p>I want to build on this.  Giving the responsibility to shape the majority of NHS services to you. </p> <p>Another question I ‘m asked is what exactly do I mean by GP commissioning?  Some have caricatured the White Paper as some sort of attempt to turn GPs into administrators.  Well, we don’t lack managers (up by 20,000 in the last decade) so we can harness them to the task.  No.  What I want is your leadership and judgement, derived from your clinical role, your community stature, and your knowledge of your patients.  I don’t want to turn you into administrators.</p> <p>In essence, GP-led consortia, with GPs in close partnership with other healthcare professionals, will establish the range of services and contracts needed to give their local population the access they need to services, and the choices they want.  In hard, practical terms, it means getting together with your colleagues across the local NHS to thrash out how you’re going to run the NHS locally.  To decide what good diabetes care looks like; what a good asthma service will provide, how pre- and post-operative care can best be organised, what a more integrated urgent care service looks like. </p> <p>And for those patients with complex needs – patients with severe mental health problems, the socially excluded, patients with multi-morbidity – areas where GPs can sometimes feel unsupported, commissioning allows you to pull in the support you need to provide better care for your patients and to prevent unnecessary admissions. <br />Commissioning is the hard-headed, difficult stuff of designing the best possible care pathways for your patients. </p> <p>Yes, there will be contracting.  Yes, there will be negotiations and accounting and administration.  But unless you want to do it, this is not your role.  Your role is to ensure that the services you provide are clinically led, put patients first and focus on improving clinical outcomes.</p> <p>And I agree that it would be “unacceptable for the rationing of limited resources to take place at the level of the individual GP and their patient”.  This isn’t what we mean by commissioning.  It’s about ensuring that the services you need are available and the choices are there.  Where investment or disinvestment is needed, these will be collective decisions, in consultation with healthcare providers and local authorities, not for an individual GP.  Of course, when budgets are tight, priorities must be set.  That is true now.  No GP should be ignorant of the relative effectiveness of treatments nor the impact of referrals or decisions on the overall service locally.  And, anyway, rationing happens now.  Too often, by PCTs in ways not sufficiently sensitive to the clinical need of patients and too often just cutting out what comes last or latest.</p> <p>GP Commissioning will not turn GPs into managers, but it will enhance your role as leaders.  Just as it takes a teacher to run a school, it really needs a GP to run a consortium.  Some will choose that route but others will show their leadership through innovation or advocacy for their patients in their practices.  Both are vital. </p> <p>And when it comes to the day-to-day managerial and administrative tasks, consortia will have a separate budget with which to buy-in the support they need, be that from a local authority, a charity or independent contractor or elsewhere.</p> <p>And you will not be alone.  The NHS Commissioning Board will be there with support and advice and to share and spread the experiences of others.   There will be no need to reinvent the wheel hundreds of times if one consortia has already worked out how to do it.</p> <p>But one thing the Commissioning Board will do as little as possible is to tell you what to do.  And nor will I.  I will not dictate what consortia should look like.  Decisions of your size, organisation and structure are not for the Secretary of State, the Department of Health or your PCT.  They are for you. </p> <p>One thing I will do is put in place a payment mechanism that acts as a powerful lever for consortia, that encourages innovation and rewards those who improve health outcomes.  I will introduce a more comprehensive, transparent and sustainable system that really does mean the money follows the patient and that quality really is rewarded.</p> <p>By 2013, we will have made a lot of progress: in getting quality into the tariff; into payment for outcomes, not just activity; into establishing efficient pricing; into developing negotiated risk-sharing or marginal pricing; and into extending tariffs into community and other services so that services can be commissioned on a care pathway or a ‘year of care’ basis.</p> <p>The success of your commissioning decisions will be determined by the relationships you develop with others.  Your local specialist community nurses will be there to help you design the best community services, just as hospital consultants will be essential for designing specialist pathways before, during and after a period in hospital.  Local authorities will be crucial for helping you integrate health with other local public services to maximise outcomes.</p> <p>And you will be free to organise yourselves within and beyond the consortia level as you see fit.  Not everything will need to be at either a single practice or a whole consortia level.  Where it makes sense, groups of practices within a consortium might work together as a sub group.  Two or more consortia might work together to draw on each others experience and expertise or to co-commission services over a wider area.  The flexibility will be built in to the system from the start because it’s up to you.</p> <p>This approach is similar to the RCGP’s own idea of Primary Care Federations.  Of practices working together to deliver a whole raft of improvements for patients, including better access, health promotion and services such as x-rays and scans delivered in the community closer to home.  The Federation model recognises that groups of GP practices working together can achieve more than individual practices working in isolation.  And so does the White Paper.</p> <p>But that collaboration need not stop at the NHS’s doorstep.  We are blessed in this country with an incredible wealth of experience, expertise and energy in the shape of our many specialist charitable organisations.  Organisations that help people with long-term conditions like diabetes, neurological diseases or dementia.  These will be a rich source of advice, information and experience as well as an valuable additional resource for you to draw upon.  This includes developing commissioning support services, as the Motor Neurone Disease Association, Parkinsons Disease Society and MS Society are currently planning.</p> <p>For there is army of volunteers out there to draw upon, people who are willing to work with general practice to improve the lives of those around them.  People like the Lindsay Leg Clubs who, working with local district nurses, have helped thousands of people suffering with leg ulcers.  As you would expect, the Clubs make sure that patients have their wounds treated and dressed and show people how to prevent them recurring in the future.  But they are about more than that.  So often, it is the isolation and embarrassment that can accompany a conditions like leg ulcers that is the hardest thing to deal with.  The Clubs help people to get back out into the world, to achieve the simple, every-day dignity of meeting new people, sharing a cup of tea and a chat.  To feel human again.</p> <p>I said earlier that you have ‘population responsibility’.  So do I.  And sometimes the NHS can focus too much on the directly clinical.  On treating the condition and curing the ill.  But the NHS cannot simply be the human equivalent to the RAC, fixing people when they break down.  We have to do far more to prevent people from needing treatment in the first place, to keep people healthy.  We need a new emphasis on public health.</p> <p>We are often great at treating ill-health in this country but we’re not so good at preventing it.  We have the highest rates of obesity in Europe, rising levels of drug and alcohol use and, despite recent falls, stubbornly high rates of smoking.  As a result, nearly a quarter of all deaths in England, at least in part, stem from an unhealthy lifestyle. </p> <p>In December, we will publish a second White Paper, this one on Public Health.  Its aim will be to transform our approach to public health: protecting the public from health emergencies like swine flu and improving the nation’s overall health and wellbeing. </p> <p>Public health reform will follow three principles:</p> <p>It will be local, with strong local democratic accountability – through Local Authorities and HealthWatch, a new local consumer champion – giving the public a real voice to reshape local public health services. </p> <p>It will be unified, with the new Public Health Service bringing together organisations like the Health Protection and Food Standards Agencies under one roof to develop and deliver policy at a national level.</p> <p>And it will be integrated, because you can’t put public health in a box.  Cycle lanes, good quality housing, effective planning, and healthy schools all play a vital role in improving public health.  Big improvements can come when lots of linked, small changes are made. </p> <p>With that, and the reforms of social care to be signalled later next year, much will change.  It will require careful, measured but purposeful implementation.</p> <p>The changes set out in the White Paper are intended to come into effect by 1 April 2013, in two and a half years time.  It is too slow for some, too fast for others.  But there is no merit in long-drawn out organisational development.  Be clear about the strategy, the changes and then implement fast, is the clear conclusion of organisational development experts. Two and a half years allows for us to resolve issues over the coming months; to support pathfinder practices in 2011-12 using delegated powers, and to give all consortia, through a learning network, the ability to prepare their relationships and support plans.  Then, in 2012-13, a full dry run before the legal transfers.</p> <p>So meanwhile, start thinking about what you will do in your area.  Consider what would be the most appropriate model to meet local needs. </p> <p>And there are lots of things you can do right now, under existing legislation.  Some practices are already leading the way.  Two consortia in Cambridgeshire launched ten days ago with control over a quarter of NHS Cambridgeshire’s £870 million budget. </p> <p>And NHS Cumbria has handed its Payment by Results community services and prescription budgets to six GP consortia.</p> <p>If you want to move faster then by all means do so.  I am not saying that you must.  But I am saying that we will give you support if you do.  Explore the possibilities, build the relationships that will be so important in the new system, prepare the ground for what is coming.  And, if you are ready, talk to your PCT about taking further advantage of the current freedoms, through Practice Based Commissioning or setting up a shadow consortium like those in Cambridge or Cumbria.</p> <p>It’s not only to general practice that we will hand power.  We will give power to patients and carers too.  As an overwhelming mountain of research demonstrates, and as every good doctor knows instinctively, treatment is always better and often cheaper when the patient is an active participant in their care, not simply a passive recipient.  In the coming years, we will give patients real control over when, where and by whom they are treated.  They will be central to all decisions about their after care, often spending their own budget in the way that suits their needs rather than the needs of the system.  And we will make much clearer the position over patient records. </p> <p>Previous plans for patient records made the fundamental error of putting the needs of the NHS before the needs of individual patients.  Your records would be put into the system and shared with all and sundry and you didn’t really have much say in the matter.  Yes, we all received a letter through our door saying we could opt out if we wanted to, but the letter was so long and poorly written that I’m sure I wasn’t the only one who struggled to understand what it was saying!</p> <p>I can tell you today that we have reviewed The Summary Care Record and it will hold only the essential medical information needed in an emergency: medication, allergies and reactions.  If people don’t want this information shared, we will make it easy for them to opt out.  If they want more information stored, it will be their choice, based on explicit consent, with clear information. </p> <p>We will start with the summary care record, but we will not stop there.  We will arm patients with a wealth of clear, easy-to-understand information that they and their GPs can use to choose and shape their care.  Yes, everyone would like their nearest hospital to be the best.  But the fact is, it may not be.  People are not stupid.  When they can see which hospital, which department, even which Consultant-led team is offering the best care, they will vote with their feet. </p> <p>Personal choice will not be the only way that people will be able to shape their care.  They will also have a say in how you shape local services.  Strong local democratic accountability will be an essential part of GP Commissioning.  Patients will have a strong voice in local decision-making through Local Authorities and HealthWatch.  For the first time, local people will have real powers of scrutiny over local health services. </p> <p>GP Commissioning also opens up the potential for working closely with local authorities to jointly commission services, even for the pooling of budgets to jointly tackle local priorities.  For example, by working closely with the local authority and social care providers, far more can be done to help older people or those with a disability to live independently.  Reducing their reliance on the NHS by avoiding things like hospital admissions.</p> <p>The Government’s proposals and the ethos of the RCGP share a common thread – we are both determined to improve the quality of the NHS and the outcomes for patients.  One example of how you are leading the way, constantly striving to improve the quality of general practice, is your Practice Accreditation Scheme.  Accreditation will show patients – patients with the power to choose – that a particular practice is safe and offers high quality care. </p> <p>I am especially pleased at how closely you’ve been working with the Care Quality Commission, ensuring a good fit with the new CQC Registration requirements, which are conversations I have enjoyed in Opposition and now in Government.  So today I can announce that if a practice achieves RCGP accreditation, the CQC will use this as evidence towards registration and take a ‘light touch’ approach to ongoing monitoring.  This will improve transparency whilst significantly reducing the burden on practices. </p> <p>Another area where the RCGP has been active is working with the Department and the General Medical Council on the revalidation system.  The public expects that their doctor is up-to-date and fit-to-practice.  As professionals, you expect nothing less of yourselves.  But there will be some who, for whatever reason, do not quite measure up to the professions’ own high standards.  Who may have let things slip a little.  Revalidation will help to lift everyone up to a basic level of competence and safety, and give the public the reassurance they need.</p> <p>Now, some people have interpreted my decision to extend piloting for another 12 months as kicking it into the long grass.  Those people are wrong.</p> <p>The extra time for piloting is not about getting rid of it.  It’s about getting it right.  It’s about making sure that we balance the needs of the system with the needs of patients.  That we are certain that the benefits clearly and significantly outweigh the costs.  That it does not become just another tick-box exercise. The extra time will allow us to test the procedures and to streamline any processes.  Practices should be thinking now about what revalidation will mean to them.  Annual appraisal of doctors, effective clinical governance, responsible officers with the right support.</p> <p>Practice Accreditation, CQC Registration and GMA Revalidation will all help to give patients and the public full confidence in NHS doctors.  This is about, as all things should be in the NHS, putting patients first.</p> <p>Before I finish, I would like to pay tribute to Steve Field who in a few weeks is stepping down after 3 years as Chair of Council. Throughout his time, Steve has believed in general practice as a positive force for change.  He has been a great representative and leader for your profession.  His work to promote the 'federated' model of patient care – with practices working together to provide more services in the community - has been an inspiration for the White Paper. He has always striven to improve the standards of care provided by GPs and primary care teams, leading the call for more patient and public engagement.  He has argued powerfully for a stronger public health priority. And he has constantly championed the causes of the most vulnerable in society, including the homeless, travellers and asylum seekers.  Steve, you leave the RCGP stronger than you found it and I am sure I speak for everyone here when I say thank you for everything you have done as Chair.</p> <p>I would also like to welcome Clare Gerada to her role.  I have already enjoyed our discussions.  Clare will take forward the new Institute of Quality Improvement, Innovation and Commission Support to help GPs to deliver the White Paper.  Clare understands the central importance of education and training for GPs, and so do I.  Later in the Autumn we will consult on how we move to an increasingly responsive, evidence-based system of education and training, making sure local skills match local needs.  As I have made clear I am looking to leadership from within the profession to shape this. And so I very much look forward to working with you, Clare, and the college as you provide this.</p> <p>I started today by saying how everything we do is based on the principle of trust.  Well, as well as trusting patients to choose, and GPs to lead, I hope that you can also trust us, the government, to do everything we can for the NHS.</p> <p>In just 11 days, George Osborne will set out his plans to rid this country of its crippling deficit, so that no longer are we burning more money than we spend on health and social care combined.  The impact of this will be significant cuts almost across the board. </p> <p>It is a measure of the importance that we place upon the National Health Service, and the future health of the nation, that its budget will not be cut, but protected. </p> <p>We all know that this doesn’t mean there will be no pain.  With a growing and ageing population, new drugs, new technologies and the ever-increasing expectations of the British people, the NHS budget will be stretched like never before.  We will need to make great efficiency savings just to stand still – and we need to do far more than just stand still – and to some it may certainly feel like an unprecedented squeeze. <br />But the key difference for the NHS will be that every penny saved, is a penny available to be reinvested in the Health Service.  It’s a penny spent on new cancer drugs we otherwise couldn’t afford.  On better public health where once this would have been the first budget to be cut.  On higher quality, integrated, patient centred, outcome focussed health services led by you.</p> <p>Real leadership is about making hard choices in difficult times.  To govern is to choose.  The choice we have made is to put the NHS first.  To trust the NHS.  And you can trust us to stick to it.</p> <p> </p> None Andrew Lansley CBE MP Secretary of State for Health's speech to the Royal College of General Practitioners Department of Health 2010-10-09 speech to the Royal College of General Practitioners
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117011.jpg" alt="Health Secretary Andrew Lansley" /> </div> <p class="introText">Oral Statement on the NHS White Paper by the Secretary of State for Health, Andrew Lansley</p> <p>(As delivered)</p> <p>With permission, Mr Speaker, I would like to make a statement on the future of the National Health Service.</p> <p>The NHS is one of our great institutions, and a symbol of our society’s solidarity and compassion. It is admired around the world for the comprehensive care it provides and for the quality, skill and dedication of its staff. I begin today by paying tribute to the staff of the NHS and the commitment they daily show to patients in their care.</p> <p>This Government will always adhere to the core principles of the NHS; a comprehensive service for all, free at the point of use, based on need not ability to pay. This principle of equity will be maintained, but we need the NHS also consistently to provide excellent care.</p> <p>The NHS today faces great challenges:</p> <ul> <li>It must respond to the demands of an increasing and ageing population, advances in medical technology and rising expectations;</li> <li>It remains stifled by a culture of top-down bureaucracy, which blocks the creativity and innovation of its staff; and</li> <li>It does not deliver outcomes in line with the best health services internationally – many of our survival rates for disease are worse than those of our neighbours.</li></ul> <p>The NHS must be equipped to meet these challenges – we believe it can do much better for patients. So today, I am publishing this White Paper, Equity and Excellence: Liberating the NHS:</p> <ul> <li>so that we can put patients right at the heart of decisions made about their care;</li> <li>to put clinicians in the driving seat on decisions about services; and</li> <li>to focus the NHS on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.</li></ul> <p>For too long, processes have come before outcomes, as NHS staff have had to contend with 100 targets and over 260,000 separate data returns to the Department each year.</p> <p>We will remove unjustified targets and the bureaucracy which sustains them. In their place, we will introduce an Outcomes Framework to set out what the service should achieve, leaving the professionals to develop how.</p> <p>We should have clear ambitions, and our approach to this will be set out shortly in a consultation document. For example, our aims could be:</p> <ul> <li>to achieve one and five year cancer survival rates above the European average;</li> <li>to minimise avoidable hospital acquired infections;</li> <li>to increase the proportion of stroke victims who are able to go home and live independently.</li></ul> <p>In short, care that is effective, safe and meets patients’ expectations.</p> <p>The Outcomes Framework will be supported by clinically established quality standards, and the NHS will be geared across-the-board towards meeting them. We will do this by:</p> <ul> <li>rewarding commissioners for delivering care in line with quality standards;</li> <li>strengthening the regulatory regime so that patients can be assured that services are safe; and</li> <li>reforming the payment system in the NHS, so that it is not just a driver for activity, but also for quality, for efficiency and for integrated care.</li></ul> <p>Patients will be at the heart of the new NHS. Our guiding principle will be ‘no decision about me, without me’. We will bring NHS resources and NHS decision-making as close to the patient as possible.</p> <ul> <li>We will extend ‘personal budgets’, giving patients with long-term conditions real choices about their care</li> <li>We will introduce real, local democratic accountability to healthcare for the first time in almost 40 years – by giving local authorities the power to agree local strategies to bring the NHS, public health and social care together. Local authorities will also be given control over local health improvement budgets. This will give an unprecedented opportunity to link health and social care services together for patients.</li> <li>We will give General Practices, working together in local consortia, the responsibility for commissioning NHS services, so that they are able to respond to the wishes and needs of their patients. This principle is vital, bringing together the management of care with the management of resources. With commissioning support, GPs collectively will lead a bottom-up design of services.</li></ul> <p>In addition, we will introduce more say for patients, at every stage of their care – extending the right to choose far beyond a choice of hospital.</p> <p>Patients will have choice over treatment options, where clinically appropriate, and the consultant-led team by whom they are treated.</p> <p>They will have the right to choose their GP practice.</p> <p>And they will have much greater access to information – including the power to control their patient record.</p> <p>We must also ensure that patients’ voices are heard, so we will establish ‘HealthWatch’ nationally and locally, based on Local Involvement Networks, to champion the needs of patients and the public at every level of the system.</p> <p>To achieve these improvements in outcomes, we need to liberate the NHS from the old command-and-control regime. So:</p> <ul> <li>all NHS trusts will become Foundation Trusts – freed from the constraints of top-down control, with power increasingly placed in the hands of their employees; and</li> <li>we will allow any willing provider to deliver services to NHS patients – provided that they deliver the high-quality standards of care we expect from them.</li></ul> <p>Our aim is to create the largest social enterprise sector in the world. But it is not a free-for-all. Monitor will become a stronger economic regulator to ensure that the services being provided are efficient and effective – and that every area of the country has the NHS services it needs to provide a comprehensive service to all.  The Care Quality Commission will safeguard standards of safety and quality.</p> <p>An independent and accountable NHS Commissioning Board will be established to drive quality improvements through national guidance and standards to inform GP-led commissioning. The Board will allocate resources according to the needs of local areas, and lead specialised commissioning.</p> <p>Mr Speaker, in the coming weeks, detailed consultation documents will enable people to comment on the implementation of this strategy, leading to the publication of a Health Bill later this year.</p> <p>I recognise that the scale of today’s reforms are challenging, but they are designed to build on the best of what the NHS is already doing.</p> <p>Clinicians are already working to facilitate patient choice, giving patients the information they need to make effective decisions.</p> <p>GP consortia are already established in some areas of the country, and are ready to go.</p> <p>Local Authorities in some areas are already working closely with local clinicians to co-ordinate health and social care and improve public health.</p> <p>Payment by Results already gives us a starting framework for building a payment system that really drives performance.</p> <p>Foundation Trusts are already using the freedoms that they have to innovate.</p> <p>We will build on this progress, not dismantle it.</p> <p>With this White Paper we are shifting power decisively towards patients and clinicians.  We will seek out and support clinical leadership. That means simplifying the NHS landscape and taking a further, radical look at the whole range of public bodies:</p> <ul> <li>We will reduce the Department of Health's NHS functions, delivering efficiency savings in administration costs.</li> <li>We will rebalance the NHS, reducing management costs by 45% over the next four years, abolishing quangos that do not need to exist, in particular if they do not meet the Government’s three tests for public bodies – and we will shift more than £1 billion from back-office to the front-line.</li> <li>Form will follow function. As we empower the front-line, so we must disempower the bureaucracy. So after a transitional period, we will phase out the top-down management hierarchy, including both Strategic Health Authorities and Primary Care Trusts.</li></ul> <p>Later in the summer, we will be publishing a report setting out how we see the future of NHS-related quangos. I can say now that this will mean a reduction of at least a third in the number of such bodies.</p> <p>This is part of the wider drive, across government, to increase the accountability of public bodies and reduce their number and cost.</p> <p>The dismantling of this bureaucracy will help the NHS realise up to £20 billion of efficiency savings by 2014 – all of which will be reinvested into patient care.</p> <p>Mr Speaker, today’s reforms set out a long-term vision for an NHS which is led by patients and professionals, not by politicians. It sets out a vision for an NHS empowered to deliver health outcomes as good as any in the world.</p> <p>I commend this statement to the House.<br /></p> <ul class="linksCollection"> <li><a href="/en/Healthcare/LiberatingtheNHS/index.htm" class="internalLink">Liberating the NHS</a></li> </ul> None Andrew Lansley CBE MP Equity and excellence: Liberating the NHS Department of Health 2010-07-12
<p>(As delivered)</p> <p>Jill [Baroness Jill Pitkeathley] thank you very much and for that kind introduction.</p> <p>And thank you to all you for inviting Paul [Burstow] and I to be here – we’re delighted to have the opportunity.</p> <p>Paul has a long record of commitment on these issues. I feel the man from the AA advert – I may not know all the answers but I know a man who does!</p> <p>There are carers here this morning not just from around the UK, but from around the world. And I understand many more are watching us live around via Carers World Radio.<br />I might be a bit old fashioned, but it seems strange to me to be being watched via the radio, but that’s the wonder of the internet!</p> <p>We’re here to discuss some very important issues. But in the past, as we’ve debated the policy on social care, we have sometimes overlooked what a very personal thing it is.</p> <p>For each of us it is about the most important needs of those we love and care about the most. </p> <p>For everyone here today, or tuning in to this debate, there is a different story, a different set of needs, and therefore a different approach.</p> <p>But, we shouldn’t forget, that many of the challenges carers face are the same.</p> <p>Many of you, in this country and elsewhere, deal with social care systems that are deeply stressed, derived from other – perhaps simpler – times, systems that are struggling to provide the service you deserve – and that often leave you to bearing a heavy and sometimes excessive burden.</p> <p>So now, we – in government – have a duty to carers, and those they support, to provide a better system.</p> <p>And we know that the demands on it are only going to increase. Like so many other countries, our population is rising – and it is ageing.</p> <p>Today there are around 6 million adults in the UK providing unpaid care and support to family members or friends – that’s one in ten people.</p> <p>In 30 years time that number will be 9 million. A 50 per cent increase.</p> <p>In England, 1 million people provide care for 50 or more hours per week – a third of those carers are themselves over 65 years old.</p> <p>Already one in six carers – again, a million people – have given up work to care.</p> <p>And the situation is not going to get better. Today for every one person in retirement there are four people working – in 20 years time that ratio will fall to just one for three.</p> <p>At a time when we’re trying to rebuild our economy, and reduce our deficit, this is a serious problem.</p> <p>Of course, it’s time we moved on from Mary Webster’s image of care in the early 1960s, when she said carers were effectively ‘under house arrest’.</p> <p>We have to provide people with the support they need so they can continue to lead the life they want.</p> <p>We have to give them the tools to ensure that they can fulfil whatever they feel is right in supporting their family members, alongside their other commitments – whether that means working, looking after children, or simply retaining a degree of independence</p> <p>So, in our Coalition Programme for government, we enshrined our commitment to provide that support:</p> <ul> <li>to extend the right to request flexible working;<br /></li> <li>to provide much more control for carers and the people the care for; <br /></li> <li>to extend the roll out of personal budgets and;<br /></li> <li>to use direct payments to carers and better community-based provision to improve access to respite care.</li></ul> <p>So how can we deliver this? How can we create the stronger, more flexible and more sustainable system we need?</p> <p>The system must be reformed – and in doing so we must be clear about the principles on which reform should be based.</p> <p>First – prevention. We must place renewed emphasis on keeping people as independent as possible, for as long as they feel able, not least by providing earlier support. People need to feel help is there as soon as problems occur.</p> <p>And we’ve made some good progress on this. We’ve changed the rules already so that hospitals are responsible for patients for 30 days after discharge – integrating the care that is provided in hospitals and in the community, giving the hospital a stake in the quality of reablement support for people as they return home.</p> <p>Second – protection. We have to ensure that people do not have to worry about becoming vulnerable – that the support they need is there, that they will be safe and secure – so they don’t feel that everything they’ve worked for throughout their lives can be compromised by the care needs they could develop.</p> <p>Third – partnership. We must ensure patients carers, families and communities can work together with health, care and support services – so that services can respond to the whole picture of a family's circumstances, rather than just considering their own specific area of expertise or responsibility. We need a partnership between the family and the state – balancing collective solidarity with state support.</p> <p>Fourth – personalisation. We must give people control of their own care, so they can choose services that best meet their needs. So that carers, and the people they care for, feel they are in charge.</p> <p>And I just want to say a word here about personalisation when it comes to palliative care.</p> <p>In a compassionate society, patients – both adults and children – should be able to receive palliative care in the manner they wish, in the setting they choose.</p> <p>Most would choose to be cared for at home, so we need to devise a funding system which is responsive to their wishes, while being fair to all providers and affordable to the public purse.</p> <p>So today, I am announcing a much-needed review of dedicated palliative care funding to allow us – to support us – in introducing such a system. Tom Hughes-Hallett, the Chief Executive of Marie Curie Cancer Care, has agreed that he will lead this review.</p> <p>Now, to bring together all those principles I’ve been describing – prevention, protection, partnership and personalisation – in the Autumn we will be publishing our vision for adult social care, including a renewed concordat on personalisation with the social care sector.</p> <p>We are also already taking a fresh look at the Carers Strategy, to see how we can make it as effective and as fit for purpose as possible.</p> <p>And, of course, we know that the state cannot rival carers in their detailed knowledge of a person’s needs, nor can it provide as broad a range of services as people require.</p> <p>So we want to hear your views. And we want to tap into the capacity and commitment that already exists in our communities. User-led organisations, especially local organisations, sometimes formed of only a few people, can provide a much broader mix of services, without having to call on formal state-funded resources.</p> <p>Now of course  when it comes to dealing with the repercussions of the financial legacy that we inherited – and I’m sure that many people here from around the world are dealing with similar debt crises, though ours is one of the worst – the role of the state is crystal clear. </p> <p>We must recognise the overriding need to reduce the deficit – and that this means tough choices on public services.<br />So we have a responsibility, with local government, to ensure that care is as efficient and effective as possible. </p> <p>We have to maximise the potential of reablement, telecare and other innovations which can dramatically improve people’s lives while also being highly efficient.  Some local authorities have picked up this challenge, others have not. We need to accelerate this change so that these services and this approach is the norm.</p> <p>But, of course, increased efficiency in the system will only take us so far. We need reform for the long-term – we need to find a new settlement to for the funding of social care.</p> <p>So we will establish an independent Commission to consider how we can ensure responsible and sustainable funding for long-term care – which strikes a fair partnership between the state and the individual, and takes into account the vital role of families and carers.</p> <p>We have to move reform forward apace.</p> <p>So the Commission will be established as soon as possible and will report within a year. We will then respond to the Commission’s findings in a White Paper in the Autumn of next year.</p> <p>Despite, financial crisis – perhaps because of it – we can’t let long-term care be kicked into the long-grass.</p> <p>It’s hard to overstate the importance of social care – or of the selfless contribution that carers make.</p> <p>In this country, the carers’ movement has been building for half a century. You’ve come a long way – from an issue that was little known, to where we are today.</p> <p>But of course the system hasn’t always kept pace.</p> <p>It wasn’t so long ago, in 1981, that the Association of Carers was refused registration as a charity because ‘carers’ themselves were not considered a suitable charitable cause.</p> <p>There is a much better awareness now, yet reform still has to catch up.</p> <p>So today we are putting social care front and centre – it is recognised in the Coalition Programme – and it one of our five priorities for the Department of Health as a ministerial team.</p> <p>We will reform funding, will reform legislation and will implement those reforms within this Parliament – within the next five years.  </p> <p>By doing that I hope we will help you meet the challenges ahead – and not just because it is our duty, but also because, as individuals, carers deserve nothing less.</p> <p>Thank you all very much indeed.<br /></p> None Andrew Lansley CBE MP Secretary of State for Health's speech to the 5th International Carers Conference - ‘The principles of social care reform’ Department of Health 2010-07-09 speech to the 5th International Carers Conference
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117011.jpg" alt="Health Secretary Andrew Lansley" /> </div> <p>Thank you for the opportunity to be with you again. </p> <p>Thank you Alun [Maryon-Davis], on the last day that you are president for the work you have done to put the case for public health forward. </p> <p>Lindsey [Davies] led on protection against pandemic flu. </p> <p>We should never underestimate the threat of novel infections. </p> <p>As lectures were given about the eradication of infectious diseases such as polio, HIV was just emerging. It is a constant threat we must guard against. </p> <p>The experience of H1N1 has given the public the feeling, ‘they said it would be bad and it wasn’t’. When a leading expert described H5N1, he said he’d never seen one so dangerous. </p> <p>We should not let our guard down. We, in this country, can lead international preparedness.</p> <p>After some six and a half years as Shadow Secretary of State it’s clear to me that we have much to be proud of in how we provide healthcare in this country. But it’s also clear to me that for too long our approach has been seriously out of balance. The emphasis we put on protecting from risk and treating illness, is not matched by the emphasis we put on preventing illness in the first place.<br /> <br />So often the treatment that is delivered in the NHS is compromised by patients’ poor diet, lack of exercise, and alcohol or drug abuse or use of tobacco. </p> <p>Britain now has the highest obesity rates in Europe, we have among the worst rates of sexually transmitted infection, and we are seeing rising rates of alcohol and drug problems.</p> <p>Even smoking, which has declined for decades, remains stubbornly high and still claims over 80,000 lives a year. Nearly a quarter of the deaths in this country each year result, at least in part, from the consequences of unhealthy lifestyles.<br /> <br />Recognising the additional demands facing the NHS in the coming decades – an increasing and ageing population, costly advances in treatments and rising expectations – we simply can’t go on like this. </p> <p>To have a fighting chance of meeting new demand in the years ahead, we have to get to grips with the real drivers of demand on our NHS now.</p> <p>Improving public health is something that need to take seriously at all levels – nationally, locally, and as individuals.</p> <p>But in recent years – and despite your best efforts in the Faculty and elsewhere – political leadership has been nowhere to be found. And we’ve seen the impact. Public health staffing has been cut, short term initiatives have come and gone with little evaluation of what works, and public health budgets have been raided to offset short-term financial pressures.  This is not something that happens every year.  It happened in 2005/6 and it was the wrong decision.</p> <p>Meanwhile, many of our greatest public health problems have escalated.</p> <p>In place of leadership, we’ve had initiatives.</p> <p>Initiatives without evidence, without evaluation, without coordination and, most of all, without awareness of the cultural need to change behaviour.</p> <p>Behaviour change is the great challenge for public health – but too often it has been ignored.</p> <p>Take alcohol – where the lack of national leadership can be seen in the sharply rising effects of alcohol consumption, and the pattern of alcohol consumption. Alcohol strategies have failed to go much beyond the public order issue.  The approach has been confined to supply, with little impact on demand.</p> <p>Public health efforts, which only try to control supply, will fail. We have to impact on demand. That means we have to change behaviour, and change people’s relationships with each other and with drugs, alcohol, tobacco and food.</p> <p>And where behaviour change has been the aim of recent initiatives, the outcomes have been patchy at best.</p> <p>It seems to me that awareness campaigns have too often sent the wrong messages – when they’re screaming at you to drink less, many people are just having their behaviour reinforced – the message doesn’t come out as ‘drink less’ but as ‘everyone drinks, so don’t worry about it’. It tells people that the norm in society is misuse of alcohol.</p> <p>How often have all of us been frustrated by a system which ‘does’ alcohol, drugs, smoking cessation, STIs, and obesity, but doesn’t seem to get it that there may be an underlying reason, or a set of factors, why our young people develop a dependent or distorted relationship with drugs, alcohol, tobacco, food or sexual relationships in the first place.</p> <p><br />Common factors like dysfunctional families, poverty, worklessness, weak family and community structures, lack of good parenting, or mental illness are all identifiable causes. But, most of all, I would argue that the reason underlying all of this, especially amongst young people, is a lack of self-esteem.</p> <p>Just as leadership drives organisational success, so self-esteem drives personal fulfilment.</p> <p>That is why, contrary to the media reporting, I applauded Jamie Oliver’s initiative on school dinners and when he went to Rotherham – because Jamie ‘got it’.</p> <p>He got that it’s not just about a witch hunt against saturated fats, salt and sugars. It’s about creating a better understanding of, and relationship with, good food and diet. And even more, it’s about self-confidence – it’s about building self-esteem. </p> <p>When you watch the programmes – and I did watch them - they were about building self-esteem, not just about what went into the food and how you cook it.</p> <p>The problem was the government’s response. Instead of working with families to engage them with the idea of building a good diet together, with food they enjoy, the bureaucracy took it over and they came up with a series of rules for what was permissible in school meals.</p> <p>The fact is, you can’t legislate for self-esteem from Westminster. We can’t pass the Elimination of Obesity Act 2010. Turning Jamie’s campaign into a list of how often you can offer chips – whilst not rationing roast potatoes cooked in oil – doesn’t do the job.</p> <p>In complex policy areas like this it has become clear that government cannot simply ‘deliver’ key policy outcomes to a disengaged and passive public. We cannot solve complex problems on our own – everyone has a role to play.</p> <p>So how do we do that?</p> <p>I freely admit that none of us have all the answers.</p> <p>But, it’s clear that we have to find a new approach – to think new thoughts. We need a paradigm shift.</p> <p>The reforms we are bringing in will empower you – the professionals – to commission services that work – to apply the best technology and the best new insights of social psychology and behavioural economics to achieve real improvements in public health. </p> <p>The latest academic research in these fields is suggesting new ways of helping people to change their behaviour, and achieve what we all want to achieve. </p> <p>Studies has shown that social norms are much more important than policymakers have traditionally assumed.  People are deeply influenced by the behaviour of those around them – and public policy should reflect that.</p> <p>Nicholas Christakis, who is a Professor of Medical Sociology at Harvard, puts it like this – ‘There is a kind of social contagion [with obesity], a kind of social domino effect. Suzy makes Betty eat poorly. And then Betty makes Jane eat poorly. And Jane makes Ann eat poorly. Suzy does not know Jane or Ann, but Suzy’s behavior and actions are influencing the interaction between Jane and Ann.’ You will be tested on this as you leave!</p> <p>He found that if a friend becomes obese your chances of becoming obese increase by more than half – and with close, mutual friends, if one becomes obese the chances of the other following suit are even higher.</p> <p>That’s pretty striking. If we can find a way to harness the intensive influence that people have on each other through social networks or social media, then we’d really be on to something. </p> <p>We should be learning the lessons of what’s worked in this country and around the world.</p> <p>There are numerous examples of how technology can be used as a cheap, effective tool for promoting public health. Research from the US has found that pedometer users increased their physical activity by over 25%.</p> <p>Smarter incentives have also been shown to be an effective way of encouraging people to adopt healthier lifestyles, particularly for disadvantaged groups.</p> <p>And we need to be smarter about how information is presented to ensure that messages really hit home.</p> <p>Researchers at UCL have found that telling smokers their ‘lung age’ makes them more likely to quit smoking.</p> <p>And advertising social norms can snap people out of the fantasy that their drinking, smoking or eating habits are the same as everyone else’s. </p> <p>Of course this is just scratching the surface – there is a proliferation of innovative ideas out there for you to draw on. We need to find out what those ideas are and how we can define the evidence base for what will work as part of a broader strategy.</p> <p>And I talk about strategy for a reason.</p> <p>For too long our approach to public health has been fragmented and complex but not effective.</p> <p>So we want to free the system up – to work with you as the champions of public health, to create a framework which empowers people to make the changes that will really make a difference in their lives.</p> <p>Working with communities and schools to develop young people’s confidence and self-esteem. Empowering them to take better decisions when young, so that they enjoy greater health and well-being though life.</p> <p>So that we reduce alcohol and drug abuse, not because we tell people to do it, but because people are in control and less dependent.</p> <p>So that young people see drug use and binge drinking not as a sign of being adult but as evidence of their immaturity.</p> <p>So that peer pressure and expectations drive greater responsibility.</p> <p>And the majority of young people who don’t take illegal drugs and do not get blind drunk on a Friday night are celebrated.</p> <p>This, more than anything, is why we need to empower all of you.</p> <p>This is why we need genuinely local strategies, based in neighbourhoods, schools and families.</p> <p>This is why we need to throw off the old ways and start seeing people and families as a whole, using local voluntary and charitable organisations much more, cutting across boundaries, encouraging innovation, using the power of new technologies and new media, joining up professions and budgets and putting the people – not the system – at the heart of the strategy. Making us all accountable for results, not just processes.</p> <p>And this cannot happen through top-down national schemes. We – that is the government – can supply resources, ideas, evidence, we can create identity for the public health strategy, but we cannot expect a national strategy to deliver everything.</p> <p>We need to build responsibility and innovation in local communities if we are to deliver.</p> <p>So my vision is for a new Public Health Service which rebalances our approach to health, ensuring we continue to respond effectively to public health emergencies and carry out the vital role of protecting the nation’s health – while also drawing together all the elements we need for preventative action for health improvement – national leadership and strategy, local leadership and delivery and, above-all, a new sense of community and social responsibility.</p> <p>Now, to prepare the ground for this new Public Health Service, first we must establish a national strategy to secure a professional, unified and efficient approach to achieve measurable improvements in public health and effective protection from public health threats. A strategy that delivers the focus, resources and infrastructure that we need.</p> <p>From my personal point of view, I am already the Secretary of State for Public Health. And we are very clear that, as a Department, we are more focussed on public health and that will be my personal ambition.</p> <p>And because the determinants of health extend far and wide, we will lead a cross-government strategy to tackle the drivers of demand on the NHS and to make Britain a healthier nation – breaking down the longstanding barriers that have prevented progress in the past.</p> <p>That’s why the Prime Minister has approved the establishment of a Cabinet Sub-Committee on Public Health, which I shall chair. In this way we will develop a strategy which not only recognises the wider determinants of health, but is equipped within government to tackle them in order to improve our health outcomes – bringing the range of potential benefits that I’ve been describing.</p> <p>We will set clear outcomes and measures to judge progress alongside NHS and social care outcomes for which my Department is responsible.</p> <p>We will strengthen the role of local government in improving public health, improving local accountability and rewarding the progress that communities make.</p> <p>And we will create a new ring-fenced public health budget – giving confidence that in the teeth of the debt crisis we inherited, we nonetheless achieve the improvement of health outcomes, that we seek and that we also reduce the dreadful scale of health inequality we inherited.</p> <p>It’s no secret that the causes of ill health are rooted in local issues such as poor housing, poor quality education, worklessness and family breakdown.</p> <p>So, alongside a new national strategy, the second thing we need is renewed local leadership. We need to empower local communities to identify their own needs and provide rigorous solutions that work for their specific circumstances.</p> <p>The Public Health Service will provide strong local leadership, supported by resources devoted to tackling those cross-cutting causes of ill-health. And through public health budgets, we will create local public health budgets to support local strategies and leadership.</p> <p>Leadership, from local authorities working together with their public health partners, through the critical role of Directors of Public Health, will have the resources and the authority to make preventative interventions to improve the health of their communities. </p> <p>They will develop strong local strategies to deliver health and well-being in individuals, families and communities.</p> <p>And just as the national strategy must extend across and beyond government, so local government must do exactly the same thing including all local partners.</p> <p>We will not be dictating the ‘how’ when it comes to achieving better public health outcomes.  But we will be very clear about the ‘what’ – what we want to measure and achieve.</p> <p>This could include: increases in life expectancy, reduction of inequality in life expectancy, decreases in infant mortality, improved immunisation rates, reduced childhood obesity, fewer alcohol-related admissions to hospital, and improvement in take-up of physical activity. One of the critical measures of success must be a demonstrable reduction in health inequalities in local areas.</p> <p>These are the kind of measures on which we will consult. And we will promote the use and collection of evidence so we build a stronger picture of what works.  </p> <p>We will be clear about what we want to achieve but not tell people how to do it.</p> <p>The funding and the freedoms that I’ve talked about will only be sustainable if they are followed by greater evidence of success – through payments to match results.  We can have a health service that reduces inequalities in public health.</p> <p>This is how the Public Health Service will work to improve the health of the poorest fastest.  </p> <p>We know that deprived communities have some of the worst and most entrenched public health problems.</p> <p>So I do want to build on the findings of Sir Michael Marmot’s review, and the six policy objectives he proposes. In the ways I’ve described today, we’re giving you new tools to tackle the problems he identified – to form new partnerships across different disciplines, and to target those determinants of poor health in ways that fit local circumstances.</p> <p>Central to this is the new ‘Health Premium’ which will support local strategies which deliver measurable results – and on which we’ll consult this year.<br />In the past the system has rewarded poor outcomes. We will start with a system that recognises deprivation and then rewards improvement.</p> <p>The third and, most important, factor for the Public Health Service is individual engagement and responsibility.</p> <p>By many measures, Britain has become one of the least cohesive and most socially divided countries in Europe. </p> <p>Failings in civic, community and family life have gone hand in hand with a decline in social and individual responsibility. The negative impact on our health and wellbeing is serious. </p> <p>For public health reform any success will have to begin to reverse this decline in responsibility.</p> <p>The temptation in the past has been to intervene – but no government campaign or programme can force people to make healthy choices.</p> <p>I looked at yesterday’s Daily Mail and while there were nine pages on politics, there were thirteen pages on health. </p> <p>There is no lack of desire for people to be healthy, our job should be to provide the right information, to create the right environment, to incentivise healthy options and build social momentum behind behaviour change in the ways I have already described.</p> <p>Nudging individuals in the right direction.  Encouraging positive choices. Not lecturing or nannying. But making people feel empowered.</p> <p>Part of this is bringing government and business together to promote innovation in thinking and practice. So we will build on the ideas and expertise from our Public Health Commission, and the Coalition for Better Health, to create a new ‘responsibility deal’, built on social responsibility, not state regulation. </p> <p>And this is everyone’s business – there is a distinctive role for all of us to achieve the positive change we need. </p> <p>Change4Life is an example of this. I have been impressed how much it has achieved to date – I’ve talked to many of you about my support for it, particularly the way it has brought som many people together - healthcare professionals, teachers, charities, businesses, and the thousands of volunteers who have added their support.</p> <p>But, again, we need a new approach. We have to make Change4life less a government campaign, more a social movement. Less paid for by government, more backed by business. Less about costly advertising, more about supporting family and individual responses.</p> <p>There has been a change of Government and there will now be a change of approach. We will be progressively scaling back the amount of taxpayers’ money spent on Change4Life and asking others, including the charities ,the commercial sector and local authorities, to fill the gap. </p> <p>While government pump-primed the brand, we will now withdraw the primer and engage others to share in making Change4Life really work – and we will focus on extending its reach and effectiveness, especially in social media.</p> <p>There is no point backing local strategies if the government is prescriptive.  Change4Life can be used by everybody to deliver their public health campaigns.</p> <p>To date, industry has made ‘in kind’ contributions. I will now be pressing them to provide actual funding behind the campaign. And they need to do more. If we are to reverse the trends in obesity, the commercial sector needs to change their business practices, including how they promote their brands and product reformulation.</p> <p>That is why I see our new approach as a partnership – access to the Change4life brand, alongside the Responsibility Deal; with an expectation of non-regulatory approaches.  We will work with partners in Change4life to give people better information in less prescriptive ways.</p> <p>I will also consider extending the Change4Life partnership to the drinks industry, who also have a major further role to play in promoting healthier lifestyles.  Change4life is not just about obesity and physical activity but other ways to be healthy.</p> <p><br />We also need to be smarter about how we engage with people. Over the next year, we will test new and innovative ways to incentivise healthier lifestyles, created with local communities and evaluated using a mix of academic and commercial sector techniques.</p> <p>Our new approach across public health services, must meet tougher tests of evidence and evaluation – demonstrating delivery of results.</p> <p>We will not retreat from our determination to prevent rising ill-health in the future – equally, we must not waste a penny of desperately scarce public money today.</p> <p>The Coalition Government’s commitment to our health services is in the circumstances remarkable – we are not going to make the nation’s health the price of paying down the nation’s debt.</p> <p>Alcohol misuse costs society over £17 billion each year and obesity much the same figure. If we ignore these issues, not only will we have to carry on paying for that failure, but we will also have to live with the consequences in worse educational outcomes, higher crime, poorer quality of life for everyone – and we will put the economic recovery at risk.</p> <p>Healthy individuals are more productive and more able to contribute to long-term growth. As the Royal Sanitary Commission noted in 1871: ‘public health is public wealth’.<br /> <br />We can make a very strong case for the cost-effectiveness of investment in health, in health promotion and the prevention of illness.</p> <p>But in the past these investments have rarely – too rarely – been accompanied by a rigorous evaluation of what works.  The idea that spending on prevention is more cost-effective than spending on treatment is not a hard and fast rule.  We have to show where it is true, how it is true and why it is true.</p> <p>In the current fiscal climate we have to see a new standard of evidence.</p> <p>We must only support effective interventions that deliver proven benefits. We must be certain that every penny invested will achieve better health outcomes.</p> <p>To conclude, later this year, we will publish a White Paper on public health setting out exactly how the Public Health Service will work – and I want to invite all of you to participate in its development.</p> <p>I want to consult with you about how we will develop this policy.</p> <p>Notwithstanding financial difficulties, we can create something better.</p> <p>My vision is of public health as a movement, owned by everyone, for everyone’s benefit. A movement which unites those who have been trying to prevent ill health with those responsible for treating it. A movement which not only transforms the way we deliver public health, but also revolutionises the way we think about it.</p> <p>So I want to enlist your help: to work hand-in-hand with colleagues across local government and the NHS; to inspire, challenge and lead others; to deliver better health for the nation; to ensure that progress on local health outcomes is maintained; to support communities and empower individuals; to change the way people think about public health.</p> <p>And as we collectively rise to this challenge you’ll have our support – I’ve set out today how we’re supporting you with ring-fenced funding, incentives and greater control.</p> <p>I’ve set out my approach structurally, financially, philosophically.</p> <p>We have the chance for the first time in this country, to create a unified, coherent and effective public health strategy – with the Public Health Service at its heart – guided by a national vision, lead by local expertise, driven by evidence – and founded on social responsibility.</p> <p>With your help, we can make that vision a reality.</p> <p>Thank you.<br /></p> None Andrew Lansley CBE MP A new approach to public health Department of Health 2010-07-07 speech to the UK Faculty of Public Health Conference
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117011.jpg" alt="Andrew Lansley, Secretary of State for Health" /> </div> <p class="introText">Not checked against delivery</p> <p><strong>Andrew Lansley, Secretary of State for Health:</strong></p> <p>Everything I do as Secretary of State will be directed towards freeing up the service to deliver better results. At every stage I will be endeavour to be open, clear and consistent about my plans. And every step we take we must take together – I want to draw on your views and your expertise, starting today.</p> <p>In opposition, and coming into Government, I have been clear about our priorities:</p> <p>First, that patients must be at the heart of everything we do – as more than simply beneficiaries of care, but as participants in its design.</p> <p>Second, the NHS must be focused on achieving continuously improving outcomes for patients – not inputs or processes, but results.</p> <p>Third, we must empower clinicians – those responsible for patient care – to deliver those improvements.</p> <p>Fourth, if we are to improve overall health outcomes and make the demands on the NHS more sustainable, we must prioritise prevention and create a public health service.</p> <p>Fifth, we must reform social care alongside healthcare – and deliver closer integration in how services are commissioned and provided.</p> <p>These are now my priorities for government.</p> <p>And today I want to talk about perhaps the most important and fundamental issue of all – improving outcomes for patients.</p> <p>This must be the primary purpose of the NHS: to improve the quality of care, and achieve outcomes that are amongst the best in the world.</p> <p>Why should we not? The service has doctors, nurses, scientists, researchers, as good as any in the world. People, I know, committed to achieving the best possible care.</p> <p>But I can’t count how many times doctors have told me, on a personal and professional level, how frustrated they are by the way the system works. How their judgements and activities are restricted by the rigidity of the system, and how their clinical priorities have been distorted by narrow process targets.  </p> <p>If we are going to achieve the outcomes we all want to see, we need to break down that system and build one that is focused on improving results for patients. To do this I think there are four steps that we need to take. </p> <p>The first is to measure those things that really matter.</p> <p>For too long the focus has been on measuring inputs and processes that are remote to patients.</p> <p>The result has been the number of managers in the NHS increasing three times faster than the number of nurses, and a proliferation of targets – with over 100 major targets now governing your every movement.</p> <p>So we are beginning to dismantle this system.</p> <p>Just last week we published a revised Operating Framework to move towards scrapping the 18 week target for hospital waiting times, the 4 hour A and E target and the 48 hour target for GP access.</p> <p>But in doing this and more in this direction, we have in parallel to develop proper measures of quality which prioritise what matters to patients – not boxes ticked and processes followed – but their actual health outcomes.</p> <p>And so I am calling for your help in constructing a national outcomes framework for the NHS. A framework that will help drive up quality across all services and show how we are performing against other countries.     A framework that I can use to hold the new NHS Commissioning Board to account, and that patients and the public can use to hold all of us to account.</p> <p>I’ve suggested some possible measures:</p> <ul> <li>Mortality amenable to healthcare brought down to the level of comparable countries</li> <li>Improving one and five year survival rates for cancer, so that they are at least in line with EU averages and progressively improve relative to comparators<br /></li> <li>Reducing premature mortality from stroke, heart disease and lung disease, so that they are at least in line with EU averages<br /></li> <li>Year-on-year improvement in patient-reported outcomes for patients living with long-term conditions<br /></li> <li>Year-on-year improvement in patients’ satisfaction with their access to and experiences of healthcare, and<br /></li> <li>Year-on-year reduction in the number of adverse events</li></ul> <p>But – I repeat – I want to hear your views. Together we need to develop a small but balanced set of national outcomes measures that encompass the three things that we need to focus on to improve quality – the effectiveness, experience and safety of care. We’ll be announcing a full consultation soon.</p> <p>In any healthcare system, a central factor in securing better outcomes is to bring the management of care together with the management of resources and services.</p> <p>Most healthcare systems do not do this successfully – most suffer from this separation: to the greatest degree in America, where the third-party payment problem has inflated costs dramatically. Examples in America of physician-led, more integrated services, demonstrate how differently – and effectively – they can deliver care. </p> <p>But even in this country there is a sense of management being separate from clinical care, whether in hospitals or where PCTs are remote from referral decisions about patients – creating the same lack of cohesion.</p> <p>So the second step is to give control of commissioning to General Practitioners, working in local consortia, supported by an independent NHS Commissioning Board.</p> <p>GPs coordinating healthcare so they are best placed to coordinate commissioning – but all clinicians must take on a much greater role. GPs will be expected to work closely with hospital consultants and their colleagues in all parts of the profession. As Iain Macleod told the BMA in the early 50s – seeing General Practice as much a multi-disciplinary team as hospital care.</p> <p>I have discussed our plans with the GPC, and I will publish our proposals soon. There will be a full consultation on the implementation with the profession. I want to hear your views on exactly how this should work – we’ll work through the details with the BMA and we’ll negotiate those aspects that affect the GP contract.<br />But in doing so let’s keep our focus on what we’re trying to achieve.</p> <p>The danger with contract negotiations is that we end up not only just seeing the trees, but actually examining, very carefully, the bark on the trees – and failing to see the wood.</p> <p>So let’s be clear – our aim is a major transfer of responsibility to the GP community; in order to empower clinical decision-making and improve outcomes for patients.</p> <p>Many GPs are keen to take this on.</p> <p>And I want to appeal to all GPs – keen, or not so keen. I understand the philosophy that says your professional responsibility is to be concerned about the patient sitting opposite you.</p> <p>But giving GPs greater commissioning responsibility isn’t about detracting from the support you give to individual patients.</p> <p>Rather, it is about making sure that the really important decisions about the services available to your patients – and the quality you expect from the people providing those services – are driven by your clinical insight and by the holistic view you have of your patients’ needs. </p> <p>It is based on the understanding that to achieve the best for each patient, you need the power to design services that are right for all your patients. And that to get the priority right for each patient, you need to set priorities for all your patients.</p> <p>As the Royal College of Physicians argues – the responsibility for the use of resources is now a core responsibility for the whole profession.</p> <p>And so, to support commissioning we need to have clear definitions of what constitutes excellence.</p> <p>So the third step is to introduce proper measures of quality across the service.</p> <p>Clinicians will be accountable in a different way – not to tick-box process targets, but to quality standards.<br />Standards which do not distort clinical judgement, but which are based on clinical evidence. Standards which achieve better outcomes and are comprehensible to patients so that they can hold clinicians to account.</p> <p>And I’m pleased to say that this work is already well under way.</p> <p>Last week we showed that we were serious about putting quality at the heart of the NHS when we scrapped unjustified process targets.</p> <p>And today the National Institute for Clinical Evidence are presenting me with the first three Quality Standards – covering stroke care, dementia care and the prevention of VTE. Setting out an authoritative, evidence-based view of what high quality care looks like.</p> <p>These standards will improve quality across the system from today. And they will be a central part of commissioning to meet key outcomes measures tomorrow.</p> <p>And not just commissioning and continuity; also they need to be central to the future design of HRGs and payments; and to the quality inspection process, so that we have consistent measures of quality, and incentives for quality, and we do away with conflicts or distorting targets and measures.</p> <p>The fourth and final step is to improve access to information – because better information means better care.</p> <p>Sweden has 69 National Quality Registers on a range of areas from cancer care to diabetes to depression – all developed by doctors themselves. And they’ve shown real results.</p> <p>Their Hip Arthroplasty Registry has been active for more than 30 years. Now covering 20,000 patients a year, it monitors their quality of life alongside revision rates. Sweden now has the lowest reported frequency of revision operations in the world.</p> <p>In England and Wales, our own National Joint Registry opened in 2003 and it is now delivering feedback to clinicians to help improve the quality and outcomes of hip and knee replacement operations. It should become a basis for quality and outcomes measurements and for information to patients to support choice.</p> <p>And we saw the benefits that this can offer when we published data on heart surgery – focusing right down to the performance of the individual surgeons.</p> <p>Sir Bruce Keogh led this work, and not only did they get the data, which was an achievement in itself, but they validated it, published it, compared results in the UK and went over to Hong Kong to draw international comparisons.<br /> <br />The 2008 National Adult Cardiac Database Report set out that, ‘despite the fact that the risk profile of patients has increased, mortality has fallen dramatically’.</p> <p>It’s a model which we should look to repeat elsewhere.</p> <p>I’m committed to publishing more data about clinical performance.</p> <p>For example, clinical audit. When I talk to clinicians about this, I find they’re content as long as it is evidence-based and does not distort what they do.</p> <p>I agree. Information should be used to support good practice and reinforce it – and clinicians must have oversight. You must have the opportunity to challenge and test the data – effectively to sign it off.</p> <p>So I am bringing forward plans to expand national clinical audit to cover a wider range of conditions and interventions.</p> <p>These audits will be collecting data on at least two outcome measures, such as survival or morbidity – and they will name the provider.  </p> <p>Putting information in the public domain is a catalyst – it forces providers and individual clinicians to look at and compare their performance. And it is essential to accountability. Patients should have a right to expect good quality, accessible information, particularly on the things that really matter to them.</p> <p>And we shouldn’t wait to begin taking these steps. I’ve already describe some examples of good practice today. And just two weeks ago, I saw a programme which embodies everything I’ve been talking about today – clinicians taking the initiative to improve their services, to improve quality of care, access to information and patient outcomes.<br />For the last two years, beginning with five high cost and high frequency interventions, including heart failure, pneumonia, and hip replacements, clinicians in the North West have been collecting outcomes data to drive improvements in their work – and their Advancing Quality programme is now going public.</p> <p>They’ve been measuring their performance – not against national targets – but against their own standards, and working to improve the quality of the service they provide.</p> <p>It’s the first time in the UK that such data has been reported on behalf of a regional health system, assured by the Audit Commission and made available online so that the public can see exactly what’s going on.</p> <p>And this programme is also playing a key role in the region’s efforts to meet the efficiency challenge that we all face.</p> <p>Last week’s Budget set out the scale and severity of the measures required to cut the deficit. It will be painful.</p> <p>We have been clear about the priority we attach to safeguarding the services that the NHS provides and on which we all rely.</p> <p>So funding for the NHS is protected, and we will increase it in real terms. But we should remember what a privileged position we’re in.</p> <p>We’re not protecting the NHS in order for things to carry on as they are, or for people working in the NHS to feel that they’re being personally insulated from the disciplines that are being applied across the public services. Still less for the NHS to go on recruiting non-essential, non-clinical jobs whilst across the rest of the public services vacancies are not filled and tough decisions are made to stop spending programmes. We must be at least as tough on ourselves.<br />This protection for the NHS is protection for patients – to ensure that the sick do not pay for the debt crisis.</p> <p>But let me be very clear, every penny saved in the NHS in efficiencies will be available to reinvest in the service – to meet the increasing challenges and increasing demands that we face, to improve the service we offer and the quality we deliver. Every penny.</p> <p>This is a huge challenge and opportunity for everyone in the NHS. We have a duty now to find exceptional levels of efficiencies so that we can reinvest in the service where the money is needed more.</p> <p>Last week the Prime Minister and the Deputy Prime Minister asked public sector workers for their ideas on finding efficiencies. All those who work on the frontline should be thinking carefully, and imaginatively, about how we can do things differently. The QIPP process is a home for this in the NHS and the way that we can implement the best and brightest ideas across the service.</p> <p>As the Prime Minister said: ‘Don’t hold back – be innovative, be radical, challenge the way things are done.’</p> <p>And you will be listened to – every serious idea will be considered and the most promising ones will be taken forward.</p> <p>I believe these changes will empower patients and clinicians. They will even empower good frontline managers. And they will disempower top-down bureaucracy.</p> <p>But the critical issue is this: what will you do with these freedoms and responsibilities? That is a question of leadership.</p> <p>I remember the profession’s anger over Modernising Medical Careers and the Medical Training Application Service (I was on the march). The problem was that the profession wasn’t involved – the engagement was only skin-deep. It wasn’t owned by you.</p> <p>So on taking my reforms forward, on publishing better information, on listening to patients’ views, commissioning services and achieving better health outcomes – we won’t be pronouncing the answers from the centre, you will have a responsibility to lead.</p> <p>Because, in liberating the NHS and empowering you to do your jobs, we are not offering a one-sided deal.</p> <p>In return, I expect you to embrace these new opportunities and assume your rightful role as clinical leaders.</p> <p>In removing targets, the public need to see a clear improvement in the quality of care that you are providing.<br />In giving you clinical freedom, I ask for responsibility for efficiency and effectiveness too.</p> <p>And in announcing the new quality standards today, I need to see a positive response – their potential will only be fully realised if the whole system aligns around them.</p> <p>Let me be clear: I am not trying to turn doctors into managers, but leaders.</p> <p>That’s how we’ll bring about a new culture of responsibility across the service.</p> <p>That’s how we will create the stronger, freer, fairer NHS that I’ve described this morning.</p> <p>That’s how we’ll empower you to achieve outcomes for patients that are among the best in the world.</p> <p>Thank you.</p> None Andrew Lansley CBE MP A shared ambition to improve outcomes Department of Health 2010-06-30
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_117011.jpg" alt="Andrew Lansley, Secretary of State for Health" /> </div> <p>Thank you very much. It's a real pleasure to be back here with you.  </p> <p>I wish I could see where you are – I can't see you! I've got lights in my eyes. I can't see all the faces out there, I was hoping they would be familiar faces. Many of you I've met many times over these years and it is a pleasure to be back with you.  </p> <p>It's a year since I was addressing you as shadow Secretary of State for health, and a year is an exceptionally long time in politics.  Much has changed. </p> <p>But, do you know, one thing hasn't changed. One thing that has remained the same. I’ve been Shadow Secretary of State for six and a half years, Secretary of State for more like six and a half weeks, but one thing that's remained the same is I've really enjoyed visiting people whose job it is to provide services to the people of this country, healthcare services of so many different kinds in so many different places.  </p> <p>Of course, when you do that as Shadow Secretary of State or as Secretary of State, there seems to be a tendency a desire to subject me to various tests.  I've seen inside my retina, I have seen inside my heart I have seen inside my abdominal aorta I have had my blood pressure checked, my cholesterol checked, my everything checked.  I even went to Preston Royal Infirmary and met the folk there who were following up on bowel cancer screening and they eyed me up a bit for the colonoscopy.  </p> <p>Earlier this week I went to Berkshire, God it seems longer ago – it was actually yesterday morning – I went to Berkshire and I was meeting the people there who were providing talking therapies, the role of out IAPT and Paul [Burstow] and I were able to announce a further extension of talking therapies and I really enjoyed meeting them there.  </p> <p>They felt the moment couldn't pass without taking the opportunity to ask us to do some computerised CBT.  Well, those of you who know about this stuff will recall in computerised CBT there is a little part of that which is about what's known as faulty thinking. I thought you'd be interested to know that as your Secretary of State I did 3 questions on the faulty thinking test and I got zero out of 3. </p> <p>But I do hope after 6 and a half years as shadow Secretary of State, if I make mistakes and no doubt I will make mistakes, that at least I hope you won't feel they are made out of sheer ignorance.  </p> <p>But, I do know that I've learned one thing over that period of which I'm absolutely certain – that there are so many people in our National Health Service who have tremendous commitment, expertise and ability. My purpose is to let all of those people get on with the job they want to do.  My role, as I see it, as speaking for the service, for the public, for the taxpayer.  But, to be a leader and not a dictator.  </p> <p>In truth, many things have changed and are changing.  The public voted for change.  But, let me tell you this: over the last year, and since this conference last year, my priorities have not changed.  </p> <p>First, that patients must be at the heart of everything we do, not just as beneficiaries of care but as participants in its design.  We must see the NHS through our patients’ eyes and make delivering what they need and want a shared experience and responsibility.  </p> <p>Second, if we are to achieve continuously improving outcomes, then it's outcomes on which we have to focus, not process targets, not measuring inputs, but a consistent, rigorous focus on those outcomes with the ambition of securing results and healthcare services in this country that are amongst the best in the world.  </p> <p>Third, we must empower professionals to deliver. We must set you and them free to use their clinical judgment to do their jobs to the best of their ability and on the basis of the evidence. That way we can secure the quality, the innovation, productivity and indeed the safe care which is vital to achieving the best outcomes.  </p> <p>Fourth, we must do much better on the health and well-being of our families and our communities.  Only by prioritising public health and by preventing ill health more effectively can we achieve the overall health outcomes for this country that we seek and need, and in doing so actually make the demands on the National Health Service for the longer term much more sustainable.  </p> <p>Fifth, we must reform social care.  Seeing the relationship between quality and outcomes in care as well as in healthcare and their interconnectedness, delivering further integration in how the services are commissioned and provided.  </p> <p>Those are our five priorities for the Department and for the National Health Service – they are the priorities of the Coalition Government and we set them out very clearly in the coalition agreement. Together we're already reshaping how we do things in order to meet those priorities.  </p> <p>That's why I have instituted a full public inquiry into the events at and around Mid Staffs Foundation Trust and how the wider system failed to prevent the tragedies that happened there – so we can learn the lessons and move as a system towards a culture of safety and indeed a culture of challenge where things may go wrong.  </p> <p>That's why, in literally the first week at the Department, I announced a moratorium on reconfigurations. Not to stop change but to empower patients and clinicians to have their say and ensure the changes that are happening now are consistent with our vision for the future. Because if we're looking to GPs to lead commissioning, it's essential that what happens now is consistent with their commissioning intentions for the future. And if we want patients to exercise choice, then those choices should influence access to services – and we cannot pre-empt and frustrate those choices now.  </p> <p>As I say, it’s not about stopping change.  On the contrary, this is about ensuring that change is visibly linked to better outcomes, that it has the support and buy in of general practitioners and primary care, and that it is supported by the local people who we serve and represent. </p> <p>And just this week by publishing a revised operating framework we took a further step – putting in place a zero tolerance approach to infections, setting out how we can move from process targets to evidence based quality, developing payments for performance geared to results and moving towards a service which empowers clinicians and makes them more accountable for achieving the best outcomes for their patients.  </p> <p>5 years ago, I told you that the NHS did not need half-baked, inconsistent reform or even a direction of travel if people had no idea what they were traveling towards or where they were going. I believed then, as I believe now, that the NHS needs coherent consistent reform and a clear understanding of where we're going and what we need to achieve.  </p> <p>Our Coalition Programme is a plan for a 5 year Parliament.  We'll set out our strategy for the NHS as early as possible so everyone in the National Health Service can share that clarity of purpose, so that we can all have a sustainable framework within which to work and not just for 5 years but for the long-term.  Everything we do then can be consistent with that strategy.  </p> <p>So, today I want to tell you about the purposes and principles which are at the heart of that strategy, following my speech a fortnight ago to the Patients Association and National Voices. In that first speech I made clear the first purpose: to create a system of patient-centred care, to put patients right at the heart of the National Health Service.  </p> <p>Now, with you let me highlight a further purpose: to empower the service, the professionals and the front line.  </p> <p>The NHS is admired around the world, and rightly so, for the skill of its staff, for our system of general practice, for the continuity of care it provides, for its evidence based approach.  But the NHS is also rightly admired for its equity.  For that ideal that inspires all of us, that the NHS is there for everyone, free at the point of need from cradle to grave.  There is much to be proud of, but it is clear to me that there is still a lot more to do.  </p> <p>The NHS should be admired not just for its equity of access, but also for the excellence that we aspire to and we achieve.  The NHS should exemplify the ideal of equity and excellence combined.  </p> <p>After 13 years of top down control from Whitehall, we still have over 100 major targets controlling clinicians and a bureaucracy that demands some 250,000 data returns from every trust each year. Yet, in the NHS today, outcomes still lag behind those of our leading European neighbours.  </p> <p>For example, survival rates for respiratory disease and for many cancers remain poor compared to other countries.  The NHS has too high rates of acute complications of diabetes or avoidable asthma admissions.  Incidence of MRSA infections remains high relative to those countries and veinous thrombosis causes 25,000 avoidable deaths each year.  </p> <p>I'm determined we must make quality of outcomes the defining principle on which this service operates and indeed when we talk about quality, for all Lord Darzi's leadership and the huge efforts many of you and your clinical colleagues have made in the past 2 years or so, the system simply is not yet designed around quality as it should be.  </p> <p>What will make the difference?  More targets, different targets?  </p> <p>No actually if we're going to improve outcomes the answers don't lie in the top down targets.  They lie in the consulting rooms, and the wards and operating theatres and the clinicians around the country – where the clinicians are and the patients are. So I want to empower front line staff, and trust the professionals closest to patients to act on their behalf. A freer more open system will mean better results. </p> <p>But I know there is a tension in the National Health Service. There always has been and always will be – between national standards in a national system funded through national taxation and local priority setting and local decision-making.  </p> <p>It is a National Health Service, but it must be a locally delivered service</p> <p>And that is where the power should lie.  </p> <p>That is what the evidence tells us.  That is how we'll improve outcomes.  That is how we'll achieve transparency and accountability. </p> <p>Clinicians must be free to exercise their clinical judgment because, quite simply, those doctors and nurses that can best respond to their patients needs will achieve the best outcomes. They need and expect to be acting in line with the evidence. But they don't expect to be told what to do in ways which conflict with their clinical judgment. </p> <p>Clinicians will be accountable in a different way.  Instead of being accountable to process targets, they will have to meet quality standards.  Those quality standards will not be about distorting their clinical judgment, rather it will be based entirely on clinical evidence and must be shown to achieve demonstrably better outcomes if followed and they will have to be clear, relevant and comprehensible for patients.  </p> <p>And if we engage public commissioners more effectively in designing local services then they will make it clear that they want the right treatment in the right place at the right time – often in precisely that same place with local clinicians taking responsibility so that we can design those services best for each community.  </p> <p>I intend that general practice should take control of commissioning, creating a direct relationship between the management of care and the management of resources that I think it is at the heart of any healthcare system. And when you look at why so many healthcare systems have lost control of what they do and resources they consume, it's simply because those who are responsible day to day for the management of care of patients are not themselves directly also responsible for the resource consequences of what they do. Making that happen must be integral to designing any healthcare system that is efficient, excellent and equitable.  </p> <p>So, to support GP consortia in their commissioning decisions we will create an autonomous NHS commissioning board, free from day to day political interference. I am hoping I'll be the first Secretary of State for health whose principal purpose has been to give up power right through my time in office, to empower others rather than take power myself.  </p> <p>But, at the heart of what the NHS board will then have to do will be to establish a set of quality standards and indicators that drive commissioning and quality – and they must mean the same thing right across the system, whether it's in commissioning and contracts, whether it's in payment systems that drive quality or whether it's in the care quality commission who are inspecting.  </p> <p>If we create consistency we can also align incentives so that at every level, managerial and clinical, people can feel that they are working to a clear and consistent sense of what quality means.  </p> <p>And this will mean improving the payment system.  If the peak of Everest is a payment system that supports precisely what commissioners are looking for and what patients need on every occasion, frankly we're barely beyond base camp.  </p> <p>With the operating framework this week we've set out our goal for the system – benchmark pricing able to be contracted across care pathways crossing boundaries between primary and secondary care, focused on outcomes more than episodes or spells of care and payments, incentivised for quality.  I want to see a system that rewards performance and is tough on poor quality. A payment system which works for clinicians and patients rather than the other way around.  A tariff made for man, not man for the tariff.  </p> <p>Actually the CQUIN framework has begun to do just that. In Birmingham it has incentivised innovation and now cancer units have agreed with their commissioners to introduce home delivery of chemotherapy making for better more convenient services for patients. In Yorkshire and the Humber, commissioners are requiring local organisations to work together to achieve improvements for patients with dementia. I know some of you here today have worked on those schemes and they are just the sort of innovation that I want to see commissioning unlock.  </p> <p>There are many other examples of that sort of innovation but we need to see it happening systematically across the service. One of the virtues of the National Health Service is it attracts and inspires some of the brightest and best from around the country and around the world, but our system has failed to make the most of this potential.  We have to set the NHS free to innovate.  We should be constantly thinking about how we can do things better, encouraging the adoption of successful ideas throughout the Health Service. </p> <p>But we don't capitalise on innovation and ideas today enough because the system is too rigid, because we do one thing at a time, what the centre dictates and when it dictates it.  </p> <p>To give you an example, recently I was in a catheter lab, happily not to have angioplasty myself, but I was talking to the cardiologist about the introduction of primary PCI. And it became clear from the way they were talking that they and I knew this from years back – they had known on the basis of the peer review journal evidence that primary PCIs as a first response to a heart attack was something that was going to be a better way forward. But they didn't believe they could do anything about it across the whole of the NHS until the Department of Health had in effect given them the permission to do so. The same was true − which I knew well − in relation to thrombolysis for stroke.</p> <p>Why can other countries then move those clinical practices forward so much faster than we have done?  Why does our National Health Service appear to have acted as a brake on change rather than an accelerator for change?  </p> <p>I think because too often we've been like a convoy.  We are big, we are national, we are all in this together, but actually that doesn't mean that we can only go at the pace of the slowest.  We have to make sure there are first mover advantages.  We have to make sure the incentives are there to do the right thing as quickly as you can, and to act on the basis of the evidence, not to wait around to be told to do it by the Department of Health. So the current way of doing things has to change.  </p> <p>I want to provide freedom, responsibility and accountability so that clinicians don't have to wait, least of all for my permission, to move from the thing that is targeted to something better.  When the evidence says something works, they should be free to get on and do it and have the incentives and levers in managerial terms to support that.  </p> <p>And of course with that responsibility comes a new kind of accountability.  In recent years it seems to me there has been something of a pretense about accountability.  Ministers have been very keen on saying that they are in charge and they have done things when things are being announced, when money is being spent, when new projects are being announced.  </p> <p>But, in reality, often it wasn't they who could guarantee whether or not those promises were going to be delivered and when something went wrong, the response of ministers in Parliament − and for years I have been standing at the other dispatch box listening to it – was that it is all the fault of local management: ‘oh no, these decisions are all local decisions being made by local primary care trusts’.  </p> <p>Well, for the future, in a strategic framework that I'm proposing, we will show what the relationships actually are and where accountability genuinely lies, with a separation of commissioning from provision which promotes individually regulated providers, commissioners themselves operating with greater autonomy, themselves having greater direct public scrutiny. </p> <p>I will set out what the Secretary of State is and is not responsible for and, where the Secretary of State is not responsible, I will set out who is.  </p> <p>My view is clear: we have to strike a new balance of power in the service so that wherever possible responsibility should lie with clinicians and managers.  I intend to provide the leadership, the strategy, and the direction, not command and control.  </p> <p>So, that means being clear what we are asking the service to achieve, not trying to tell you how to do it. It means more than ever we're making clinicians accountable to the people who really matter, the patients. Accountable in terms of the choices patients make but also for the results that the service achieves.  Supported by greater access to information for patients to empower them to make more and better choices about their care, and a democratic accountability too. As we set out in the coalition agreement, for the first time, the voice of the public will be heard across commissioning, the public health service and in relation to social care. Because in these very difficult financial circumstances, accountability for how we use taxpayers money – accountability to the public for the service we provide with the money that they provide is even more important.  </p> <p>Funding for the NHS will rise in real terms in each year in this Parliament.  The real terms increase will not, however, be remotely of the order of recent years nor even what the NHS has been accustomed to over the whole of its life.  It affords a degree of protection, yes, but at the same time how that money is used is critical. So I want to deliver to you the same message that I delivered to you last year – which is that although the National Health Service will have protection relative to others parts of the public services in this period of serious financial constraint, I must apply, we must apply to ourselves exactly the same disciplines that are applied across the public services.</p> <p>Protection for the National Health Service is not protection from the need for efficiency.  It is protection for patients.  </p> <p>So the funding settlement will come with some pretty testing challenges for how that money is being spent and the results being achieved. So we have to provide discipline to what we are doing at every level, to management costs, to capital projects, in continuous improvement and in reducing the unit costs of what we do.  </p> <p>The £20 billion of savings that David Nicholson has rightly identified and asked for is not a cut to our budget.  It's not about doing less, still less about doing worse.  </p> <p>It's a 20 billion pound efficiency saving.  It's about doing more for less and that should be out central discipline across the service because in my view it is both a management and a moral imperative to reinvest those savings, to save money in what we deliver now so that we can meet the demand and quality changes which we face in the future.  </p> <p>The NHS should be an example among the public services and an example to the private sector in terms of what it is possible to achieve and that is going to mean radical changes in the way things are done.  </p> <p>For example, management costs are too high and they have escalated in recent years, so we will reverse the recent increase and we'll do that this year – and then that will be the baseline for the further reduction by a third which I announced last year. </p> <p>Remember the deal is this: every penny you release through greater efficiency and a discipline for financial disciplines, will be reinvested in improving services to help us meet the challenges we face.  Savings today will be our fund for growth tomorrow.  </p> <p>I know the changes I'm proposing are far reaching.  They're intended to be.  </p> <p>We are intending to see significant changes in the way the NHS does its work.</p> <p>Bottom up, not top down. </p> <p>Purposeful, not process dominated. </p> <p>Patient led, not target driven.  </p> <p>As decision-making shifts and we work together to deliver change, I know there will be some uncertainty, I can't avoid that. But I can and will create a bridge between the past and the future and help to map out the journey we need to take.  </p> <p>I will be clear about what the strategy is and the shape of the new priorities and systems – and I will do this as soon as possible.  I will build on the good work being done, on QIPP, which is fundamental to success, on CQUIN, on Payment by Results, on practice-based commissioning, on foundation trust freedoms, the piloting of personal health budgets and joint working with local government.  </p> <p>There is a great deal of work there which I think can be a basis for what we do in the future – but put into a system that is far more coherent and works better for those who are trying to drive reform.  </p> <p>And not least I will give leaders and managers real freedom and responsibility to deliver results and I want also to involve all of you in working out how to implement that strategy and to engage you consistently in the future.  </p> <p>Functions will change so organisational form will change too.  But at the heart of making all of this happen will be leadership.  Stronger clinical leadership, stronger managerial leadership and I hope to give stronger political leadership.  </p> <p>And in incredibly tough circumstances strong management is essential.  We're going to need high quality management, we're going to need leadership.  </p> <p>For those who can offer both the reforms will offer real opportunities.  It is no surprise to me that some of the people who have most railed to me over years about a top down command and control system and the bureaucracy that it has created, are the managers who want to be able to run their hospitals and services and to show what they can deliver.  </p> <p>For those managers in fact who themselves recognise the clinical imperatives of safety and quality and outcomes, and who are capable to motivate clinicians also to understand why and how we need the disciplines of performance management and financial control, they actually have exciting possibilities ahead.  </p> <p>David Nicholson will be talking to you tomorrow, I've asked him to talk to you about the practical steps we need to take and how we want to engage you to make this happen.  I just want to say, David's understanding, far beyond mine, of what you do, how you work, how you have made things happen, the possibilities in many of the projects you have already started, I think has been really important for me to be able to rely upon. I have really appreciated it and I sort of knew we were getting somewhere when David Nicholson first smiled - it took a day or two!  </p> <p>I know that what I've said today will throw up dozens of questions, I am tempted to say:  David will answer them tomorrow, but no.  </p> <p>People will be thinking: what does this mean for my organisation?  How is GP commissioning going to work in practice?  How long will this take?  What does it mean for me?  </p> <p>And I understand all of those questions and more, and I want to work with you to make sure that we answer those questions as soon as we can.  </p> <p>All my efforts to publish our strategy and to do it early are in order to increase certainty, to let all of you know and others not just the direction we're traveling but where we're going, what that world looks like and how we can make it happen.  </p> <p>Because I hear people asking other questions: How can I get involved?  How can we make this happen?  Do I need to rethink what we're doing now?  </p> <p>We can start making progress now, we are not on the terraces as it were, but actually we all of us – and strictly speaking you more than me – you're on the pitch.  You are the people who are making this happen day by day and there is a lot we can do.  </p> <p>We can accelerate in Primary Care Trusts the process of engaging commissioning consortia, practice based commissioning consortia, making it real now.  </p> <p>NHS trusts that are not yet Foundation Trusts can now be pushing themselves to achieve FT status and think about how they can use the greater freedoms and responsibility we'll give.  </p> <p>Everyone can ready themselves, in terms of the culture of our approach – a culture of safety, a culture of focusing on outcomes, of shared decision-making with patients, of opening up new avenues to public engagement and accountability.  </p> <p>So let's remember why we're all doing this.  Because the NHS is special. Because of a shared commitment to the values of the NHS, because we know for all its brilliant achievements there is still more we need to do. We're doing these things so that we can improve the service the NHS provides, so we can improve outcomes for patients, improve patients’ experience, so we can ready the service to meet demographic and demand challenges, so we can continually improve the quality of what we do and achieve health outcomes that are literally as good as any health system in the world.  </p> <p>We have a chance now to institute a clear plan for reform for the longer term and that's what I plan to do.  My mission is not a revolution but it is to give everyone clarity of how autonomy and accountability for the service in the future is to be exercised.  </p> <p>The NHS today is strong, much has been achieved by people here in this hall.  I know the passion that people I meet right across the service have for what they do and the ability they have to do it.  </p> <p>My goal now is to release that passion – to liberate that passion and ability in order to deliver.  </p> <p>In a report the Confederation has published today, the Confederation points out that too often the NHS has been subject to unclear, poorly designed, short lived reforms.  </p> <p>I understand that and I don't intend to fall into that trap.  </p> <p>And I understand the warning expressed in the title of the report – it is called ‘The triumph of hope over experience’.  </p> <p>Now, I don't actually think any of us would prefer to have a triumph of experience over hope; we know we can't stand still, we know there are problems to solve, we know there are things we can and will improve.  </p> <p>What we need is both of those things together – to employ the wealth of experience within the service to realise our common hope for a better future for the National Health Service.  </p> <p>With your help, and that of everyone in the NHS, that is what I intend to achieve.  </p> <p>Thank you. </p> <ul class="linksCollection"> <li><a href="" class="externalLink" target="_blank">NHS Confederation Annual Conference and Exhibition 2010 <span class="tool-tip" title="Opens new window"><span class="accessibility"> (opens new window)</span></span></a></li> </ul> None Andrew Lansley CBE MP Shifting power to the frontline Department of Health 2010-06-24 speech to the NHS Confederation
<p>Thank you all for being here, and for giving us the opportunity to show that patients are at the heart of our plans to improve the NHS.</p> <p>There was a moment, after six and a half years as Shadow Secretary, when the thought, “many a slip twixt cup and lip”, came back to me.</p> <p>Between the verdict of the electorate and the uncertainties of coalition-building, there were reasons to be cautious. But the people voted for change, and in relation to health and social care, we were readily and quickly able to bring together a Coalition Programme – one, I think, which promises, not just change, but a clear, consistent, coherent strategy for our health and social care services.</p> <p>May I just tell you, between ourselves, that there was of course that moment in the Cabinet Room, with the Prime Minister. As I sat down, I recalled a day, fifteen years ago, when David and I, who had worked together in the Conservative Research Department, were talking to George Osborne, who was leaving the Department.</p> <p>I said to David and George, “when you two are running the country” – we always knew they had it in them – “I want a job”. They gave me what my mother would call an ‘old-fashioned look’, “What job?” they said. So, I replied “I want to be the Governor General of Bermuda, with the shorts, the hat, especially the feathers – the lot!”.</p> <p>I’m happy to say the Prime Minister didn’t remember.</p> <p>Because over these years, as Shadow Secretary of State, I have shaped a personal ambition.</p> <p>An ambition rooted in the commitment to the core values of the NHS – of a comprehensive service, free at the point of use, based on need, not ability to pay.</p> <p>But an ambition beyond that. Beyond achieving equity and the social solidarity of access to a National Health Service. My ambition is that we can achieve health outcomes – and quality health services – as good as any in the world. That we can achieve a unique combination of equity and excellence, including for the most vulnerable. An ambition for excellence. I’m buoyed by the knowledge that we have medics, nurses and scientists as good as anywhere in the world, I know that we can achieve this.</p> <p>It is my passion. To back the NHS. To put my heart and soul into achieving success for the NHS, and for, you, the patients.</p> <p>Over the last six years the key changes that will enable us to realise this ambition, have become increasingly clear.</p> <p>These now represent our priorities for government:</p> <p>First, that patients must be at the heart of everything we do, not just as beneficiaries of care, but as participants, in shared decision-making. As patients, there should be no decision about us, without us.</p> <p>Second, that if we are to seek to achieve continuously improving outcomes, then that is what we must focus on. Not politically-motivated process targets, not simply measuring inputs or constant changes to structures, but a consistent, rigorous focus on outcomes – achieving results for patients.</p> <p>Third we must empower professionals to deliver. This is the only way we can secure the quality, innovation, productivity and safe care, all of which are essential to achieving those outcomes.</p> <p>Engaged and empowered professionals will deliver results. Disempowered, demoralised and demotivated staff will not.</p> <p>Fourth, we must, as a society, do much better on the health and well-being of our families and our communities. Only by prioritising health and well-being and by preventing ill-health more effectively, can we achieve the overall health outcomes we seek, not just good health services but good population-wide health outcomes, and reduce the inequalities in health, which so blight our society.</p> <p>Fifth, we must see the many links and connections between health and social care, seeing care in its wider aspects. Whether provided by their families, by carers, by support workers or by health professionals, all are part of a spectrum of care for those in need. Health and social care should be integrated more. And so we need to reform social care alongside healthcare, so that we can support and empower people – not least as individuals – to be more safe and secure and, themselves, to be able to exercise greater control over their care.</p> <p>These will be our priorities. We will act across the breadth of health and social care to deliver these priorities and, in doing so, we will establish and embed the consistent, sustainable strategy for reform, which will give our services the long-term stability they have so desperately needed for so long.</p> <p>The Coalition Programme is a programme for a five year Parliament. My intention is to deliver a strategy as early as possible, so that people have a sustainable framework with within to work, and not just for five years but for longer.</p> <p>I will not today set out all the aspects of that strategy. I don’t want begin by talking about structures, funding or processes. I want to focus on the first priority – to put patients at the heart of all that we do. And for that reason I am delighted to be here at the Bromley-by-Bow Centre.</p> <p>Sam Everington and I have several times discussed what you do here. And it’s great to see how you bring together all aspects of health, wellbeing and community in one place. Health is an holistic experience; it is more than simply the absence of, or treatment of, disease.</p> <p>And I am so pleased to be able to address the Patients’ Association and National Voices, who I have worked with in the past and who have brought us here today, as well as representatives from the Local Involvement Networks. Each of you, in your respective ways, speak for patients – and I hope I will too. Because I believe that we must see everything that we do through the eyes of patients, as well as with the objective view of the clinical evidence – both are necessary if we are to fashion a service which is truly of the highest quality.</p> <p>In this way, I hope I can escape from one of the enduring frustrations of my predecessors. As the BMJ said in a review of Richard Crossman’s diaries: “All Ministers of Health were in the unenviable position of being regarded as the agents of government by the health professions and as agents of the professions by their ministerial colleagues”.</p> <p>I do not propose to be caught in that trap. I serve the public. I know too how committed health professionals are to the cause of their patients. Politicians and professionals in service of public and patients – that is our common ground.</p> <p>And so to put patients first, we need a cultural shift in the way the health service works. </p> <p>We need to put priority on the things that matter most to patients. We need to see the service from the patients’ point of view, to listen to patients, to shift power down through the system – and, where possible, to put power and control into the hands of patients themselves.</p> <p>So let me tell you some of the things that patients have told me matter most to them. They most often say: ‘Mr Lansley, I’d just like to tell you that the care I received from the NHS was fantastic; the staff couldn’t have been more wonderful or more helpful.’</p> <p>That is the most common thing I hear – and nothing I say today should detract from that. So I want to say to NHS staff: I know how often you get it right. You know I want to support you to get it even more right, even more often. And when things go wrong, I want to help you to put it right.</p> <p>So, the first principle must be ‘do no harm’. When it goes wrong in the NHS, patients suffer and patients die. Safety for patients is at the heart of quality care and of the professional responsibility of nurses and doctors. So there is no trade-off between safety and efficiency. Good care is safe care. Unsafe care costs more, in lives and in cash. High levels of infection, VTE, emergency readmissions, falls, pressure sores. They all lead to more suffering and more cost.</p> <p>So I will not countenance a “production line” approach to healthcare which measures the volume but ignores the quality. Patients expect their care both to be safe and high quality.</p> <p>I will back every effort to put patient safety first in the NHS. For patients, they need to know who is providing quality, safe, effective, accessible services. Information will drive higher standards. It’s not just about choice, although patients value choice, even if the choice they make continues to be to go to their local practice and their local hospital. The combination of information and choice will hold people to account and drive up standards.</p> <p>So our vision must be of an information revolution across the NHS. Shared decision-making between patients and professionals at every stage. With rapid progress in identifying the evidence base for quality standards, which will be the basis of comparative information on quality and performance, enabling patients to be confident both of the service they should receive and the quality of the hospital or other healthcare provider they are actually receiving.</p> <p>Putting the information out there – accessible to everyone – is a catalyst. It drives comparison and performance.</p> <p>Sir Bruce Keogh and the cardiac surgeons have led work in this country, publishing and benchmarking in depth information on their performance and results. The result has been very encouraging – as their 2008 National Cardiac Database reported, “Despite the fact that the risk profile of patients has increased, mortality has fallen dramatically”.</p> <p>That is one specialty in this country. Where they lead others can follow. But in the spirit of benchmarking, let’s remember Sweden has 69 National Quality Registers.</p> <p>Information for patients must embrace all that goes to make up quality – including access, waiting times, cleanliness, infection rates, quality of clinical care, results for patients, access to same sex accommodation and single rooms, cancelled operations, emergency readmissions, discharge arrangements, numbers of complaints, patient experience and patient-reported outcomes.</p> <p>That sounds pretty forbidding perhaps. But most of this data already exists – it’s just that you can’t access it. So, as I began to do last week, we will continue to put information out there, where patients can see it. Where people such as “I Want Great Care”, Dr. Foster, CHKS, and others can enable patients to see who is doing well and badly; putting patients in the driving seat.</p> <p>I simply don’t believe that in an open information culture of that kind, the scandalous failings that took place in Maidstone and Tunbridge Wells and then at Stafford Hospitals could have gone unchallenged for so long.</p> <p>But I will take no chances. I will not let a culture of “don’t ask, don’t tell, don’t complain” persist.</p> <p>At Mid-Staffs there was clearly a sense among some of the professionals, and indeed the public, that the hospital had problems, but that was just the way things were. Well that’s not good enough. We can never allow this sort of situation to develop again. And I will be saying more about how we can learn the lessons from and about Mid-Staffs in the next few days, and about the relationship of the whole healthcare system to a hospital like Mid-Staffs.</p> <p>We need to develop a culture of active responsibility. So that everyone – GPs as local commissioners, LINKs,  local authorities and others – will all be empowered to ask, to challenge and to intervene. Those who are charged with managing the care of patients, and purchasing services, must be commissioning for quality.</p> <p>The standards that will drive quality accounts and benchmarks of performance, must also be linked to payment, so that we’re not just paying for activity – but for performance and results.</p> <p>And there’s a specific point I want to tackle here. Over the last ten years emergency readmissions have increased by over 50 per cent. Not, it seems, primarily because patients have become more frail, although some may have, but because hospitals have been incentivised to cut lengths of stay and send patients home sooner – process targets creating risks for patients.</p> <p>So in addition to getting rid of targets that have no clinical justification, we’re going to ensure that hospitals are responsible for patients not just during their treatment but also for the 30 days after they’ve been discharged. It will be in the interests of the hospital for patients to be discharged only when it is ready and safe for them to do so.</p> <p>And if a patient is readmitted within those 30 days the hospital will not receive any additional payment for the additional treatment – they will be focused on successful initial treatment and reablement and support for people as they return home.</p> <p>The outcome for the patients is the only outcome that matters – and so we are sending a clear message to the NHS that patient care doesn’t end when they walk out of the hospital door. This will have the added benefit of  driving the further integration of hospital and community services where it most matters. Patients don’t talk about ‘primary’ and ‘secondary’ care, they see it simply as treatment and care for the problem they have, whether at home or in hospital. </p> <p>Within hospitals and across the health service the culture must also be one of patient safety above all else.</p> <p>I remember hearing about what a safety culture in the NHS could be, from a pilot called Martin Bromiley. He tragically lost his wife because of an error in an operating theatre. As a pilot, he knew what it means to be in a ‘high reliability’ organisation, where an undetected human error can lead to deaths. And now he, and his colleagues in the Clinical Human Factors Group, tell NHS staff about building a safety culture.</p> <p>Reliability, consistency of operating procedures, and a culture of challenge are all required. A culture where the offence is not to make a mistake – to err is human – but the offence is to ignore an error or, even worse, to cover it up.</p> <p>So we will work with NHS staff to embed a safety culture across the NHS where instead of thinking of ‘whistle-blowing’ as going outside the organisation, we see challenge of that kind as integral to the safety and improvement within the organisation.</p> <p>And in the same way, instead of seeing complaints as a burden, or a distraction or something to be dealt with outside the mainstream of service provision, we must see complaints as integral to the improvement of the service we provide.</p> <p>Think about it – learning from our mistakes, listening to complaints, comparing what we do, evaluating our performance and constantly seeking to improve our quality – these are the features of the best-performing organisations in every sector – and they are there in the best-performing NHS organisations already.</p> <p>I am determined to make the best become the norm; and excellence become everyone’s expectation.</p> <p>Let me give you some further examples of how I want to take these principles forward.</p> <p>On safety and on infections. Last week, I began this process by requiring the publication of weekly data on MRSA bloodstream and C Diff infections. I have spent too long with too many people who have lost loved ones to healthcare-associated infections, not to be determined to act on this.</p> <p>Five years ago, at the Royal Berks, I saw them taking what they described as a ‘zero-tolerance’ approach on infections. The then Government was calling for a 30% reduction. How can you target a 30% reduction in infections? The only acceptable strategy is a zero tolerance strategy. There is no tolerable level of preventable infections.</p> <p>The NHS in the South East has set the task of eliminating preventable healthcare associated infections by next year. I welcome that ambition – that is an outcome I support. And if they can do it, so can others.</p> <p>We will be signalling to the service that a zero-tolerance approach to infections will be our strategy.</p> <p>And what about the relationship of information to choice? The expectation of choice has been a feature of maternity services going back to Julia Cumberlege’s 1993 report, “Changing Childbirth”. But choosing between a home delivery, a midwife-led service and an obstetric delivery is a limiting concept of choice. </p> <p>Mothers-to-be should have information about the different aspects of maternity care including choices of location, but also issues like pain-relief, choice of providers as well as risk assessments – because not all choices will be appropriate or safe for all women. They should have the ability not only to compare key aspects of care, like continuity of midwifery support and one-to-one midwifery support in labour; but they should also be able to see what other mothers’ experiences have been and to hear their views of the safety and quality of care.</p> <p>Mothers must have this information not only to exercise choice when originally booking their maternity care, but to be able to be in control of their childbirth, exercising safe choices at each stage.</p> <p>Because, like that process of choice, listening to patients is at the heart of what we should be doing.</p> <p>And listening to patients – asking, reporting, and learning from patient experience – will be of great importance in designing and improving services, including achieving greater efficiency. Just look at the high levels of patient-reported satisfaction in productive wards.</p> <p>But the NHS too often asks insufficiently penetrating questions, insufficiently often, of too few patients.</p> <p>Patient Access Surveys in General Practice miss the point of whether patients are doing well and if they have good outcomes, if they required treatment or advice. Access is not as important as outcomes.</p> <p>And the NHS Patient Survey, asking if patients were satisfied with the care they received, is too much like asking patients whether they were grateful.</p> <p>I have seen other hospitals asking more immediate questions, with more relevant and particular questions, like, “when you pressed the call button, was the response what you expected, better than you expected or worse than you expected?”. That’s how you get real answers about the care that’s being provided.</p> <p>Such questions, done frequently and disaggregated to ward-level where possible, give a management focus on what is happening in a hospital; and can be the basis of a much more informed and interactive relationship, with the population that is served by the hospital.</p> <p>I know there will be some, including in the medical profession, who regard this with alarm. They will imagine that patients’ wishes and wants are insatiable and unjustifiable; that their needs are susceptible only to the evidence-based judgement of clinicians.</p> <p>Well, I would just invite those who think this to take a look at the evidence. Engaged patients are more likely to manage self-care and more likely to be compliant with treatments. Informed patients, expressing choice, are less likely to seek unnecessary intensive and invasive treatments. Informed patients are more likely to have a good patient experience and a better outcome.</p> <p>With individual patients, doctors expect to listen to them, to understand their needs and expectations, they know that patients are the experts about themselves, that they have the greatest knowledge about their own experience, and that they have a right to informed choice. Why shouldn’t the NHS as a system do at least as much?</p> <p>Frankly this isn’t about money, it’s about raising standards and quality. As the Health Foundation said in a recent report, quality can save money. Because that’s where we need to be – a service which is being supported to meet rising demands. But one which must deliver continually improving quality. Actually the focus on quality and outcomes will enable us to deliver more from the resources we currently deploy. And as are supported by the taxpayer with a rising budget we must do more with what we already have.</p> <p>So we will empower patients and we will empower health professionals. That means we will have to disempower someone. And I think it might be me! I know that others know better about their care and are better placed to make certain decisions.</p> <p>So we will disempower the hierarchy, the bureaucracy, the Primary Care Trusts and the Strategic Health Authorities. I don’t want the whole of the NHS to wait to hear from me. I want it to listen to patients, and to take responsibility for action.</p> <p>Action to give patients and care-users more control, to exercise choice – from choice of GP to choice of treatment, all the way through to personal budgets.</p> <p>Action to empower patients collectively in thinking about what quality standards and commissioning guidelines should look like, as well as patients and the public locally, impacting on decisions about access and design of local services to meet local needs.</p> <p>Action to empower patients through access to information, from a plurality of information providers, with the ability to hold their own patient records, to interact more readily with their clinicians. To be able to use this new information ecology, to secure the quality of care and service we want as patients – and collectively, to drive an improvement in standards and outcomes.</p> <p>I began today by talking about my ambition: for health outcomes and healthcare services in this country to be as good as any in the world.</p> <p>I know it won’t happen by creating more process-driven targets, by demanding more data returns, by issuing more Department of Health circulars, pursuing more structural upheavals, increasing the number of administrators in PCTs, nor even just by supplying more money, important as resources are.</p> <p>I know these things either don’t work or even work against improving outcomes, despite the best efforts of NHS staff, because they have been the approach of the last Government over 13 years.</p> <p>Reform has stalled. Targets have trumped quality. On too many key areas our health outcomes lag behind our European neighbours.</p> <p>We need change. We need to set the service free to deliver high-quality care, based on evidence of what works. Accountable for results. Answerable to informed and engaged patients. Focussed on what matters most to those patients – safe, reliable, effective care. The best care for each patient and the best outcomes for all patients. </p> <p>That is my ambition, and I have been delighted today to be able to share it with you.</p> <p>Thank you.<br /></p> None Andrew Lansley CBE MP My ambition for patient-centred care Department of Health 2010-06-08
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_095830.jpg" alt="Sir David Nicholson, Chief Executive of the NHS in England" /> </div> <p class="introText">ACC Liverpool, Friday 25 June 2010</p> <p><strong>Sir David Nicholson, Chief Executive of the NHS in England</strong></p> <p>Thank you.  Right then, well it's great to be here.  I have to say I spent yesterday watching the Secretary of State and I was completely distracted by the words up there, so I'll try to be very careful not to say any words that might be construed as inappropriate.  The other thing I would say is that - just a slight apology for me.  I've got - you've heard of people who've got a cold, and you've heard of man flu, and I've got Chief Executive flu.  So, if you hear intonation in my voice it's because I am depressed or miserable about what's happening.  I genuinely am not.</p> <p>And one of the things I thought about the Secretary of State yesterday when he said that after a week I'd smiled - I know when you heard someone shout at the back "it was wind", but I'll leave you to make your own judgments about all of that.</p> <p>It's really fantastic to be here.  I think I need just to say something about Keith Pearson who did a fantastic job in the East of England, led a great turn around of that particular part of a system, who did huge amounts of work in relation to the Constitution, the real kind of beating heart of the NHS, and it's great to see him as chair of the Confederation.  I really do look forward to working with Keith over the next period.</p> <p>The last six weeks, in particular, have been extraordinary for us at the centre in particular.  The development of the Coalition Government, the work around that is completely different to anything that certainly I had seen before.  I have seen four different Secretary of States, three Prime Ministers now.  And nothing quite equipped me for what was going to happen when the Coalition came into being. We can see that in all sorts of things that are happening, not just in terms of the substance of what they're saying but also in terms of the way that they work. </p> <p>We have this extraordinary thing now where we have a programme for five years.  We've got a Government that's saying it's going to be there for five years and we have a very detailed programme for those five years. So it seems to me that's a fantastic thing for us in the NHS because one of the things we'  have constantly had to deal with, this real big issue, first about clarity, but also about consistency of purpose. And I think I can certainly see in the way the Coalition is working that you possibly we can get both of those things.</p> <p>It is not the same, I have to say, as having a one party in charge.  Our ministerial team has a Liberal Democrat as part of that membership.  They discuss openly the issues of concern between them in the Department and they are genuinely trying to work together in a way that genuinely surprised me. And I think we'll see this as we go through the next few years, the implication of all of that.</p> <p>Now, one of the things, though I think you saw yesterday and I guess those of you who have been following the work that Andrew Lansley has been doing over the last period, is that this is a really very, very significant and important set of changes that are being proposed at the moment for the NHS which will have a big implication over the next few years.  And just to kind of give you a flavour of that I think - I mean first of all Andrew has been in Opposition and been the Opposition spokesman for six and a half years. So he's been walking round talking to many of the people in this room over the last six and a half years.  I can't think of any Secretary of State who's ever come into a place where they've been in that position.</p> <p>But he's also a man in a hurry.  I think we have to understand that in terms of the way the Coalition is approaching all of this.  One of the criticism - or critiques if you like, of the change of government between Tory and Labour last time, was it took Labour about four or five years before it developed its fully formed ideas about the NHS and about the need for reform. And in a sense, the critique is that they lost four or five years during that period.  So, there is an absolute determination; we're going to make change, we're going to make it soon.  That's a great in lots of ways, an aspiration, and we can understand why people are in that place, but I think we need to understand that as we go forward.</p> <p>The other thing I think that I would say, certainly my experience over the last period, is that you do have to start changing the way you think in order to understand the direction that people want us to go, the Government want us to go in.  There is no doubt if you look at some of the big issues, and I'll talk about it in a little more detail later, the GP consortia for example, a natural response in these circumstances because we're the kind of people that we are, is to think OK so how is the governance going to work, how is the accounting officer arrangements going to work, how is all of that mechanics going to work?  And I think that's important stuff, but in a sense it misses the point.  It's what we need to be doing as leaders of the system is think: what are the opportunities available?  The sort of things that we've tried to do in the past and haven't been able to work, the way we want to change services for patients which for a variety of reasons we haven't been - what are the opportunities for that in the future?</p> <p>I have been going through that process myself over the last five or six weeks.  I've heard the ideas and I've been going back and working out, so how can I mitigate them?  How can I stop the worst excesses of them?  That won't get us the direction, it won't be able to provide us leadership in the system if we do that.  So, big change, big change. </p> <p>And what are the lessons from the past?  Well, I've been in the NHS a long time and I know many of you have and I read with interest Nigel's document on big change and I think the thing - well, two things I would say about it.  The first thing is that - and all the evidence shows this of course - is that 70 per cent of big change programmes don't work.  They fail.  A real possibility in these circumstances.  70 per cent don't work.  Of the 30 per cent that do work, what are the de fining characteristics?  Well, the defining characteristic is not the brilliance of the vision.  You can have the most fantastic and coherent vision available, but unless the management of change, unless the transition is properly led, you simply won't deliver it.  You can have poorly thought out visions, which actually deliver real change.  So, while the vision is critical and important, the transition is what will make the difference.  The transition is the thing that will make the difference between success and failure.  And who is going to lead that transition?  You are.  And that is the big test I think for us as we go forward.</p> <p>Big lessons from the past but the most important lesson from the past for me if I think about change I've been involved in is when we lose sight of the purpose, that's where it all goes wrong.  If we think about the problems we got ourselves into in 2004/2005, we got so obsessed and excited about the mechanisms and the mechanics of change, we lost sight of why we were there.  How do I know this?  Our staff told us, when we asked them, that's what was happening.  They thought the NHS was much more interested in a whole set of reforms than it was about delivering improvements of service for our patients. </p> <p>So, when we go through this change, how can we make that bridge between the past and the future?  Because that is the thing.  That is the transition.  That is the thing that is going to make the difference for us as we go forward.  And that bridge is very clearly absolutely fundamental to the work that we've done over the years and is reflected in High Quality Care for All.  If you look at that document, it is absolutely the bridge between the past and the future. </p> <p>What it sets out is that quality should be the organising principle of the NHS going forward and you get that through empowered clinicians and patients with clout.  That is the way you do it and that is absolutely central to the direction going forward that we need to keep hold of it.  It will make sense to us and it will make sense to our people if we concentrate our attention on that issue around purpose.</p> <p>Now, if you look at quality and outcomes, critical for us as we go forward, and we put a lot of effort over the last two years of improving quality of service for our patients, and we have a systematic approach to it. We've talked about the setting of quality standards, we've got quality accounts, we've talked about transparency in information, we've produced huge amounts of comparative clinical data about what people are doing, people have got into quality improvement in all sorts of significant ways.  We made great, great progress.  But, we need to move further and faster.  We need to mobilise the whole of our system to improve quality.  One of the things that we learned from that is that quality was systemic.  It wasn't just about the activities of one individual clinician with all of us supporting it.  It was about a whole system.  It was about getting your screening right; getting your early intervention right; getting the primary care right, getting multi-disciplinary teams in the right place; properly managing end of life care.  All of those things are absolutely critical and that is what we need to focus our attention on as we go forward into the new world, but we need to do it further and faster.</p> <p>It's no accident that next week we're going to be launching the very first quality standard, national quality standard on stroke services.  A real gold standard there for us to mobilise the system and our organisations and our people around to make real top quality services for people who suffer from a stroke in our society.  But, we need to move with it.</p> <p>On patients, if I'm sort of self critical about the work we did around High Quality Care for All, we said we wanted to give patients more clout. But when you look at the way in which we dealt with all of that, the effort we put into it as compared with items on quality, I don't think we really did consistently in an organised way - we got a set of very interesting policies, but when you put them altogether, I don't think they make a step change for patients. So, how can we go forward using choice, using transparency, using all of those activities?  How can we do that to really give patients clout?  A really important thing I think as we go forward.</p> <p>And, finally, the issue of clinical empowerment, empowering clinical staff.  Again, good work across the patch.  There are some practice based commissioning organisations which work really well, but it's not gone far enough and it's not consistent enough.  It's not an accident that we think that clinical service in primary care needs to take a greater role in the direction and moving of the NHS in the future.  GPs are amongst the most trusted people in our society.  Dare I say even more trusted than NHS managers and politicians.  And we need to understand that and work with it.  They also have a major effect on the way in which resources across the system are used.  Some of you may have heard the work that James Kingsland and his team have done which show that relatively small bits of change in primary care activity can have a massive cost impact on the service.  If each GP asks for one less blood test a week, referred one less patient to hospital a week, that would make half a billion pounds worth of difference to the cost in the system.  Now, I'm not suggesting that alone should be the reason why we should give them a greater role in the future of commissioning for the NHS, but it gives you a sense of the power that we could unleash if me could get that aligned with the improvement in quality of service for patients that we need.</p> <p>But, that just doesn't apply to primary care, of course.  It would be a real problem for us if we managed to engage and encourage and support and develop GP consortia, but in secondary care the response was bureaucratic; that actually you couldn't get primary and secondary care clinicians talking together to improve service; that in secondary care people had to go through bureaucratic arrangements to make things change.</p> <p>So it's just as much a challenge to secondary care and I know in secondary care, service line reporting, all of that really important, but I do think this issue about clinical engagement is not just an issue about primary care, it's also an issue about secondary care and we really do need to take that forward.</p> <p>So, can we make this change? Well, I think we can.  We've got a fantastic record of managing change in the NHS.  If you think about the last 15, 20 years, the way in which we've moved services, the way in which we've shaped organisations, the way we've transformed the way we deliver care for our patients.  We can do that. </p> <p>The question for me I think is whether - and the question for us all in this room - is whether we have got the will and whether we've got the energy to make it happen.</p> <p>From my point of view, what I would say to you is that I'm absolutely dedicated to the NHS.  I have worked in it for 32 years and I think what I will say to you is, first of all, I will always tell it to you absolutely straight.  I will not give you false assurances when they are not there, and I will do everything that I can to make sure that we have a set of systems and processes that underpin this big change, that treat people, our people, the people who have delivered so much for us over the last few years, with the amount of respect that they deserve.  It seems to me that's absolutely what I've got to do as Chief Executive of the NHS in this particular moment.</p> <p>And we've all got to look at these changes and I certainly have got to look at those changes in four kinds of ways.  First of all, can I use them to improve the quality of service for our patients?  Critical thing for us.  Can I use them to make sure that our patients can have a greater say in their care, can be more central to what we do?  Can I use them to make sure that clinicians and our staff are more empowered to make the changes that they need to make?  And finally for me, absolutely critical for me, are they consistent with a universal service free at the point of use?  But not a consumerist system, not one which deals with people as they arrive, but actually seeks people out who are in the most disadvantaged communities to make sure they get services wrapped around them.  It seems to me they're the important issues as we go forward in relation to these tests.</p> <p>In light of all of this, what should we all do as we go forward?  If we take first, all providers of care.  Clearly, the QIPP process is critical to this.  The QIPP challenge delivering quality and productivity over the next period is going to be absolutely critical and even the most optimistic people, and there are even some in this room, even the most optimistic people would not say that we'll get this new system up and running in the next couple of years or so.  It simply isn't going to be there.</p> <p>Even the best practice based commissioners at the moment, on a scale of one to 10 are about three or four in relation to the ability to be a GP consortia.  They're going to be able to help us and support us, but they're not actually going to be able to make that change.  We're going to have to make that change.</p> <p>People who work in providers now are going to have to make those, so QIPP is absolutely critical to keep our handle on all of that as we go forward.</p> <p>Those of you who are not yet FTs - whether it is community, mental health, ambulance or acute hospitals - get yourselves to become foundation trusts, and by going through that process, you'll have to do QIPP plans you'll have to do all of that. </p> <p>So, no excuse for not becoming a foundation trust. Even David Lawton in Wolverhampton will have to become a foundation trust in future.  Wolverhampton hospital has had a whole series of problem in the past. David has done a fantastic job turning it around.  It is, in fact, a year yesterday since they had their last case of MRSA in the hospital so a fantastic job you've done there David {applause}. Worth congratulating and recognising on all of that, so if you not a FT become one. </p> <p>If you are running community services, the purchaser provider split, we've got to do it end of March, make it happen, but that's not the big issue.  The big issue is how can community services be transformed for our patients to support the shift from secondary to primary care, to really get into intervention, early intervention, all of those things that me know will make the big change for our patients.</p> <p>And ambulance services.  Something for all of us, actually. One of the ways in which we will get success over the next few years is to reform and transform urgent care.  Ambulance service have a critical role to play in all of that.   And you need to focus your attention on working with the rest of the system to make it a reality.</p> <p>So, commissioners.  What's the message for commissioners as we go forward?  Well, the same in relation to quality innovation and productivity.  Very important that you get your plans together.  Start to build the new capacity for GP commissioners.  Get amongst them.  I've seen the results of the world-class commissioning stuff recently.  It's going to be published by PCTs sometimes towards the end of July.  It shows a remarkable improvement in our ability to commission.  We've built up huge amounts of skills and capacity in our system; some hugely talented people in our system.  We don't want to lose that.  We want to make sure we continue to improve our commissioning skills.  Now, sometimes they're not always recognised by the rest of the system.  Absolutely true.  That does not mean that they don't exist.  They do.  And getting amongst GPs, getting to understand the kinds of things we've learned over the last period about commissioning will be absolutely critical as we go forward, so make sure you get amongst them.  Make sure that the skills that you have as commissioners constantly improves.  Make sure that we don't take a step back on some really hard won and I say fantastic skills that people have got around the system.</p> <p>For leaders in general,  and all of us here, we have to get ourselves, our minds, inside the way the world will look in the future.  It's our responsibility to do that, to make sure that we can do that.  Now, while all this is going on we've still got - and the immediate effect of all of this is probably on about 100,000 people in the NHS when you look at all the people in PCTs, SHAs, departments, arms length bodies, general practice - about 100,000 people. Which still leaves 1.2 million, 1.3 million people out there delivering services for our patients.  Now, they need oxygen from us.  They need support and help from us.  They do not need us to look at our own navels and get worried about the future.  They need that oxygen that only we as leaders can provide them.</p> <p>And that's why it is so important this whole issue about behaviours.  And there are three things I'd say about those behaviours as we go forward.  The first thing is we need to avoid turning into commentators. We need to avoid that - I can perfectly understand it.  I've been there.  Sat in the terraces telling people what they think of what's happening.  There will always be a bit of that and I understand that's part of being an organisation but we need to be there actually making things happen and the faster we do that the more likely we are to get the results that we need.</p> <p>Secondly we can't afford to be inward looking, we - there lies real dangers for our patients and our system.  It is very - I can perfectly understand the attractiveness of being able to say well I'll look after my department or I will look after my organisation and the rest of them, well, that's up to them.  The idea of islands of success in a sea of failure for the NHS is not a place we can get ourselves into.</p> <p>Good leadership has always been about looking across boundaries, it has always been about that sort of thing, it has never been about standing behind your walls and defending yourself. And in this time of change it is inevitable that people will worry about that but we simply can't allow ourselves to do it. </p> <p>And the final thing about behaviours is, well, I think we've seen it in the World Cup, we've seen it in that we do not want to be the French football team of the NHS.  We don't want people to look back to us and say we turned into the French, though I have noticed one or two Anelkas around as I have been looking but we don't want to be in that place. </p> <p>We have to get hold of this and I know I've said to you on occasions before, looking out not up, focusing our attention on our communities and our patients, is where we'll get things absolutely, absolutely right.</p> <p>So, I think we can make these changes.  Have we got the will and the energy?  Well I think my will and my energy comes from the values I hold as a person who works in the NHS I am sure it does for you as well. And it seems to me this is the time for us who call ourselves leaders in these circumstances, this is the time that we've got to take up that particular challenge. Aned where it says on the tin, says leaders on the tin, that's what we have got to do now, we have got to lead.</p> <p>Conclusion</p> <p>I want to leave you with this with this thought. There are significant changes; there is no doubt about it. For many people in this room, and many colleagues that we've worked with for a considerable amount of time, over the next two or three years we are going to see that change unfold.  It is going to unfold in a different way to what it has done in the past.</p> <p>One of the issues about the past, whenever I think about Commissioning a Patient-Led NHS or Shifting the Balance of Power, with all of those things there was a certain a kind of something happened, then something else happened, then something else.  This is going to be a slightly different way of change happening, much more of a kind of chemical reaction of changes than a sort of set of levers and structures happening.</p> <p>So, in that environment that we're working in, I have obviously said that it is part of my responsibility to make sure that people are treated with respect and we support people through all of that.  But there are three things I would say about as we go forward in relation to that.</p> <p>The first one is focus our attention on purpose.  Lose that and we lose everything.  Make sure as we go through this change we concentrate on improving quality of service for our patients, making patients at the centre all what we do, and empowering and supporting our staff to make it happen. </p> <p>Secondly I think we need to be realistic.  There is a big management cost saving to be made; a significant management cost saving to be made.  I am not going to kid you that it's all going to be okay.  Its not.  Some people are going to lose their jobs during this time.  So we have to be realistic.  Do not give people false hope.</p> <p>But the third and final thing for me in relation to that is that we should have confidence because we have done great things before.  We have as a group made great change in the past.  And I am absolutely sure that we should use that confidence for the future.</p> <p>I will finish off by saying something that I know many people have heard me say before. When the British people are asked about their greatest achievements, they say the founding of the NHS was one of, if not the greatest achievement, that the British people have ever made.</p> <p>The NHS is not the plaything of individual in this room, it is not the plaything of managers, it is not the plaything of boards.  It's not even the plaything of politicians.  It is a very, very important thing for our people.</p> <p>And just to read the beginning of the Constitution, for me focuses us on the purpose.  Focuses on why we are here.</p> <p>It says:  'The NHS belongs to the people.  It is there to improve our health and well-being, supporting to us keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of are lives.  It works at the limits of science - bringing the highest levels of human knowledge and skill to save lives and improve health.  It touches our lives at times of basic human need, when care and compassion are what matters most.'</p> <p>It seems to me that is a fantastic aspiration and a fantastic purpose that we, as leaders of the NHS going forward ,need to keep very central over the next few years.  Thank you very much.<br /></p> None Sir David Nicholson Chief Executive of the NHS in England's speech to the NHS Confederation Department of Health 2010-06-25 speech to the NHS Confederation
<p>Thank you.  Now the eagle-eyed among you will have noticed that, despite what it may say on the website, I am not in fact Andrew Lansley.  Andrew sends his sincere apologies for not being able to be here, but Cabinet business keeps him away.</p> <p>I know that Andrew was particularly keen to be here to speak with you today, for the same reason that I was more than happy to take his place.  The annual Patient Safety Congress has quickly become the place to be if you are interested in improving patient safety and that is exactly what Andrew and I want most of all.</p> <p>Judging by the number of exhibitors and looking at the long list of speakers and workshops, it’s easy to see why this is the case.  There are so many people here, not only from England, but from around the world.  All with fresh ideas and new ways of thinking about patient safety.  All hungry to learn from each other the lessons of their experience. </p> <p><strong>Bottom-up, not top-down</strong></p> <p>And it is this enthusiasm for patient safety that I hope our plans to modernise the Health Service will promote.  Because no matter how hard we try, I just don’t think it is possible to mandate patient safety from Whitehall. </p> <p>While we will use legislation wherever we need to to create the best framework for patient safety, it needs an awful lot more than new laws to have any sort of lasting impact.  It needs a culture of safety to seep into every last corner of the NHS, and you can’t make that happen simply by declaring that it should.</p> <p>So what can we do from Whitehall?  Well I believe there is a great deal we can do.  Things that can start to make a real difference, that can start to encourage and support that culture of patient safety that we so badly need throughout the NHS.</p> <p>Just over 100 years ago, the US supreme court judge Louis Brandeis argued that ‘sunlight is the best disinfectant’ for any organisation acting in the public interest.  A century on, his words continue to resonate across all public services – especially within the National Health Service.  Openness and transparency acts like U.V light – irradiating poor practice and giving incompetence no place to hide. </p> <p>We need to be utterly transparent about exactly how well the NHS – how well each individual part of the NHS – is performing.</p> <p><strong>Outcomes</strong></p> <p>We need to change how we measure success in the NHS.  For what does it matter that you treat more people in a shorter period of time, if the quality of the care suffers and the outcomes aren’t up to scratch?  If a patient’s safety is put at risk?</p> <p>Too often we measure the success of the Health Service by the number of units it processes – as though it were some sort of assembly line producing widgets – not by how well it improves lives of individual people.</p> <p>From now on, I want all parts of the NHS to be judged on the clinical outcomes they achieve. </p> <p>In December, we published the Outcomes Framework to help clinicians all across the country to pull in the same direction.  From now on, we will judge the success of NHS providers based on whether they are:</p> <p>• Improving survival rates;<br />• improving the quality of life for people with chronic conditions;<br />• enhancing recovery after treatment;<br />• continually improving patients’ experience of their own healthcare;<br />• cutting the number of infections and maximising safety.</p> <p>On all of these points, NICE are developing quality standards that we can use to see how well providers are performing and we will publish the results for all the world to see. </p> <p>Not only at the provider level.  But for each department and even each consultant-led team.  If you provide NHS services, then you will be open to scrutiny by your clinical colleagues and by the public.</p> <p><strong>NRLS</strong></p> <p>This is not entirely new, of course.  The NPSA should be congratulated for the success of the National Reporting and Learning Service, which covers all adverse incidents.  The most comprehensive of its type anywhere in the world. </p> <p>And I can confirm that we will build upon its success with an investment of £3.7 million in this financial year for the system to be developed further.  Improving patient safety by making it easier to learn lessons and to improve care.</p> <p><strong>Never Events</strong></p> <p>We have also increased the number of ‘Never Events’ from eight to 25.  The things that under no circumstances should ever happen, things like wrong site surgery or the maladministration of Insulin.</p> <p>And should such an event occur, which I hope will be increasingly infrequent, commissioners will be able to withdraw payment for it and for any subsequent treatment needed as a result.  A powerful additional incentive for providers to avoid making such potentially fatal errors in the first place.</p> <p><strong>Transparency</strong></p> <p>I believe this will herald a new era of openness.  And I expect the results of transparency to be startling.  Just as they have been already for cardiac surgery.</p> <p>About a decade ago, cardiac surgeons, entirely independent of government, decided to measure the outcomes of their work and then, some 5 years ago, they took the important further step of publishing those results.  This was not an easy decision to take.  Standing underneath a spotlight can be a very difficult thing to do professionally.  But they took the risk and they have reaped the rewards.</p> <p>During those five years, they examined their performance and worked hard to improve it.  And improve it they certainly have.</p> <p>At the start, mortality rates were around the European average.  Since then, they have halved, taking them significantly below that average. </p> <p>That is a remarkable achievement in a relatively short space of time.  An incredible example of what clinical leadership can do.  And it is one that I want to see replicated across the whole of the NHS.</p> <p>Last month the National Cancer Intelligence Network published, for the first time, mortality rates 30 days following surgery for bowel cancer.  Across the country, the figure was 5.8%.  Not bad, perhaps.  But that national figure masked huge variation.  From just 1.7% at Central Manchester University Hospital to 15.6% at Burton Hospital in Staffordshire.</p> <p>Now this doesn’t automatically mean that care at one place is necessarily better or worse than elsewhere.  As you know, there will be all sorts of factors at play.  But it does give clinical teams pause for thought. </p> <p>To ask the questions:<br />• is there more that we can do? <br />• can we make our care safer? <br />• are there things the best performers are doing that we are not?</p> <p>And we can learn by knowing more about them</p> <p>This new era of openness and transparency will, I believe, have an huge impact on the safety culture within the NHS.  I want people to take great pride in their safety record.  This can only happen if everyone’s record is available for everyone to see.</p> <p><strong>Whistleblowing</strong></p> <p>One important step along the way will be to eradicate the culture of blame from within the NHS.  I want people to feel not only that they will not be unfairly blamed for speaking up, but that they will be encouraged and supported in doing so.</p> <p>Now this change may take some time to become universal.  Longer in some organisations than in others.  But I think we are designing the incentives in a way that means it will happen.</p> <p>For a start, we are strengthening the protection of whistleblowers.  Already, all NHS organisations must comply with the terms of the Public Interest Disclosure Act, but implementation is not always consistent. </p> <p>So we’ve issued guidance to all NHS organisations that their terms and conditions of employment must cover whistleblowing rights. </p> <p>We’ve worked with NHS trade unions to amend the terms and conditions of the service handbook to include a contractual right to raise concerns.</p> <p>And we’re looking at reinforcing the NHS Constitution to make clear staff and employer rights and responsibilities when it comes to whistleblowing.</p> <p>But giving protection to those who feel they cannot speak out publicly, or who feel their organisation just won’t listen, still implies that there is some way to go.  I look forward to a time when there is no need for people to ‘blow the whistle’ because the culture of openness and transparency is such that it is never necessary.</p> <p><strong>NHS Commissioning Board</strong></p> <p>If this is going to happen, then the responsibility for patient safety cannot remain at arms length to the Health Service.  It must be ingrained within it.</p> <p>That is why many of the responsibilities of the National Patient Safety Agency will move to the new NHS Commissioning Board.</p> <p>It will be for the Commissioning Board itself to decide on the best approach to embedding patient safety.  And it will do so based on the best clinical evidence available.</p> <p>In doing so, the Board will learn the lessons of tragedies such as what happened at Mid Staffs, where a culture of secrecy led to the death and poor treatment of far too many people. </p> <p>It will take heed of the current listening exercise and of an ongoing dialogue with the professions to make sure that it is always changing, always adapting as necessary to improve patient safety.  Never getting stuck in the past, doing what might have been best once, but is no longer the case. </p> <p>Flexibility will be vital to ensuring patient safety both now and long into the future.</p> <p><strong>Commissioning</strong></p> <p>With the Commissioning Board in the lead, the central importance of patient safety can be embedded throughout the NHS through clinical commissioning and the contracts agreed with all providers of NHS services.</p> <p>Soon, every contract within the NHS will demand specific attention to patient safety.  And every organisation will be held directly accountable for it, with their patient safety outcomes published for all to see. </p> <p>It will be in the direct interests of every provider, every commissioner, every individual operating within the NHS to place patient safety at the top of their list of priorities.</p> <p><strong>Clinical leadership</strong></p> <p>But it will also be their responsibility – your responsibility – to work out just how best to improve your own organisation’s safety record.  For while government will do all it can to put patient safety at the top of everyone’s list, as I said before, it’s not possible to mandate patient safety from Whitehall. </p> <p>That is where the other side of our plans for the modernisation of the Health Service come to the fore.  We want to remove the politics with a capital ‘P’ from the NHS.  To end the constant micro-management and interference from politicians like me, spurred on the that morning’s headlines and driven to endless centrally-imposed initiatives that do little more than drive you to distraction.</p> <p>No.  If patient safety is to really take off as we want it to, if clinical outcomes really are the most important thing, then the NHS must be genuinely clinically led.</p> <p><strong>Listening</strong></p> <p>That is why it is so important that we get the Health and Social Care Bill right.  Because this isn’t about another top-down reorganisation, whatever people might think. </p> <p>On the contrary, this is about putting a stop to the constant meddling from above by placing real power in your hands. </p> <p>You know your organisations and your patients far better than we ever could in Whitehall.  So it’s right that you are the ones in charge of doing whatever it takes to ensure patient safety.</p> <p>With all of this, we need to make sure that what we want to happen is the same as what actually happens.  We need to get the Bill right, we need to get modernisation right – and just as you are the ones who should lead the NHS in the future, it’s also you who are best placed to help us get this right today.</p> <p>So I urge all of you to go to one of the many listening events happening around the country or to make your views known directly through the Department of Health website. </p> <p>For the foundations we lay in the coming months will affect your daily lives for years to come. </p> <p><strong>Conclusion</strong></p> <p>But with clinical leadership, a genuine focus on outcomes and whole new level of transparency, I know we can change the NHS for the better.  I know we can create a new culture within the NHS.  A culture of openness, where errors are not hidden away, but discussed, learned from and shared. </p> <p>If we can only harness the determination and enthusiasm on show here at this Congress, then I am not only confident we can make a huge impact on patient safety.  I am certain of it.</p> <p>Thank you.<br /></p> None Simon Burns MP Patient Safety Congress'Delivering a safer NHS: Openness, Transparency &amp; Outcomes' Department of Health 2011-05-18
<p>Thank you [Dr John Heyworth, President, College of Emergency Medicine].</p> <p>We are all immensely proud of our NHS.  In many ways it already leads the world.  The esteemed Washington-based think tank, the Commonwealth Fund, recently rated the NHS as the best in the developed world when it comes to issues of access, equity and cost.</p> <p>All this is thanks to the incredible hard work and dedication of the many who make up the NHS.  That and, I will admit, the significant investment it has received in recent years.</p> <p>But while we perform well in some ways, in others we have real room for improvement.  In recent years funding for the NHS has risen more or less to the European average.  But there has not been a corresponding increase in outcomes. </p> <p>Survival rates for cervical, colo-rectal and breast cancer are among the worst in the OECD. <br />We are on the wrong side of the average for premature mortality from lung cancer, and heart and respiratory disease. </p> <p>And you’re more than twice as likely to die from a heart attack in the UK than in France. </p> <p>What has held us back has not been a lack of funds or a lack of skill and dedication from staff.  I believe what has held the NHS back from delivering to its potential is the system itself. </p> <p>The top-down system of management that starts from the office of the Secretary of State and flows downward through various layers of bureaucracy to the front line.  This approach has been propagated by parties of all colours throughout the history of the NHS.</p> <p>It is a system that tells people what to do rather than encouraging and supporting them to do the best they can.  A system that stifles innovation and free thinking in order to achieve particular targets mandated from above. </p> <p>Targets that are often as much about getting good headlines as they are about improving care.</p> <p>I believe we need to take a more nuanced and sophisticated view.  We need an approach that moves beyond process and instead makes a wider assessment of the quality of outcomes received by individual patients. </p> <p>We, and by that I mean people like me in the Department of Health, should not be micro-managing the day-to-day work of the Health Service, constantly telling you how to do your jobs.  We should instead do more to give you the support you need to excel.</p> <p>Emergency care has, in recent years, received its fare share of investment.  This investment has produced a large number of well equipped Accident and Emergency Departments and has seen the 4-hour waiting time standard met in almost every case across the country.</p> <p>But while this has undeniably produced results, can we honestly say that it has produced the right results?  For while time is, of course, an important factor in emergency care, it is far from the only one. </p> <p>And as well as not being the best way of improving care for patients, neither are unjustified process targets necessarily good for clinicians – undermining their clinical judgement and adding unnecessarily to already high stress levels.</p> <p>But the NHS is changing.  Emergency medicine is changing.  We have already amended the threshold for the 4-hour waiting time standard to give clinicians more flexibility.  We will soon shift the focus from a single measure of time to a wider measure of the of the treatment that patients receive and the outcomes that those treatments achieve.</p> <p>This is an opportunity for clinicians to really focus on providing the best care they possibly can. </p> <p>The indicators – developed by senior clinicians [including John Hayworth] – operate as a set and are both a broader and more sophisticated assessment of clinically relevant care than the old one-shot target. </p> <p>I hope they will promote discussion and debate.  These indicators are not, after all, etched in stone, but open to annual review as evidence allows us to improve their effectiveness. </p> <p>I hope they will also enable real improvements in quality.  Improvements that will be led from the front line and made on continual basis.  Not just piling on the pressure from above. </p> <p>This is an exciting time to be working in emergency medicine.  There are real opportunities for clinicians to influence the way emergency care is provided and to bring about real improvements. </p> <p>Advances in technology and medical practice means that clinicians now conduct a far greater number of investigations, and a greater level of care, prior to admission. </p> <p>They are also more able to safely discharge people for community care or self care. </p> <p>So yes, emergency care is changing.  And it needs to change.  One of the main drivers of improvements in the NHS has been significant annual increases in the budget.  While we are protecting the NHS budget, increasing it every year, because of the realities of the current economic climate, the increases will not be like those in recent years. </p> <p>This is why it is so vitally important that we improve the productivity of the NHS, releasing money, every penny of which can be ploughed back into front line care.</p> <p>Across the Health Service we need to unleash the talent and creativity of staff to improve outcomes for patients and to improve the cost effectiveness of care. </p> <p>The two cannot be separated or seen in isolation.  This is not simply an exercise in saving money, nor is it about throwing cash at a problem.  We must – and we can – deliver cost effective services while at the same time improving the quality of care.</p> <p>One area where we can improve a patient’s experience of the Health Service, improving the care they receive whilst also reducing costs is through a focus on Ambulatory care. <br />On treating people with urgent or emergency care needs in a way that avoids admission to hospital.</p> <p>Ambulatory care is to emergency care what day surgery is to elective care. </p> <p>• It is clinically safe,<br />• It provides a good experience of care for patients,<br />• it reduces pressure on hospitals,<br />• it makes the best use of scarce resources, and<br />• it provides better value for money for taxpayers.</p> <p>It’s also nothing new.  It’s already widely practiced by paediatricians, and by doctors and nurses in Emergency Departments and acute medical units. </p> <p>So this isn’t about a new initiative, it about implementing tried and tested good practice, making the existing pockets of excellence the norm across the Health Service.</p> <p>That in itself is a big job.  While some level of variation can be expected across the country because of local populations, it is clear that not all areas are making the most effective use of ambulatory emergency care.</p> <p>The NHS Institute estimate that as many as one in six patients who are currently admitted as emergencies could avoid admission if they were managed on ambulatory care pathways.  Saving the NHS as much as £250 million a year.</p> <p>The NHS Institute’s Directory of Ambulatory Emergency Care for Adults outlines forty-nine conditions that can be safely managed without overnight stays.  I would encourage all of you to use the Directory to assess the potential to reduce emergency overnight stays.</p> <p>Ambulatory Emergency Care is one of the A&amp;amp;E quality indicators.  While cellulitis and DVT are highlighted in the implementation guide, I’m sure you will want to go further, adopting the majority of the pathways outlined in the Directory and developing still more that are important to you locally.</p> <p>You all have a great deal to offer and a great deal you can learn from each other.  One of the most valuable changes with this and many other areas of care will be clear and transparent bench-marking of performance data.  You will all be able to clearly see how you are performing in relation to your peers and be free to work together to drive up standards in your own areas.</p> <p>Although there is no tariff for ambulatory emergency care, I see no reason why innovative Trusts cannot work with commissioners to agree the best way to fairly remunerate ambulatory activity.  Such an arrangement could benefit all concerned, the patient most of all.</p> <p>Delivering effective ambulatory emergency care is not easy.  It requires different parts of the NHS to work together, focusing on the patient journey.  It requires innovation and, most of all, it requires leadership.  But it’s a real opportunity for you to improve the care of your patients.</p> <p>I’m really pleased to open a conference that offers practical support for the NHS from some leading experts in the field.  This is what we will see more and more of in the future.  Services being driven by clinical leaders, focussed not on targets that please only Ministers, but on outcomes that improve care for patients. </p> <p>Emergency care can be a difficult choice as a career.  But as challenging as it is, it is equally rewarding and varied. </p> <p>I hope that with the changes we are making –</p> <p>by giving clinicians more freedom to shape services...</p> <p>by ending the constant micro-management from above and...</p> <p>by shifting the focus on improving clinical outcomes for patients, one of the benefits will also be to make it a more attractive field for the next generation of emergency care professionals.</p> <p>So I would like to thank NHS London and the NHS Emergency Care Intensive Support Team for organising this conference and for all of their work to improve urgent and emergency care in this country.  I am sure you will have an interesting and stimulating day.  And I hope you will be left enthused and inspired to transform emergency care in your own communities.</p> <p>Thank you.<br /></p> None Simon Burns MP NHS Ambulatory Emergency Care Conference Department of Health 2011-01-19
<p>Thank you Paul (Paul Assinder HFMA President &amp;amp; Director of Finance, Dudley Group of Hospitals NHSFT)</p> <p>I am delighted to be here to help celebrate 60 years of the Healthcare Financial Management Association. </p> <p>Starting out in 1950, just 2 years after the creation of the National Health Service, the founding members of the then-named Association of Chief Financial Officers understood the vital importance of sound financial management to the success of the new NHS. </p> <p>Through six decades you and other members have upheld the highest standards of probity, efficiency and sound accounting. When people think of the NHS, they tend to think first of doctors and nurses.  It’s only natural I suppose, as these are the people they meet when they visit their loved ones in hospital, or if they need NHS services themselves. </p> <p>But clinicians are not the only ones the NHS relies upon to deliver high quality care.  If an army marches on its stomach, then the NHS depends on strong financial management to survive.  Decisions about finance aren’t some sort of peripheral add-on, they are clinical decisions in their own right.</p> <p>This is because the opportunity cost of the decisions you make means the difference between offering one service or another.  Providing services this way or that way.  Most of all, the proper management of finite resources often is the difference between delivering a service, and not delivering it at all.</p> <p>And what a difference you have made in recent years!</p> <p>Five years ago the NHS was, quite frankly, in a mess financially.  It was running an overall deficit of around £0.5 billion, with 179 separate NHS organisations running a deficit.  But due to your determined efforts, you have turned that around.  Today only a small number of organisations are in the red – and they all have recovery plans in place – and the NHS is currently running a net surplus of around £1.5 billion.</p> <p>This really is an incredible success story.  2 years ago, the surplus was around £1.7 billion.  £200 million of the surplus has been subsequently used for front line spending.  The remaining surplus will give Primary Care Trusts the financial flexibility they need as they go through the transition to the new devolved NHS.</p> <p>So one of my main messages for today is a simple one – thank you.  Thank you and well done for such impressive work.  And all at a time when you were having to produce annual financial accounts faster and in a different form to meet tougher and improved standards and requirements.</p> <p>Your work has laid a strong foundation for the challenges that lie ahead.  And the challenges are considerable.</p> <p>First, there is the obvious financial challenge.  You know the situation.  Despite the government’s commitment to NHS funding, the costs of care will rise far faster.  Our growing and ageing population, expensive new drugs and treatments and the increasing expectations of the public all place NHS budgets under incredible pressure.  Not to mention the shock of an end to annual funding increases of around 6% that we’ve seen in recent years.</p> <p>Through the QIPP programme, we need to make efficiency savings of up to £20 billion.  While achievable, this will be far from easy.  And without your continued help and dedication, it will be impossible. </p> <p>The QIPP programme must be a marriage between better clinical and better financial management.</p> <p>You have already demonstrated how well you work with clinicians by engaging them for costing and budgeting. In addition, the HFMA has set out in their recent joint statement with the Academy of Medical Royal Colleges and the NHS Confederation, the importance of engaging with clinicians to deliver high quality and cost effective care.</p> <p>These working relationships will become ever more important in the years ahead.</p> <p>The second main challenge will to implement the government’s reforms to the NHS in England. </p> <p>Einstein put it perfectly when he said that the definition of insanity was doing the same thing over and over again and expecting different results.  We cannot continue to do things as we are now.  To cope with rising demand and tighter budgets, the NHS must change, and change significantly.</p> <p>We set out how we intend to do this in our White Paper – Equity and Excellence: Liberating the NHS.  At its heart is a wholesale devolution of power away from people like me in Westminster and civil servants in Whitehall and down to the front line of care to local NHS organisations and to patients themselves. </p> <p>We will give patients control, we will give GPs and their colleagues the ability to design and pay for local services and we will free any willing provider of healthcare to fulfil its potential.</p> <p><strong>Patient choice</strong></p> <p>First, patients.  If patients are given control over their own care, then they can have a real impact on its quality.  People will have the genuine ability to choose when, where and by whom they are treated. </p> <p>The response to this idea is often to say that people don’t want choice, that what they want is for their local hospital to provide excellent care.  Even if that were true, and there is considerable evidence to the contrary, in reality it is not always the case.</p> <p>People are not fools.  If they see that one hospital is better than another, or that their local hospital actually provides a poor standard of care, they will vote with their feet.  And making such a choice will soon become a habit.  Change can take some time to get used to.  But once it is accepted, people soon forget what things were like before. </p> <p><strong>GP Commissioning</strong></p> <p>Of course, patients will make these choices jointly with their GP.  GPs and their colleagues across primary, secondary and community care, will play a far greater role in the design and management of local services as GP Consortia replace Primary Care Trusts. </p> <p>Professional responsibility must go hand in hand with responsibility for resources.  If healthcare professionals do not feel the impact of wasteful, unnecessary or excessively expensive care, it will be impossible to deliver quality efficiently.  We need to reconcile clinical decision making with resources.  We will do this through GP commissioning.</p> <p>But the move to GP Consortia will not turn GPs into managers or accountants.  More than ever before, they will need the continuing support, knowledge and expertise of excellent financial managers. </p> <p><strong>Providers</strong></p> <p>On the provider side, the delivery of healthcare will no longer be restricted to traditional NHS organisations.  We will allow any willing provider to enter the market and compete to provide patients with outcomes among the best in the world. </p> <p>Soon all NHS Trusts must become, or become a part of an independent NHS Foundation Trust.  As long as they meet basic standards of quality and financial probity, they will be free to run their services as they see fit.  And they will compete on as level a playing field as possible with other providers.</p> <p>We want to create the largest, most vibrant social enterprise sector in the world, with providers free to innovate in the pursuit of ever better care for patients.</p> <p>Subject to consultation, we propose to abolish the cap on the amount of private income that Foundation Trusts can raise themselves.  This is about using the entrepreneurial spirit of Foundation Trusts to generate new sources of income that will benefit NHS patients. </p> <p>The core legal purpose of a Foundation Trust will always be to provide high quality services to NHS patients.  This will not change.  But we want to free Foundation Trusts to pursue commercial opportunities that will ultimately result in better care for NHS patients.</p> <p>Similarly, we propose to abolish their limits on borrowing.  Foundation Trusts need to be treated like adults and trusted to manage their own finances. </p> <p>We also propose to make it easier for Foundation Trusts to merge without having to obtain permission from Monitor, the Department of Health or the Secretary of State.  Where this leads to better patient care and better value for money for the tax payer, it is surely ludicrous that bureaucratic rules should get in the way.</p> <p><strong>Incentives</strong></p> <p>Patient choice, GP commissioning and providers need the freedom to compete.  This is the body of reform, but its meat will be information and its drink will be money – the two great incentives that will drive the NHS forward.</p> <p>If people are to choose, they will need high quality, easily accessible information with which to make that choice.  We want the information revolution that has done so much to transform business and personal relationships in recent years to have a similar impact on the NHS.  We will publish more and more data in an easy to understand, unbiased and comparable way so that people can choose where to go.</p> <p>Publishing data will also have a powerful impact on clinicians. The ablility to compare their performance with their peers, professional pride will drive people to ever greater effort.  The fruits of this approach can already be seen in cardiac surgery.</p> <p>According to a study by the European Association for Cardio-thoracic Surgery published last month, patients undergoing heart surgery in England have a greater chance of survival than in almost any other European country.  In the past 5 years, death rates in England have halved and are now 25% lower than the European average. </p> <p>This is not down to a government target.  But the direct result of the collection, analysis and publication of outcome data by cardiac professionals. </p> <p>A new culture of increased transparency will mean a big cultural change for the NHS, but one that I hope will be welcomed.</p> <p>The other big incentive will be money.  The choices that people make, the improvements in quality that clinicians can bring will be rewarded financially.  Poor quality care, and poor safety records, will be penalised.  The incentive to constantly improve will be plain for all to see.</p> <p>But to deal with this new transparency, with the mechanisms of competition and with rewards for improving outcomes, a solid foundation of financial management is imperative. </p> <p>Do not think for one moment that there will not be a place for high quality financial managers in the new NHS.  Your role will be more important, more fundamental to the success of local health services than ever in your sixty year history.</p> <p>Whether you work in a hospital, a community care organisation, a GP Consortium or anywhere else, sound financial management of the highest order will be pivotal.</p> <p>And as clinical and resource decisions will be more closely linked, your experience in educating and training those of a non-financial background will also be vital.  The HFMA’s popular e-learning suite has already done so much to bring the classroom to people’s desktops.  It will continue to be a valued service as more non-financial people need to take on a degree of responsibility for financial decision making.</p> <p><strong>Conclusion</strong></p> <p>Soon, Primary Care Trusts will start to devolve more powers to shadow GP Consortia before eventually closing.  In their place will be an incredibly diverse, innovative and dynamic market for healthcare.  Tight financial control and robust new accounting systems will be essential every step of the way.</p> <p>I know the future may appear uncertain.  Change always brings with it a degree of insecurity.  But I hope you will soon look upon the changes we are making with excitement and enthusiasm.  The role of highly competent financial managers will only become more important as we move to the new NHS.</p> <p>The organisation you work in may well change.  But the importance of your role to the future success of the NHS will always stay the same.</p> None Simon Burns MP Healthcare Financial Management Association Department of Health 2010-12-09
<p class="introText"><br /></p> <p><strong>Introduction</strong></p> <p>Thank you, Margaret [Dangoor, President, Patient Safety Section, Royal Society of Medicine]. </p> <p>Nothing any of us do at any time is wholly without risk.  From the moment we get out of bed in the morning to the moment we fall back into it at night, we are constantly calculating, mitigating and managing risk, consciously or not.  And beyond making sure we don’t get hit by a bus on the way to work, we – and in particular, you – all manage risk in our professional lives too.<br /> <br />The ever-more effective management of that risk is vital to the future of the Health Service. </p> <p>This government has one overriding goal for the NHS – for it to produce outcomes that are among the best in the world.  Simple to say – hard to deliver – impossible without an absolute commitment to patient safety.</p> <p>To achieve it, we need to learn.  We need to be open to the experiences and lessons of others, from within the NHS and far beyond it, from the UK and around the world.  For there is nothing, I repeat, nothing that is as important as ensuring patient safety.  When other objectives conflict with safety, safety must be the priority.</p> <p>The National Health Service is an organisation of staggering complexity and size.  It employs the talents of well over one million people who see, treat and care for one million others every 36 hours.  It is just not possible for every single procedure, every single intervention for every single patient to go precisely as planned. </p> <p>There is not a system in the world that has managed to eliminate risk.  It is impossible because of the innate fallibility of human beings.  But if we cannot eliminate those risks, we must do everything we can to minimise them.  And when something does go wrong, we must learn from it and prevent it from happening again.  The question is how best to do this?<br />The events at Mid Staffordshire Hospital are a pertinent reminder.  Events which led to poor quality care going unnoticed, unreported and unacted upon – where sadly, an inexcusable attitude toward patient safety contributed to the tragic deaths of too many patients.</p> <p><strong>The traditional NHS culture</strong></p> <p>Whatever the specific reasons why things went so badly wrong at Mid Staffordshire, I believe there is a wider issue about the way in which the NHS is run that undermines patient safety.</p> <p>From its birth, more than 60 years ago, the NHS has been managed very much from the top-down.  In recent years, this has been magnified by a seemingly endless stream of process driven targets that, however well meaning, have created a system focussed on process and not on people – a system that can undermine a doctor’s own professional judgement, forcing them to put ticking boxes over and above doing what they knows is right.</p> <p>There is always a temptation to react to something going wrong with an extra set of rules and regulations.  In any specific instance, this is perfectly sensible.  But over time, as these rules build up, they can act a barrier to patient safety rather than its guarantor.</p> <p><strong>Never Events</strong></p> <p>There are, of course, certain things that should never happen to a patient in NHS care.  Things we should never tolerate.  We are currently looking at expanding the list of these lines in the sand, so-called “never events” – incidents such as wrong site surgery or the transfusion of the wrong blood type – from 8 to around 22. </p> <p>If such a ‘never event’ happens, it is a clear indication that something has gone very wrong.  Not only in the specific circumstances of the incident, but that the wider systems and procedures in place within the organisation are inadequate.</p> <p><strong>A new way</strong></p> <p>If our goal is outcomes among the best in the world...</p> <p>If we demand the highest levels of patient safety...</p> <p>Can we achieve this only by continuing to add to the rule book and by expanding still further the bureaucracy that polices it? </p> <p>Or should we take a different approach?</p> <p>One that places more value on personal responsibility, transparency and accountability? </p> <p>One that focuses on the clinical evidence of what works, here and around the world?<br />I believe we can only achieve the highest levels of safety and quality by liberating doctors, surgeons and other healthcare professionals to do their jobs to the best of their ability and make them accountable for the outcomes of their care. </p> <p>By creating a culture of openness that places patient safety above all other things. </p> <p>By trusting that people can do a better job than “the system” ever could. </p> <p>Let me give you two examples.  One, the result of the general rules based approach.  Another the result of placing our trust in openness, evidence and the professionalism of the people of the NHS.</p> <p>Two reports were published last month.  One, the Dr Foster Hospital Guide, argued that although there have been improvements overall, there were still high levels of “adverse medical events” combined with the widespread under-reporting of such incidents and too many hospitals with death-rates higher than one would expect. </p> <p>Contrast this to another report released last month.  According to a study by the European Association for Cardiothoracic Surgery, patients undergoing heart surgery in England have a greater chance of survival than in almost any other European country.  In the past 5 years, death rates have halved and are now 25% lower than the European average. </p> <p>This quite stunning improvement was not down to a government target.  It was the direct result of the collection, analysis and publication of outcome data by cardiac professionals.  It was their idea, their lead and it is they who should be lauded for the results.</p> <p>If you take responsibility for patient safety out of the hands of professionals – from people – and place our trust instead in rules and regulations – in pieces of paper – then we run the very real risk of undermining patient safety.</p> <p>This government’s approach is to trust the professionals, to empower people and to insist on a culture of openness and transparency to drive improvement.</p> <p><strong>Whistle Blowing</strong></p> <p>Now, transparency is not easy.  Especially when things aren’t as they should be.  It can be difficult to speak out when you see bad practice.  Too often, it is easier to just keep your head down and hope that the problem will go away.  It almost never does. </p> <p>Probably the biggest reason why people feel so nervous about coming forward is their perception that if they do they’ll be persecuted for it.  A culture of blame is a poisonous thing.  And it is incompatible with a desire to learn from mistakes and to deliver better patient care.</p> <p>Staff should feel comfortable voicing concerns and know that they will be taken seriously. </p> <p>We want to amend the NHS Constitution to highlight enshrine these whistle blowing rights for staff, to expect them to act on any suspicions and to commit employers to support staff who raise concerns. </p> <p>Negotiating with the unions, we want to amend the terms and conditions of service for NHS staff to include a contractual right to raise concerns in the public interest.</p> <p>We are issuing unequivocal guidance to NHS organisations that all of their contracts should cover staff whistleblowing rights.</p> <p>And we will issue new guidance to the NHS to help them support those who raise concerns.</p> <p>I want to do away with any remaining culture of fear, bullying and secrecy, and to do so as quickly as possible. </p> <p><strong>Surgical checklist</strong></p> <p>Hand in hand with openness must go a commitment to implementing what the evidence shows us improves clinical safety.  One excellent example, and one that you will all be familiar with, is the World Health Organisation’s “surgical safety checklist”.</p> <p>The WHO estimates that every year, around half a million people die needlessly on the operating table.  Their surgical checklist, inspired by the aviation industry – a sort of pre-, during- and post-flight check – has now been implemented in all NHS organisations. </p> <p>A recent study in the Netherlands demonstrated how the same list there has reduced deaths by almost half and complications by more than a third.</p> <p>Now some may take umbrage at being made to make such basic checks, but I believe the BMJ had it right when they said the following in an editorial last year.</p> <p>It said, “Try asking your neighbour – ‘If we were going to operate on you, would it be a good idea to take a few minutes to ensure all the operating theatre team knows the plan and we have the correct equipment? – the answer is predictable.”</p> <p><strong>European Working Time Directive</strong></p> <p>A recent survey of NHS Trusts in England by the Royal College of Surgeons of England highlighted the impact of the Working Time Directive on the NHS.  They estimate that NHS Trusts in England spent more than three quarters of a billion pounds last year on locums.  That’s almost double what was spent three years ago.</p> <p>We are committed to reduce the amount of money we spend on agency and locum staff.  None of us want to return to the bad old days of doctors too tired to work safely, but we need to be flexible. </p> <p>People should be able to choose the hours they work.  The Coalition Agreement commits the government to limiting the application of the Working Time Directive.  People already have the right to opt-out of the agreement and work up to a maximum of 56 hours a week if they so wish.  We will support anyone who wants to exercise this right.</p> <p>At the same time, we are taking the Working Time Directive back to the EU.  We want to keep people’s right to opt-out of the agreement but also give ourselves, not least in health, the flexibility we currently lack.</p> <p><strong>Reform and Finance</strong></p> <p>But it’s not only safety that we wish to place in the hands of professionals.  In July, we outlined our plans to reform the NHS in England.  In the coming years, there will be a wholesale devolution of power from Westminster to the front line of healthcare.  For those who may be unfamiliar with these plans, allow me to set out the main points.</p> <p>First, we will hand responsibility for the design and commissioning of local health services to GP Consortia, working with their colleagues across primary, community and secondary care. </p> <p>Second, all hospitals and NHS organisations must achieve “Foundation Trust” status, giving them the freedom and responsibility to organise themselves as best they can, free from the shackles of central government. </p> <p>Third, we will create the largest and most vibrant social market in the world by allowing any willing provider to compete to provide patients with the very highest levels of care.</p> <p>And fourth, we will give power directly to patients to choose their GP and – with the support of their doctor – the choice of where, when, how and by whom they are treated. </p> <p>Patients will become an active participant in their own care, not just a passive recipient of it. </p> <p>To make all of this happen, we will spark an information revolution.  We will publish as much data as we can in a way that is accessible and easy to understand.  Not only will this give patients the information they need to make informed choices, it will tell health professionals how they are doing in relation to their peers – as cardiac surgeons have done – and it will give all sorts of organisations the ability to study and scrutinise the day to day performance of every part of the NHS. </p> <p>These reforms will place the Health Service in England under a more brilliant and disinfecting spotlight than ever in its history.  And they will place patient safety as the single most important aspect of every decision made within the NHS.</p> <p><strong>Why now is the right time</strong></p> <p>One thing that that will be obvious to you all is the economic backdrop to any NHS reforms wherever you happen to be in the United Kingdom.  Above all else, this government is determined to restore order to our public finances.  Despite our commitment to continued, significant investment in the NHS, we will still need to find massive efficiency savings – up to £20 billion – from within the NHS budget to continue to meet demand.</p> <p>£20 billion pounds of savings, every single penny of which will be ploughed back into NHS front line services.</p> <p>Some say that, with these financial pressures, now is not the time to embark on a programme of significant reform.  That to seek huge savings at the same time as changing the way we run NHS will create real and unnecessary risks to patient safety. </p> <p>But if we do not reform, meeting the financial challenge will be impossible. </p> <p>If we do not reform, doctors will continue to work with one hand tied behind their back. </p> <p>If we do not reform and replace politically-driven process targets with the pursuit of improved outcomes, patient safety will suffer.<br />I believe that you are far more capable of improving patient safety than any number of pieces of paper from Whitehall telling you how to do your job. </p> <p>It is not the people of the NHS who are at fault, it is the system.  And the only way to really improve patient safety, is to reform that system and to put our trust in the professionals.</p> <p>Thank you.<br /></p> None Simon Burns MP Reducing Errors in the Operating Team”Wednesday 8 December Department of Health 2010-12-08 speech at the Royal College of Surgeons of Edinburgh
<p class="introText">Simon Burns speaks at the NHS Medical Directors conference</p> <p><strong>Introduction</strong></p> <p>The Health Service is one of this Coalition Government’s highest priorities  That’s why, despite the difficult decisions taken that have seen significant reductions in budgets across Whitehall, we are honouring our commitment to increase spending on the NHS in real terms in every year of this Parliament. </p> <p>But protecting the budget is not the only significant thing we are doing.  Our aging and growing population, the ever higher costs of new drugs and new treatments, and a public that always, and quite rightly, expects the very best mean that the rising costs of healthcare will outstrip its growing budget. <br />Inefficiency must be rooted out.  Productivity must surge.  We must squeeze the most out of every penny we invest.  And in return, every penny that we save with be ploughed back into the Health Service to improve patient care.</p> <p>You understand better than most that effective management of budgets is not a distant abstract problem, solely the reserve of accountants and managers.  Decisions over the use of resources are clinical decisions. </p> <p>They affect patient care as sure as a doctor’s choice of which drug to prescribe.  It will be crucial to have strong, effective financial and clinical management as we transform the NHS from the ground up.</p> <p>I’m sure you’ve heard Einstein’s definition of insanity – “doing the same thing over and over again and expecting different results”.  We need different results. </p> <p>We need better results and we need to get those better results within ever tighter budgets.  Reform isn’t an option.  It’s a necessity.</p> <p>And we will reform the NHS as we will reform other public services, by stepping back and handing power to patients and to you. </p> <p>Go back as long as you like and the trend in government has been to centralise. </p> <p>• To gradually, almost imperceptibly, undermine local democratically elected councils by pulling ever more power to Westminster. </p> <p>• To undermine professionals in all areas of public life by tying them up in ever longer strips of red tape, drowning them in bureaucracy until it is hard to see for piles of paper. </p> <p>• To undermine individual people by taking away their freedoms, clocking their every move and treating them like children rather than adults.</p> <p>Governments of all colours have been guilty of this.  Although I might say the previous government was perhaps more adept than most.  The result is a central government with more power than almost any democratic country in the world.</p> <p>With local authorities, the professions and individuals so disempowered, it is understandable that many have also become increasingly cynical and disengaged from the political process.</p> <p>So across the public services, we are determined to reverse this trend.  We’re going to give power back.<br /> <br />• Back to local authorities so they can exercise their democratic mandate. </p> <p>• Back to individuals to they can enjoy their lives free from unnecessary intrusion from the State. </p> <p>• And back to professionals who, to be frank, tend to know more about their own area of expertise than any number of Ministers in Westminster and civil servants in Whitehall ever could.  This is a radical localist vision that is turning Whitehall on its head. </p> <p>Now, for many this isn’t a comfortable idea.  And when the only way you think you can improve something is by grasping it ever tighter like some overbearing parent, it’s easy to see why.  But I have more confidence in people than that.  Far from everything collapsing in a heap, I believe we will see an era of unprecedented creativity and excellence within the public services, despite the far more challenging financial backdrop.</p> <p>This is especially true within the Health Service, where the innate professionalism and expertise that exists within the NHS could see it scale new heights – within an environment of robust, economic- and quality-based regulation, the more freedom we devolve to patients, to GPs, to providers – to you – the better patient care will be.</p> <p><strong>Operating Framework</strong></p> <p>Even before we present the NHS Bill to Parliament, we’re already pressing ahead.  This year’s revised Operating Framework saw an end to the performance management of the 18 Week target and we’ve changed the A&amp;amp;E waiting time threshold to a more clinically relevant 95%. </p> <p>And next year we’ll go further.  We’re reviewing all current indicators and if they are not clinically relevant, if they are not about improving health outcomes, then we’ll ditch them too. </p> <p>We will end this pointless and wasteful obsession with process-based targets and focus on what patients really care about – health outcomes. </p> <p><strong>Other White Paper reforms</strong></p> <p>The NHS White Paper – Equity and Excellence: Liberating the NHS – sets out other ways we will shift power downwards.  We will abolish Strategic Health Authorities and Primary Care Trusts, saving hundreds of millions of pounds every year. </p> <p>Instead, we will hand power for commissioning to general practice through the new GP consortia, a partnership lead by GPs but encompassing professionals from across primary, secondary, community and social care and working closely with patients and councils.</p> <p>So far, most of the talk about the White Paper has focused on GP Commissioning.  On how commissioning will be re-drawn with a new, clearer clinical focus. </p> <p>But GP Commissioning is not uniquely radical.  Across the whole of the NHS, our reforms are about a new partnership between patients and clinicians, between clinicians and managers, between the NHS and other local services.  Jointly leading for excellence.</p> <p>Patients and their GPs will be able to choose from any willing provider. </p> <p>Money will follow the patient. </p> <p>And because of patient choice it will flow to the very best providers.   </p> <p>We will free providers from central control.  Freeing them to organise themselves to the best of their abilities.  Competing with others to provide the very best outcomes for patients.</p> <p>And as a recent report from Bristol University - Reform, Competition and Patient Outcomes in the National Health Service –concluded, “the effect of competition is to save lives without raising costs”.</p> <p>The challenge for Chief Executives, will be to lead their organisations in a spirit of openness and collaboration. </p> <p>The challenge for senior healthcare professionals will be to stand up and be counted, to put their heads above the parapet and take decisions jointly with management to improve the services they offer.</p> <p>The reward for meeting these challenges will be a more vibrant, dynamic and entrepreneurial NHS.</p> <p>What does all this mean in practical terms?  Well, for those who are willing to embrace it, it means a genuine opportunity to deliver clinical excellence and to be rewarded for it. </p> <p>The public aren’t fools.  If they can see for themselves, or if their GP shows them, how one hospital will give them a far better standard of care than another, even if it’s further away, most people will go for the best care.  And if a hospital garners a reputation for poor quality care, patients will avoid it.  To pretend otherwise, I think, does patients a disservice.</p> <p>So money will follow the patient to the best providers.  And the best hospitals, the best departments, the best consultants will be free to invest that money in even better services, or to expand them across the region or even across the country.  And the hospitals that fair less well will have a strong incentive to examine what they might do to improve their performance.</p> <p>The State will no longer stand in the way of spreading excellence.  Instead we will do everything we can to encourage it.  An example of how we are already starting to do this is through the new NHS Atlas of Variation, which we’re launching today.</p> <p>This tool, essentially a series of maps, shows unexplained variations in activity, spend, safety and outcomes across the country. <br />So if doctors in one hospital are spending more on stroke care than those in another, but only achieving similar or worse results, then perhaps there is something they can learn from the other’s experience. </p> <p>Of course, the media will react in horror and cry “postcode lottery” from the rooftops.  But if we can get past that and simply be open and honest about how the NHS is performing, by encouraging a culture of transparency in all things and by working together to learn and improve, there is incredible potential to transform the Health Service.</p> <p>As medical directors from across the NHS, I hope you can see the enormous potential of the White Paper reforms.  This is not about what government wants to achieve so much as what you want to achieve. <br />We will set the environment, one of strong clinical and economic regulation based around quality standards, but after that, to be frank, it’s pretty much down to you. </p> <p>What do you want the NHS to be like? <br />How do you want your hospital, your community service, your GP consortium to operate? </p> <p>What are the things that you always wanted to change but were prevented from doing by the heavy hand of central control? </p> <p>Now is your opportunity to act. </p> <p>To stand up and take control. </p> <p>To work with managers, with GP consortia and healthcare professionals from across the NHS, with local authorities and others to really make a difference to your organisations and, most importantly, to your new, most important partners – your patients.</p> <p><strong>Conclusion</strong></p> <p>So what will the NHS look like in 10 years time?  This is a question that people often ask politicians.  But it should not be for politicians to decide.  The Health Service is not a machine to be engineered.  It is organic.  It is made up of over a million people, each with ideas about how the NHS can be better.  The best possible future for the Health Service will come only if we can harness those ideas, that passion, that creativity.</p> <p>But if you ask me what the NHS will be like in 10 years time?  That I can answer.  It will be dynamic, innovative and responsive.  It will place the needs of patients first, every step of the way.  It will be led by professionals and democratically accountable to local people.  And it will, I believe, offer people outcomes among the best in the world.</p> <p>These are exciting times for the NHS.  I believe we stand on the cusp of a new era of high quality healthcare in this country.  But for this to happen we need to get these reforms right.  And for that, we need your help.  While we have set the destination, we need you to help lead us there. </p> <p>Alone, government doesn’t have the answers.  But by working closely together, and by trusting each other, I believe that we can overcome anything in our path.<br /></p> None Simon Burns MP NHS Medical Directors Conference Department of Health 2010-11-25
<p>Thank you Chris [Ham, CEO King’s Fund]. </p> <p>We are rightly proud of the Health Service in this country.  I was lucky enough to be in Washington last week, at the annual gathering of the Commonwealth Fund.  Every year, this august institution compares the healthcare systems of developed nations around the world.  And in many ways, the UK came out very well.</p> <p>In terms of access, equity and cost, the NHS generally performs better than others.  If you get sick in the UK, you don’t face the fear of being unable to pay potentially vast medical bills as you might elsewhere.  You can see a doctor reasonably quickly.  And if you get seriously ill, people in Britain are confident that they will get the care they need.</p> <p>So should we just sit back and congratulate ourselves on a job well done?  I don’t think that would be wise.</p> <p>While we do well when it comes to equity, we do not combine that with consistent levels of excellence.   </p> <p>• In Britain, you are twice as likely to die from a heart attack than our cousins are across the Channel in France.<br /></p> <p>• Survival rates for cervical, colorectal and breast cancer are amongst the worst in the OECD. And,</p> <p>• When it comes to premature death from respiratory disease, we compare poorly to the leading European countries.</p> <p>And think of the poor individual who gets sick, particularly if they need both hospital treatment and social care.  There may only be one person in need of help, but the organisations they need to deal with are multiple.  Each with their own forms to fill, staff to meet, assessments to make, plans to draft and procedures to follow.  And you’re having to deal with all of this while you’re ill.  When all you want is to be is to be left alone and let others take care of everything for you. </p> <p>And think of the taxpayer.  We all know the financial context is challenging and that we need to be as efficient as possible with the resources at our disposal, so is this really the best way of doing things?</p> <p>I hope that, by being here today, and having spent the whole day discussing integrated working, you will agree that it is not.</p> <p>Think for a moment of the benefits of truly joined up services.  Where GPs and other healthcare professionals, social care providers and the various parts of the local council all come together to provide seamless services.  Where, as far as the patient is concerned, the lines drawn between these organisations fade to nothing. </p> <p>Proper integrated working will produce better outcomes for patients and a far better return for the taxpayer. </p> <p>We all know this.  To give them their due, the previous government knew this too.  It’s all very well to talk about integrating services, we’ve been doing so for years, but it doesn’t happen by talking about it.  Organisational culture, professional boundaries and everyone’s personal and professional boxes – so hard to break out of – all act to block the path of progress.</p> <p><strong>Patient Power</strong></p> <p>So what can we do to break this model and really get things moving?  I think we can do it in a number of ways, but essentially we need to push power to – or as near as possible to – the one person who is common throughout – the patient and the service user.</p> <p>Our White Paper, Equity and Excellence: Liberating the NHS, puts the patient in the driving seat and places everything else in the NHS and beyond in a position to support this fundamental shift in gravity.</p> <p>There are really two aspects to patient power – giving them control over their own care and giving them the information and the tools to exercise that control.</p> <p>Patients will be able to choose their GP and, with their doctor, their hospital or NHS provider, their consultant team, even their treatment where this is appropriate.  And because the money will follow the patient, their choice really matters. </p> <p>But you cannot choose unless you have options to choose from.  This is one of the main reasons for opening out the delivery of NHS services to any willing provider.  The other being the power of competition to drive up quality whilst at the same time lowering prices.</p> <p>And because it is impossible to make an informed choice between providers unless you know what it is you’re getting, we will start an information revolution. </p> <p>We will make unprecedented amounts of data available for all to see – patients and their representatives, professionals and the public – in a clear and easily comparable way. </p> <p>But in a way, even this is a job half done.  A real impetus for change will come as we hand financial control to the patient.  Last week, we published our vision for social care.  A central pillar of which is the roll out of personal budgets and making it possible to combine social care budgets with personal health budgets.</p> <p>Think of Jane.  She has Huntington’s and is cared for at home by her husband.  He uses her personal social care budget to employ a Personal Assistant during the day to support his wife. </p> <p>When Jane’s condition deteriorates and she needs 24-hour NHS care, thanks to the Personal Health Budget pilot programme, was able to employ the same Personal Assistant and also pay for additional over-night care.  Continuity of care is ensured and as no agency fees are paid, saving money.</p> <p>Personal budgets will give people real control over the way their money – and it is their money – is spent, giving them real choice.</p> <p>The pilots will continue to run until 2012 and I very much encourage you to join in. </p> <p>But before then, by designing services around the individual, we want system to break free of cosy organisational silos and unite. </p> <p>Patients need health and social care, councils and their partners to come together, integrating services not around systems and processes, but around individuals and outcomes. </p> <p>And it will be those organisations that do this, that improve outcomes the most, that make the patient’s or service-user’s experience as simple as possible and that operate most efficiently, that will prosper. </p> <p><strong>GPs</strong></p> <p>Throughout, patients will have the support of their GP.  A GP who will be an integral part not only of their personal care but of designing local health services based on the latest evidence of what works and with clear responsibility for the costs of those services.</p> <p>But this is not a case of the GPs getting together to decide unilaterally what services should look like.  In fact, the opposite is true.</p> <p>GPs are perfectly positioned to coordinate services for their patient.  Why?  There are 300 million reasons.  That’s 300 million appointments every year, seeing every conceivable type of patient with every conceivable ailment. </p> <p>GPs take a broad view of care, working with others across primary, community and secondary care to manage, treat and refer their patient. </p> <p>They are ideally positioned to take precisely the same approach when designing services in collaboration with all appropriate people within and, importantly, beyond the NHS, including with patients themselves.  All coming together to design flexible, integrated services built around the needs of the individual.</p> <p>Already, early adopting GP Consortia Pathfinders are coming together to take increasing levels of responsibility from Primary Care Trusts.  From the outset, they are working in partnership with their colleagues in social care and local councils.  These relationships are not a nice add on – good practice, but not essential to the real business of healthcare.  They are the core of good GP-led commissioning. </p> <p>And we already have the experiences of the Integrated Care Pilots to draw on.  These demonstrate the incredible levels of innovation that are possible when people are brought together and encouraged to solve problems as a team for the benefit of an individual. </p> <p>For example, in Wakefield, a pilot on substance misuse has developed close relationships with Job Centre Plus and the criminal justice system, allowing a far more holistic approach to the service user.</p> <p>And whether in a Pathfinder, a Pilot or not, clinicians everywhere will need to start working with their local councils as they start to develop Consortia.</p> <p>And Primary Care Trusts will need to work with local authorities to develop their QIPP and reform plans.</p> <p>We said in the White Paper that councils will play a strategic role, promoting the integration of health and adult social care, children's services and the wider local authority agenda, bringing a whole new level of democratic accountability to local services.</p> <p>The consultation asks how we can best do this – possibly councils and GP consortia working together in Health and Wellbeing Boards in local authorities.  We’re still looking at this, although we hope to publish our response shortly.</p> <p>And while they will be phased out, Primary Care Trusts have a vital role to play in the transition to the new system.  I ask all PCTs to start working now with GPs and councils, if they are not already:</p> <p>• to support local authorities to adopt their new, strengthened strategic role in relation to health and social care,<br />• to put in place solid succession plans,<br />• to ensure that knowledge is shared, and<br />• to transfer existing pooled budgets and joint commissioning arrangements.</p> <p>Another thing that will spur greater integrated working is shared funding.  When this government was elected to office, we knew that, with the steps we need to take to reduce the deficit, local government funding for social care would come under pressure.</p> <p>With rising demand for social care services from an aging population, we knew that we would have to act to prevent a deterioration in services and an increase in emergency admissions to the NHS.</p> <p>This is why the NHS will set aside funding, rising to £1bn in 2014-15, to support social care.</p> <p>This will fund social care services that specifically benefit health, and improve health outcomes for individuals.  Things like re-ablement services, which can help people regain their confidence and independence following discharge from hospital.  We’re doing this because we understand that the NHS does not stand alone.  The NHS is simply one part of a larger care system in this country. </p> <p>And there will also be an additional £1bn by 2014/15 going through local government to support social care services.</p> <p>This means, as long as we get the efficiency savings we know are possible, there will be enough funding available both to protect people’s access to services and deliver new approaches to improve quality and outcomes.</p> <p>Today the King’s Fund have published their report on integrated care.  I welcome this report.  Particularly because it agrees that, "There is no inherent contradiction between choice and competition, on the one hand, and integration on the other; both should be encouraged."</p> <p>This is exactly right.  To give a practical example, GP consortia could design and negotiate long-term contracts, integrating the range of services needed for a population with multiple, complex needs – such as for those approaching the end of life.  Or the care and support of frail older people. </p> <p>They can then contract with one or more lead providers, placing the responsibility for co-ordinating the different services and resources required  where it belongs – with the provider.  Such contracts can give individuals choice either between the main contract providers, or more likely, through their sub-contractors – providing choice of different treatments settings and staff.  The East of England is currently developing a model based on these lines.</p> <p>And on the provider side, new, innovative social enterprises will be well-placed to integrate services.  Forging new partnerships with NHS providers, local authorities and voluntary organisations.  The Right to Request Social Partnership in Hull, City Health Care Partnership, is already actively building these new relationships across health and social care and far beyond.</p> <p><strong>Conclusion</strong></p> <p>While the financial context is challenging, this is an exciting time for the NHS.  We have an opportunity to reverse the decades long trend of centralising power.  Bringing new life to communities, professionals and individuals by empowering them to act in their own best interests.</p> <p>As I said at the beginning, the NHS has an admiral record when it comes to equity and access.  But that alone is not enough.  Our goal is to achieve health outcomes that are among the best in the world.  To have equity and excellence.  And the only way we will achieve this is by placing our trust in patients, service users and those who actually deliver the care we so want to improve.  Not just in the NHS, but across all those who provide care and support for the individual.</p> <p>Integrated working, centred around not only the needs, but the wants and the preferences of the individual patient, will go a very long way to achieving this goal.</p> <p>Thank you.<br /></p> None Simon Burns MP The King's Fund Annual Conference Department of Health 2010-11-23
<p>Thank you Ed [Sturton].</p> <p>Over the years, many Ministers will have stood before you and waxed lyrical about the incredible job you do, how valued you are and how proud we are of the job you do day in and day out for patients and the public.  They meant every word, as do I.  You do do an incredible job.  You are valued, more than I can say.  And I am extremely proud.</p> <p>But, as they say, talk is cheap.  It is not good enough to say how amazing we think you are one moment only to undermine your professional judgement the next.  Or to talk about the wonderful job you do only to tie your hands with red tape.</p> <p>The current system of centrally-driven process targets, of layer upon layer of bureaucracy, of a blizzard of diktats flowing from Westminster and Whitehall telling managers how to do their jobs won’t work any more.</p> <p>In health, everything that this new government does, everything we want to achieve, every policy and White Paper we publish is based around a simple principle – trust.</p> <p>This government trusts the people of the NHS.  We trust doctors, nurses and other healthcare professionals to know their patients better than we do.  We trust clinicians and managers to know what excellent healthcare looks like and to know what gets in its way better than we do.  And we trust you and your colleagues to lead the NHS into a new era of patient choice, of local accountability, and of health outcomes comparable to the best in the world. </p> <p>The NHS White Paper – Equity and Excellence: Liberating the NHS – is about putting that trust into action.  And I’m pleased that its principles have been welcomed by the NHS Confederation.  It is about making “the system” reflect and support the essential human relationships that exist within the Health Service.  Not to act as a barrier, but as a conduit. </p> <p>We believe that decisions should be taken as close to those affected as possible.  Across government, this is leading to a fundamental re-think of how we conduct business.  Of the powers of local authorities and local communities over local resources.  Of the right of individuals to shape their own lives, free from central control.</p> <p>The same is true in the NHS.  The White Paper signals a radical shift of gravity within the Health Service – from top-down to bottom-up. </p> <p>The NHS has been in a constant state of flux for a decade.  Of course, the next few years will see yet more change.  But this will be change led by you.  Change that you and your colleagues, working closely with GPs and patients, deem to be most beneficial to your organisation, your employees and your patients.  The only thing top-down about the White Paper is a unilateral decision to give power away, to put you, to put patients, to put local communities in charge. </p> <p>We want a new era of partnership between patients and their doctors, taking decisions about care together.  To make this possible, we will provide patients with unprecedented amounts of comparable, easy to understand data about the quality of care available across NHS organisations.  And more than access, we will give patients control over their own records.  To see them, share them and add to them.</p> <p>Consortia of GPs, working with their clinical colleagues across primary, secondary and community care, with local authorities and their local communities, will plan and commission clinically led health services as they see fit.  Not as people like me tell them to.</p> <p>All NHS Trusts will become Foundation Trusts – free to decide how they want to run their own services; free to manage their own finances; free to become as good as they can possibly be. </p> <p>And we will open the provision of care to any willing provider of it.  To social enterprises, to groups of NHS staff that wish to form a social enterprise, to independent organisations.  All competing on quality to provide patients with ever improving outcomes. </p> <p>Because the results will be there for all to see – for professionals as well as patients; because the money really will follow the patient; and because the whole system of payment and incentives will be geared towards the single unifying goal of achieving health outcomes that are among the best in the world.  Because of all of this, I believe we will see a confident, rejuvenated Health Service.  A Health Service that is led from the front, not smothered from on high. </p> <p>This is a time of real change for the NHS.  But combined with new freedom comes tight restrictions on spending as the massive year-on-year increases in the health budget come to an end. </p> <p>This year, before we spend a single penny on health, on education, on defense or on anything else, we will pay £43 billion simply to service the interest on our debts.  That’s about £120 million a day.  Or over £80,000 every single minute. </p> <p>This is wasted money and it makes so angry that we cannot spend it on better education for our children or better infrastructure for our economy or even put some of it back into your pocket.</p> <p>The colossal debts wracked up by the previous government are crippling this country.  If we are to get back on track, we need to act now and act decisively.</p> <p>This government’s priority is to turn the country’s finances around.  By the end of this Parliament, our national debt will be falling instead of rising as a proportion of national income.  To achieve this, difficult decisions have had to be taken.  More lie ahead.  But the end result will be a strong economy, more jobs and sustainable public services. </p> <p>And this is not our only priority.  Every bit as important as reducing the deficit is protecting and improving the nation’s health.  So while public spending will fall in almost every other area, the NHS budget stands protected.  More than that, it will receive small, real terms increases in every year of this Parliament. </p> <p>Yet with a growing and aging population, new drugs, new technologies and the ever-increasing expectations of the British people, the NHS budget will still be stretched like never before.  We will need to make huge efficiency savings of up to £20 billion.</p> <p>One major way we will meet this challenge is the QIPP programme – Quality, Innovation, Productivity, Prevention.  It’s a two-pronged attack – to drive out inefficiencies from the system and improve the way the NHS delivers services. </p> <p>This is about working smarter.  It’s about doing the right things, in the right place, in the right way, at the right time.  Innovating to improve patient care and constantly striving for ways to make the system more efficient. </p> <p>It’s about creating an atmosphere of openness and transparency.  An atmosphere within which people feel able to come forward with any concerns about patient safety.  Probably the biggest reason why people feel so nervous about coming forward is their perception that if they do they’ll be persecuted for it.  A culture of blame is a poisonous thing.  And it is incompatible with a desire to learn from mistakes and to deliver better patient care.</p> <p>Staff should feel comfortable voicing concerns and know that they will be taken seriously.  We want to amend the NHS Constitution to enshrine these whistle blowing rights for staff, to expect them to act on any suspicions and to commit employers to supporting staff who raise concerns. </p> <p>It is also about the workforce.  Changing how we plan, train, reward, support and engage with staff throughout the NHS to deliver services.  Equipping and supporting NHS staff to become more flexible to meet the complex and diverse patient needs.  Recognising and realising people’s potential to innovate and improve services for their patients.</p> <p>I am pleased to announce today a further £10 million to support the NHS Apprenticeship programme.  Apprenticeships are about getting real ‘on the job’ experience and qualifications while making a genuine contribution to the NHS. </p> <p>The NHS, Skills for Health and NHS Employers are working together to promote a highly skilled and flexible workforce, with apprenticeships a vital part of improving the quality of healthcare for patients.</p> <p>It may come as a surprise to some, though I hope not to all, that I recognise that there are things the previous government did for the Health Service that should be commended.  Over the past decade, the way the Health Service rewards, recognises and supports NHS staff has improved.  Pay and conditions have been made fairer, significant workforce contracts have been changed in partnership with the professions and there have been unprecedented investments in education and training.</p> <p>Today, the NHS employs almost a third more people than it did ten years ago.  Now, most of these people work on the front line of healthcare.  Doctors, nurses and other allied health professionals.  But the number of administrative and managerial staff also rose significantly.  Of course, no large organisation can operate efficiently and effectively without talented, highly skilled management.  They are and always will be essential.  But the fact is that as staff numbers have grown, productivity has fallen.  Workforce is now the biggest single investment within the NHS and we must make sure the taxpayer is getting value for money.</p> <p>Over the course of this Parliament, we will reduce management costs by over 45%.  But this isn’t only about saving money, it’s about improving services within a very tight financial settlement.  You can’t do that simply by wielding the axe.  You do that by fundamentally redesigning the way you do things.</p> <p>As we get rid of top-down central control, so we will dismantle the apparatus of central control.  Over the next few years, Primary Care Trusts and Strategic Health Authorities will be phased out.  This will save the NHS hundreds of millions of pounds to reinvest into front-line care. </p> <p>Because people want more services closer to home, we’re working with clinicians to redesign care pathways, to prevent unnecessary hospital admissions and to discharge patients from hospital earlier.  Improving patient experience and reducing the number of staff and beds needed in hospitals.</p> <p>Over time, this will inevitably mean that more staff will work in Primary or Community Care settings, with fewer working in acute hospitals.  The precise impact is unclear and will depend on the decisions made by local GP Commissioners working with their colleagues across secondary and community care. </p> <p>Our shared aim with staff and unions is to retain and re-train staff wherever possible.</p> <p>But some people will lose their jobs, particularly those now in PCTs and SHAs.  Losing a job can be an incredibly difficult and frightening experience.  This isn’t about statistics, it’s about real people.  Real people with bills to pay and families to care for.  While this is not a reason not to act, it is a reason to act with sensitivity.  We need to do all we can, in government and in the organisations affected, to support people who find themselves in this position. </p> <p>We are working with trade unions through the Social Partnership Forum and with staff to keep the need for compulsory redundancies to a minimum.  We’ve recently introduced a National Voluntary Severance Scheme and we’re developing an HR Framework to support staff who are displaced giving them preferential access to vacancies and support with retraining and redeployment. </p> <p>It cannot be over-stressed how vitally important you will be to making the transition to the new system work.  Dealing with staff in a fair and transparent way and improving outcomes while operating within far more constrained budgets. </p> <p>Every one of us here is committed to the values and ideals of the National Health Service.  High quality care for all, free at the point of need.  And my colleague Claire Chapman will say more about these in a moment. </p> <p>As difficult as the years ahead may be, we should always keep at the front of our minds the concrete certainty that what we are doing is for the benefit of the patients we serve. </p> <p>That every penny saved, is a penny reinvested in front line care;</p> <p>is a penny spent on new cancer drugs we couldn’t otherwise afford; </p> <p>On better public health where once this would have been the first budget to be cut. </p> <p>On higher quality, integrated, patient centred, outcome focussed health services led by you.</p> <p>Thank you.</p> None Simon Burns MP NHS Employers Department of Health 2010-11-23
<p>The way we collect, interpret, share and use data affects almost every aspect of our lives.  From the moment we wake each morning, practically everything we see, hear, touch, taste and smell has been produced, manufactured, bar-coded, shipped, tracked, monitored and sold to us all thanks to the efficient use of various forms of information.</p> <p>It is this creative use of data and technology that enables great global companies to function with speed and efficiency and individual sole traders to run businesses that would once have taken a small army. </p> <p>But of course, access to vast amounts of information is no longer restricted to the realm of business.  Since that rather brilliant little thing called the internet exploded on the scene just 20 years ago, every single person in the world can, potentially, access more information than they could ever hope to use in a thousand lifetimes.  There are now 2.7 billion Google searches every single month.</p> <p>This has changed us.  As ever more information is placed now quite literally in the palm of our hands, we have the potential to become ever more empowered citizens.  Not only can we look at product reviews on Amazon or find out what’s on at our local cinema. </p> <p>We can know what is going on anywhere in the world literally as it happens.  We can learn and understand our rights in a confusing world.  And we can know what our political leaders are doing in order to hold them to account. </p> <p>But access to information was just the start.  Fairly recently, the flow of information has changed.  We can now can join in.  The proliferation of sites like YouTube, Twitter and Wordpress have made information sharing just as important as information receiving.  Yes, there is a huge amount of drivel, idiocy and plain wrong-headedness online, but there are incredible things too. </p> <p>Sites like Twitter and YouTube have helped people in countries like Iran and Burma to exercise their rights to free assembly and free expression.  During last year’s Iranian elections, Twitter was used to help organise peaceful protests.</p> <p>And here in the UK, a 15 year old boy, Rhys Morgan, has led a campaign against a so-called ‘miracle cure’ for Crohn’s Disease – literally an industrial bleach – that has not only seen online retailers in the UK shut down by Trading Standards but has led the World Health Organisation to send out an international alert to instruct authorities everywhere to follow suit.  All this from his bedroom in Wales.</p> <p>But, again, there is more.  People and businesses were quick to see the potential to do more than just share information.  You can buy and sell.  You can compare and choose.  You can manage and organise an increasingly large part of your life online.  And once we make the change, it’s surprising how quickly we forget what life was like before. </p> <p>In just a few short years, we have gone from queuing up to see the bank manager to managing our finances online.  Rather than face the last minute crush, many of us will do our Christmas shopping from the comfort of our own homes.  And where we once used paper tickets to travel around London, now millions of people carry the convenience of an oyster card in their pocket.</p> <p>In each case, we hand our personal information over to someone we cannot see, that we do not know, and yet we decide we can trust.  We judge that what we get in return – a better deal, more choice or greater convenience – is worth it.</p> <p>There really is an information revolution.  But while successful businesses and individual people around the world embrace it, there in one sector that has so far failed to properly join in and reap the benefits...</p> <p>Government. </p> <p>This is perhaps surprising considering the vast amount of data we collect and hold. </p> <p>Yet in so many instances, the information we collect in one place is incompatible with that stored in another.  Incredible insights made by one organisation fail to make it through to others.  And far more often than not, information is seen as an instrument for those on the inside to manage services, not as an enabling tool for those on the outside receiving them.  We are missing a very big trick.</p> <p><strong>Our Vision</strong></p> <p>In June, we published our White Paper, Equity and Excellence: liberating the NHS.  At it’s heart is a single aim – to achieve health outcomes that are among the best in the world.  We intend to achieve this with a simple, powerful idea - trust. </p> <p>We will strip out the unnecessary bureaucracy and process-driven targets that stifle the NHS and stop it from achieving its full potential.  Instead we will hand power over to NHS staff and to patients themselves to create a locally-led, clinically driven health service.</p> <p>When the NHS first came into being, over 60 years ago, this would have been impossible.  But with the information revolution, it is not only possible, it is essential.<br /> <br />Last month we launched our consultation on our information strategy, An Information Revolution.  It is about transforming the way we access, control and use information in the NHS and adult social care services.</p> <p>Information will be vital to driving better health, better care, better outcomes and greater efficiency.  It’s an essential part of our vision for “putting patients first”, giving people more choice, greater control and more shared decision-making between individuals and their care professionals.  If we give people the right information, in a way they can easily understand and use, they can take more responsibility for their own health and social care. </p> <p>Information technology is key to this.  We should be able to communicate with health and care professionals on-line, making care more convenient.  We should be able to get our test results digitally. </p> <p>We should look to maximise the potential of remote monitoring – making more use of telehealth and telecare – so we can deliver more effective care, more efficiently. </p> <p>We now even have the ability to imbed a chip within a patient to regularly monitor their condition, immediately alerting them and their doctor if something goes wrong.  Leaving them be if everything is OK.  No need for regular check-ups.  You see your doctor only as and when.</p> <p>Importantly, patients should have far greater control of their own information.  We should all be able to see it and change it if we see errors in our medical records – making our care safer. </p> <p>We should be able to share in decision making with health and care professionals – there really should be “no decision about me, without me”. </p> <p>But control is more than access.  It’s more than being allowed to see what others have written about us.  Control is about deciding what happens to that information.  If we really control our own information, then we can choose to share it.  What if Cancer Research, instead of asking people to donate money, asked people to donate their data?  Would you do that?  I think a lot of people would. </p> <p>If we really control our own record, then we can add to it.  We can include our end of life or crisis plans, we can add any specific requirements we may have – wheelchair access or a vegetarian menu. <br />If we really control, it goes beyond a mere record in a file.  It becomes a tool in our hands.</p> <p>We also need to give more information to health and care professionals about the quality and efficiency of services.  We need to give them a clear picture of what else is out there, what other professionals are doing and the results they are achieving.  The sort of information that they can use to make their own services better and achieve our aim of health outcomes among the best in the world. </p> <p>None of this will happen without your help.  I know that there is a huge amount expertise and imagination out there.  The Health Service needs your knowledge and your ideas. </p> <p>What works?  What doesn’t work?  What ideas have gone before and what we can do better?  We can’t continue to take small steps.  It’s time for a giant leap.</p> <p>But to do this, we face a number of challenges.</p> <p><strong>Information for everyone</strong></p> <p>First is making sure that this revolution benefits everyone.  I spoke at the beginning of the incredible exponential growth and impact of the internet.  Well, 10 million people in the UK have never used it.  We need to ensure the benefits reach everyone, including those 10 million.  It is a vision of greater openness, transparency and choice for everyone.  Not just for those with broadband and a laptop.</p> <p>Often even when we have the information we need it is hard to understand and interpret.  We can be more innovative in the way we present information.  We need to tailor it to meet individual needs, for example for children or the elderly, for those with disabilities or hard to reach groups.  To make an analogy, we need to go from 1980s mobile the size of a brick to an iPhone – easy, intuitive, practical. </p> <p><strong>3rd Parties</strong></p> <p>And we need to move away from the idea that it will be mainly the Government providing information on the quality of services.  Instead, we need a broad range of organisations able to offer it to a variety of audiences.  This requires greater openness. </p> <p>All NHS and adult social care organisations should offer the public and third parties the greatest possible access to the information they hold as soon as possible.  This includes the Health and Social Care Information Centre, which will collect and publish national data. </p> <p>The mass of anonymised data held by the NHS is an incredibly rich resource that could be far better mined if it were available to all. </p> <p>Publishing quickly will also enable greater public scrutiny and the scrutiny of a broad range of organisations interpreting and presenting the information in different ways for different audiences - even if the raw information isn’t completely polished. </p> <p>As of July, we already do this with infection data – updating infection rates by hospital for MRSA and c. dificile every week and placing it online for all to see.  This will be another driver of change.  For while this sort of information will enable informed personal choice, it will also lead to greater public scrutiny of health and social care, which will in turn lead to better services.</p> <p><strong>Trust</strong></p> <p>But while we will go to great lengths to publish aggregate data, the personal health information of individuals must be protected.  People should have access to their own information but the NHS and other organisations holding that information should keep it safe. </p> <p>The appalling memory of government databases lost in the post are still fresh in the mind and we will need to go to great lengths to reassure the public that their records are safe.  It is essential that we earn and keep the public’s trust. </p> <p>People also need to have confidence in the information provided by intermediaries.  We need to make it easy for new organisations, particularly smaller ones, to enter the market whilst ensuring that people can easily identify accurate, high quality information.  We’re consulting on this and are looking to work with interested parties to explore how we can ensure public trust in what they produce. </p> <p>We’re looking at things like voluntary accreditation schemes or industry-owned standards of good practice.  And because we don’t want to reinvent the wheel, we’ll also draw on existing models to ensure quality in information by making use of international standards.</p> <p><strong>Structured Data</strong></p> <p>As well as trusted sources, people need information that will genuinely lead to better outcomes.  We’re undertaking a fundamental review of NHS and adult social care data returns, with a public consultation next year.  This will help us to work out whether we are capturing the right sort of information.  This isn’t about collecting more data.  We don’t want to collect anything unless it is genuinely necessary and improves services. </p> <p>Our starting point is the data we already collect and seeing how we can use it more effectively.  Discarding what is redundant, adding only where there is real value.</p> <p>There is so much data already in the system.  This isn’t the problem.  The problem is being able to take full advantage of it.  To do this, it needs to be properly structured. </p> <p>Imagine buying an airline ticket to New York.  You find the best deal, book your seat on a particular flight and check in, all online.  You’ll then print off your boarding pass or even have it on your phone.  But this data is not only the concern of the airline with whom you’re travelling. </p> <p>The same information needs to be shared with the airport, with security, it needs to be accessible by the police and security services, even with the authorities abroad.  None of this is possible if the data is not properly organised and structured across the whole organisational and supply chain.</p> <p>This will be a huge challenge for the NHS, to structure its data.  But the potential rewards are huge.</p> <p><strong>A change in culture</strong></p> <p>Another challenge is that the information revolution requires a genuine change in culture.  More generally, we need to move away from the notion of patients and service users as passive recipients of care, to them being active participants in it. <br />We need a similar cultural shift when it comes to information. </p> <p>Some may doubt the appetite of the general public to get involved.  But think of the number of reviews there are on Amazon or the number of blogs on every subject under the sun.  Think of the public’s hunger for news on health. </p> <p>There are often more pages in newspapers dedicated to health features than there are to the rest of the news put together.  And in the last year, people have made over 100 million visits to the NHS Choices website, rated by Which? as the best place on the web for medical information.  The demand is there.  The public are itching to share their opinions.  We just need to work out how to manage the flood.</p> <p>For services to be truly patient led we need to listen to them.  We need a greater emphasis on patient generated information – on PROMs, the Patient-Reported Outcomes Measures, patient experience information, and feedback. </p> <p>But more than that, we need to have an ongoing dialogue with them.  You see this everywhere in the commercial world.  Companies increasingly use the internet as a way of engaging with their customers, inviting their feedback and ideas.  The good companies then respond to those ideas to improve how they work.  And good NHS organisations are starting to do this too.</p> <p>Professor Paul Gringras  at Guy’s and St. Thomas’s and Dr Santosh at Great Ormond Street have developed HealthTracker – a simple and secure way of remotely monitoring young people with a range of conditions.  It uses questions, games and cartoons to measure symptoms and side-effects, moods and feelings. </p> <p>And patients aren’t tied to the hospital bed.  They use it online at home or at a local library.  This way, hospital consultants, parents, GPs and anyone else that needs to see how someone is doing has instant access to an incredibly high level of detail.</p> <p>Another example is PatientView, developed by RIXG [Rick’s Gee], a UK group representing renal patients and professionals.  It gives renal patients information online about their diagnosis, their treatment and their latest test results. Patients can then share this with anyone they want and view it from anywhere in the world.</p> <p>And because the information comes directly from the hospital databases, if a patient suspects a mistake, they can check with your own doctor.</p> <p>Perhaps the most important source of data is the patient’s own care record, the data that’s recorded and updated as they progress through their treatment. </p> <p>When you visit your GP, you’ll see them typing up your notes while you’re there in the consulting room.  But elsewhere things can be very different.</p> <p>Think of the inherent complexity of treating an individual patient.  Then multiply that complexity by a whole hospital ward and you start to see why it can be so difficult to keep a patient’s record 100% accurate.  Especially if there’s a gap between seeing a patient and writing up their notes. </p> <p>But what if a doctor could tap her lapel and record what they need to there and then?  Their voice could be translated into text and added instantly to the patient’s record?  Better data, less form filling, superior care.</p> <p><strong>All staff</strong></p> <p>The primary use of data should always be to improve outcomes for patients.  All staff need to understand this.  But they will also need to be supported to adopt up-to-date practices and use new technologies. </p> <p>This will not be easy for many and we need to be aware of the difficulties ahead.  We will work with regulatory bodies, professional organisations and non-clinical training bodies to improve the skills of staff. <br />We need to imbed information and informatics skills into the workforce and into professional regulation.</p> <p>This isn’t about turning nurses into IT professionals.  It’s about placing information at the centre of care in a way that people hardly even have to think about.  In a way that produces clear benefits and is not just seen as “another form to fill in”.</p> <p>And within an environment of greater local autonomy and choice, IT professionals will become ever more influential.  Within a vibrant marketplace of suppliers, they will need to help develop local information strategies that underpin and support plans to improve the health of the local population. </p> <p><strong>Taking this forward</strong></p> <p>We have set the direction with the White Paper.  But we need your ideas to shape the Information Strategy.  The strategy will be about putting the information revolution into effect, setting the goals and the timetable as well as examining the challenges.</p> <p>Challenges such as how we get databases to talk to each other by using common standards.  We need common standards in terminology, in patient and care records, and in how we use an individual’s NHS number to link it all together.</p> <p>This isn’t a case of a small group of experts deciding behind closed doors what is best for people, what’s best for the system.  It’s about creating an environment within which innovation and creativity can flourish. </p> <p>I mentioned the iPhone earlier.  If all it did was look good, make calls and send texts, few would have bought it.  The real value of the iPhone – what made it so remarkable – was that it wasn’t really about the ‘phone’ at all.  It was about the ‘App Store’.  It was the fact that companies large and small, even individuals with a bright idea and a basic understanding of programming, could get involved.  From a common set of standards came an explosion of innovation and creativity that has created a multi-billion dollar industry practically overnight.  This is what I want to see in the NHS.</p> <p><strong>No new money</strong></p> <p>We also need to look at how information can deliver benefits in the current financial climate.  Let me be straight with you - there is no new money for the information revolution.  It must pay for itself.  But there is huge potential for information to deliver real savings and we must make full use of that potential.</p> <p>In the NHS and public services in general, we need to get away from the notion that you can’t do anything without ever increasing budgets. </p> <p>Hermann Hauser, the Cambridge-based founder of a number of successful computer companies, said “I gave my designers two advantages over Intel and other chip manufactures.  I gave them no money and I gave them no people.”  The result is the hugely influential chip designer ARM, whose chips will be powering the mobile phone of almost every single person in this room.</p> <p><strong>The NHS needs you!</strong></p> <p>Over the next few years, our reforms will change the NHS.  Pushing power away from Whitehall and down to doctors and nurses will mean that decisions are taken based purely on what is best for the patient, not on what is politically expedient for Ministers. </p> <p>Pushing power to patients will make them genuine partners in their own care and give them real power of scrutiny over their local NHS.</p> <p>We have an unprecedented opportunity to improve the health of this country.  But to make it happen, we need to grasp it by the scruff of the neck.  And we will need your help. </p> <p>Information technology will play an ever-increasing role in our economic future.  As the Prime Minister set out earlier this month, we want Britain to become the destination of choice for bright ideas and new companies.  We in government have a role to play, but it is not picking winners or backing the biggest.  It is changing the law where it acts as a barrier to innovation.  It is encouraging, cajoling and influencing the change we want to see.  It is creating the best possible environment for innovation and success.  And we will do precisely the same thing in the NHS.</p> <p>As Information professionals, you will have a greater role and higher profile within the Health Service.  You will be the in vanguard of this revolution, making information the lifeblood of the NHS. <br />Our consultation, Liberating the NHS: An Information Revolution, sets out our broad vision and direction.  It sets out what we want to achieve, not how we are going to achieve it.  That is where the NHS needs you.</p> <p>It needs you:</p> <p>• to show us the opportunities we’ve missed,<br />• to help us make a difference to people quickly,<br />• to help drive a change in the culture, and<br />• to show us how information can deliver better outcomes.</p> <p>We need your knowledge, we need your ideas and we need your enthusiasm to give people control of their own records, to encourage third parties into the market and to structure our data.</p> <p>The information revolution has the potential to change everything.  But it can only do that if we all work together.   What will you do to make it happen?<br /></p> None Simon Burns MP E-Health Insider Live Department of Health 2010-11-09
<div class="ImageAndCaption"> <img src="/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_120741.jpg" alt="Simon Burns MP" /> </div> <p>It is a pleasure for me to be with you all today. I do not need to tell you how the work of COBSEO and the organisations it represents makes an incredible difference.  And I thank you for it. </p> <p>As the son, the grandson, the step-son and the nephew of armed forces personnel, I hope I understand some of the pressures of life in the armed forces. Certainly some of the pressures on family life, moving from base to base and country to country.</p> <p>I have the deepest respect for all those who serve their country and put themselves in harm's way.</p> <p>The silent processions through the crowded streets of Wootton Bassett are an all too familiar reminder of the debt we owe to those who have fallen in combat, and the high esteem in which they are held by the public. For them, we can only remember and honour their sacrifice and give their loved ones every support in such a difficult time.</p> <p>But for those hurt and injured in Iraq and Afghanistan we can do more.</p> <p><strong>Strategic Defence and Security Review</strong><br />The military, like all areas of government spending, face some difficult challenges in the coming years.  The Strategic Defence and Security Review protected the front line because Afghanistan is the Government's top priority.  But the implications of the Review will have a long lasting impact on all of the services. </p> <p>To dig this country out from under the mountain of debt built up by the previous government requires strong and determined action.  But, as the Chancellor and Prime Minister have often said, we will not ask the sick to foot the bill for the debt crisis.</p> <p>This is why we have not only protected the NHS budget, but will actually increase it in real terms every year of this Parliament.  It is why we will honour the £2 million commitment made by the previous government to support the work of Combat Stress and our other partners.  And it is why the Strategic Defence and Security Review commits a further £20 million a year for the healthcare of Service personnel.</p> <p><strong>Military Covenant<br /></strong>In recent years, the Military Covenant – the implicit agreement between the Nation and its military to treat the members of our armed services fairly – has been damaged.  Despite the unavoidable reductions in military budgets, this Government wants to repair that damage. </p> <p>The rebuilt Armed Forces Covenant will guide policy across government.</p> <p>The MOD is working with Departments across Whitehall – including my own – with the military and with service charities to improve the detail of the Covenant.  We’re looking at what we can do, within existing budgets, to make a real difference to men and women on the ground, both in theatre and back home in the UK. </p> <p><strong>Transition</strong><br />The price of valour can be high.  And for some, the most difficult part of combat can be the return home, especially when they leave military service.  Rather than an easy return to civilian life, they can face a daily struggle as they deal with the realities of life outside the armed forces. </p> <p>Every year, around 22,000 people make this transition to civilian life.  Now, the vast majority of service men and women make the switch with no real issues.  But others find the move more difficult. </p> <p>The issues they face can be fairly straight forward - the simple logistical problems of finding a GP and a dentist.  But because we are involved in active combat, some face issues that are far more complex. </p> <p>If someone has been seriously wounded, they may require a lifetime of ongoing health and social care.  In these cases, we need a seamless transition from the military health apparatus into the NHS.  Nothing less will do.  We cannot accept a single person “falling through the gaps”. </p> <p>I’m determined to do right by those who have given so much for their country.  To do whatever we can to meet their physical, mental and social care needs.  And some progress is being made. </p> <p>The MOD and the Department of Health have worked together to develop Transition Protocols, which are now being piloted.  MOD medical and welfare staff are being trained on the importance of making early links with their NHS colleagues when discharging seriously injured personnel.</p> <p>These pilots highlight the need for clear lines of responsibility for case management, for stronger links at the local level between NHS and Defence Medical Services and for the close involvement of service charities from the beginning.<br />We are also working with the MOD to ensure that a person’s medical records are properly transferred to the NHS.  This includes identifying a named GP prior to discharge.  The absence of this link can lead to ex-service personnel vanishing from the record and missing out on any care they might need.</p> <p><strong>Prosthetics</strong><br />And once under the care of the NHS, we must make sure that all veterans receive the same high levels of care and treatment.  It cannot be right that while today’s veterans of Iraq and Afghanistan get the very latest in prosthetic technology from Headley Court, veterans of previous conflicts in places like Northern Ireland, do not.</p> <p>So we will ensure that all veterans who lost a limb on active service benefit from the latest technology, where this would be clinically appropriate.</p> <p>In practical terms, this underlines, once again, the importance of early and close engagement between the military and the NHS so that individual patients get the right support and ongoing maintenance from the start.</p> <p>Vital to supporting this process will be the new ‘Armed Forces Networks’.  These Networks will help bring together and coordinate services for ex-service personnel within a Strategic Health Authority area.</p> <p>I invite you all to join with these Networks to provide a strong local voice for veterans, their families and the families of those currently serving.  With your help we can make sure that these groups are not put at a disadvantage when accessing healthcare.</p> <p><strong>Mental health</strong><br />For a few, the scars of battle are not physical, but mental. Those who suffer from mental health problems can experience anxiety, depression or even post traumatic stress disorder. </p> <p>Earlier this month [6 October], we published Dr Andrew Murrison’s report, 'Fighting Fit - A mental health plan for servicemen and veterans'.  He had been asked by the Prime Minister to look at what more we could do to assess and meet the needs of serving and ex-service personnel. </p> <p>Again, Dr Murrison emphasised the importance of close, early contact with the NHS.  Of making people aware of the help that is available to them when they leave the armed forces. </p> <p>We are already working to implement two of his recommendations.  We will introduce an additional 30 mental health nurses to work alongside staff from Combat Stress and other charities to ensure that mental health services in every part of England/ the UK meet the needs of local veterans.  And a dedicated 24- hour help line, run with Combat Stress and the Mental Helplines Partnership, will enable veterans to find the support they need.  This should be up and running within the next month or so.</p> <p>We will also be looking at how we can develop an online community to provide further support for veterans with mental health issues.</p> <p>Dr Murrison’s recommendations build on other work already underway.  We’re currently evaluating 6 community mental health pilots, to make sure that the learning and best practice gained is fed back into the wider system.  And the Improving Access to Psychological Therapies guidance now includes veteran-specific recommendations.</p> <p><strong>Conclusion</strong><br />The National Health Service provides some of the best physical and mental healthcare in the world.  But it cannot do everything.  It’s organisations like the Royal British Legion, Combat Stress, the Department of Health’s voluntary sector strategic partners, and all those represented under the COBSEO banner that provide the emotional support, the hand to hold, the experience of having been there themselves, that can be so important.</p> <p>This government wants to support and empower voluntary organisations.  To give them the freedom and skills they need to make a significant and lasting impact on the lives of individuals.  Real partnership across all of government and the voluntary sector, joining up and drawing from expertise across the board – from mental health charities and children’s voluntary organisations to our strategic partners.  Working together to improve services and to support veterans and their families.</p> <p>I truly value the excellent work we do together.  One recent example is the publication last month of the leaflet, ‘Meeting the Healthcare needs of Veterans’ produced in conjunction with the Royal College of General Practitioners.  This will help to raise awareness of veterans’ issues among GPs, helping them understand the particular needs of this group of patients.</p> <p>I am constantly humbled by the courage shown and the sacrifices made by all of our armed forces in the line of duty.  The least we can do is to give those who return home the support they need to lead as full a life outside of the military as they did in it.</p> None Simon Burns MP Minister of State for Health's speech to the Confederation of British Service and Ex-Service Organisations Department of Health 2010-10-27 speech to the Confederation of British Service and Ex
<p>Thank you Carol [Dame Carol Black, Chair of the CfWI Governing Board]</p> <p>This is a time of real change for the NHS.  Set against a backdrop of a protected but challenging financial settlement for the NHS, the White Paper heralds a new dawn of locally-led, clinically led, patient focussed care.  A change more radical than anything in the history of the Health Service.</p> <p>It cannot be over-stressed how vitally important the people of the NHS will be to making the transition to the new system work and to improving outcomes while operating within far more constrained budgets.</p> <p>The Centre for Workforce Intelligence will play a valuable role in helping the Health Service through the transition and to plan for the future.  So may I first thank Peter Sharpe [CEO] and Carol [Black] for everything they have done to bring the CfWI to this point, and for everything they will do to help the NHS plan for the future.</p> <p><strong>The White Paper</strong></p> <p>In health, everything that this new government does, everything we want to achieve, every policy and White Paper we publish is based upon one simple principle – trust.</p> <p>This government trusts the people of the NHS.  We trust you to know patients better than we do.  We trust you to know what excellent healthcare looks like and to know what gets in its way better than we do.  And we trust you and your colleagues to lead the NHS into a new era of patient choice, of local accountability, and of health outcomes comparable with the best in the world. </p> <p>If the White Paper is about nothing else, it is about putting that trust into action.  It is about making “the system” reflect and support the essential human relationships that exist within it.  Not to act as a barrier, but as a conduit.</p> <p>The recent White Paper – Equity and Excellence: Liberating the NHS – will shift the centre of gravity for the NHS.  Top-down direction from Whitehall will be replaced by bottom-up local decision making.  Consortia of GPs, working with their clinical colleagues across primary, secondary and community care, local authorities and their local communities will plan and commission clinically led health services as they see fit. </p> <p>Not as politicians like me tell them, micro-managing from Whitehall.</p> <p>All NHS Trusts will become Foundation Trusts – free to decide how they want to run their own services; free to manage their own finances; free to reach their own potential.</p> <p>And patient choice will be more than just something we speak about, it will become an integral, every-day fact of life.  In the coming years, we will give patients real control over when, where and by whom they are treated.  They will be central to all decisions about their after care, often spending their own budget in the way that suits their needs rather than the needs of the system</p> <p>This is an opportunity to have a more streamlined NHS with less bureaucracy.  A more patient focussed NHS with their interests put first every step of the way.  A higher quality NHS with clinical outcomes among the best in the world.</p> <p>None of this, not one single part of it, can be delivered without a highly trained and highly motivated workforce.  Of course, change is difficult.  There will be many challenges along the way.  But with proper planning based on insight and intelligence, we can overcome them.  We can build a Service that reflects the values of the staff working within it.  Liberating staff to do a better job for their patients.</p> <p>In a moment Clare will speak in more detail about the impact of the White Paper on workforce and on education and training and the consultation we will run later in the year.</p> <p><strong>Workforce</strong></p> <p>We know that a top-down management approach will not work.  We need a devolved, clinically-led solution that meets the individual needs of patients.  As we are giving General Practice responsibility for commissioning, and providers extra responsibility for designing their own services, we need to give employers responsibility for workforce planning and for education and training alongside professional oversight of quality.</p> <p>The system must mirror the principles of the White Paper.  It needs to be clinically-led, responsive to local needs and to changes in the supply and demand for local services. </p> <p>The Centre for Workforce Intelligence will have a vital role to play in providing the evidence that can drive workforce and service reform.</p> <p><strong>QIPP</strong></p> <p>I said at the beginning that we face challenging financial times.  On Wednesday, the Chancellor of the Exchequer, George Osborne, will set out his plans to tackle this country’s crippling deficit and start paying back the massive debts that this government inherited from the last one. </p> <p>It is a measure of the importance that we place upon the National Health Service, and the future health of the nation, that the NHS budget will not be cut, but protected.  For every year of this Parliament we will increase, in real terms, NHS funding. </p> <p>We all know that this will not be easy.  With a growing and aging population, new drugs, new technologies and the ever-increasing expectations of the British people, the NHS budget will be stretched like never before.  We will need to make huge efficiency savings of up to £20 billion a year. </p> <p>But every penny saved, is a penny reinvested in the Health Service.  It’s a penny spent on new cancer drugs we otherwise couldn’t afford.  On better public health where once this would have been the first budget to be cut. <br />On higher quality, integrated, patient centred, outcome focussed health services led by you.</p> <p>One major way we will meet this challenge is the QIPP programme – quality, innovation, productivity, prevention.  It is a two-pronged attack: drive out inefficiencies from the system, including in the way it deploys staff, and improve the way the NHS delivers services. </p> <p>QIPP is about working smarter.  It’s about doing the right things, in the right place, in the right way, at the right time.  Innovating to improve patient care and constantly striving for ways to make the system more efficient.</p> <p>It is also about the workforce.  Changing how we plan, train, reward, support and engage with staff throughout the NHS in deliver services. </p> <p>This is about more than just being efficient.  It is about equipping and supporting NHS staff to become more flexible, meeting the complex and diverse needs of its patients.  It’s about recognising and realising their potential to innovate and improve services for patients.</p> <p><strong>CfWI and QIPP</strong></p> <p>The Centre for Workforce Intelligence will play a vital role in supporting QIPP.  It will mean that future decisions on investment in education and training will be underpinned by sound evidence of what works.  Helping providers to respond to the reforms that lie ahead and to improve the quality and shape of local services.</p> <p>The Centre will analyse the changing needs of the NHS, assessing the future demand for doctors and other clinicians.  It will develop practical, pathway-specific guides.  Guides that will help different health organisations and consortia to assess the workforce implications as local services evolve. </p> <p>It will enable innovative workforce solutions that will make an important contribution toward the QIPP savings. </p> <p><strong>Close</strong></p> <p>Change is needed and change is coming.  Yes, some things will be difficult because of tighter budgets.  But I believe we stand on the brink on the most exciting period of NHS history since it was founded over sixty years ago.</p> <p>For the first time, the NHS will not be micro-managed by people like me in the Westminster bubble.  But by lead from the bottom up but the people who understand the NHS better than anyone.  By the people who make it happen every day.  By you. </p> <p>And the Centre for Workforce Intelligence has an important contribution to make.  Helping local NHS organisations respond to a new world of patient choice, local leadership and health outcomes that are among the best in the world.</p> None Simon Burns MP Centre for Workforce Intelligence Department of Health 2010-10-18
<p>Thank you very much for inviting me and I am very pleased to have been able to come today.  Pleased, because this is my first opportunity to address you all, but also pleased to look ahead to the future of the ambulance service.</p> <p>Late buses, spiders in the bath and not being able to get through to the Strictly Come Dancing voting lines aside, the vast majority of people who call 999 are in a fairly desperate state. </p> <p>If you need medical attention, if you need an ambulance, the knowledge that professional help is rushing to your side must be one of the most valuable services that the NHS can provide.</p> <p>And you have proven time and again just how good a service you are.  Despite dealing with more calls than ever before, call handling is better than ever with the vast majority of Category A calls responded to within 8 minutes.</p> <p>But behind the numbers are the individual cases that make such a huge difference to individual people. </p> <p><strong>The White Paper</strong></p> <p>Ambulance services across the country do a good job in difficult circumstances.  And I’m afraid to say that some of those difficult circumstances are the fault of government.  Targets that pay scant regard to the evidence of what actually improves patient outcomes.  A confusing, ad hoc system of urgent care and out of hours services that leads the public into dialling 999 by default, when better more appropriate care is available elsewhere. </p> <p>Increased centralisation has long been seen as the solution.  For too long it has been a large part of the problem.  There are so many ways in which the NHS in general and ambulance services in particular can be much better if only the civil servants and politicians – and yes, I do mean me – got out of the way and let you and your colleagues across the NHS get on with the job.</p> <p>That, in essence, is what the White Paper is all about.  As its name implies, Equity and Excellence: Liberating the NHS, is about setting NHS organisations free to achieve their potential.  It’s about treating the NHS and the professions like grown ups.  It’s about trusting that – working in partnership with your colleagues across the Health Service, other emergency services and in local government – you can organise yourselves from the bottom-up better than we in Westminster ever could from the top-down.</p> <p>From empowering general practice to design and commission local services to turning every NHS Trust into a Foundation Trust, with the additional freedoms that go with Foundation Status.  From getting rid of every politically-motivated, process-driven top-down target that cannot prove its worth, to giving patients a genuine choice over their own care and making sure that their choices have a real impact on providers.  The White Paper will shift the NHS’s centre of gravity.</p> <p>A locally-led, clinically-led Health Service, where what matters are not tick-box targets but real, measurable health outcomes.</p> <p><strong>Ambulance Service reform</strong></p> <p>This is very much the case for ambulance services.  Where targets distort priorities and impede patient care, then they must go.  Now of course, the speed with which an ambulance can arrive at the scene can be vital to the overall clinical outcome.  It can, and often does, mean the difference between life and death.  But that is not the case in all situations.  By taking a blanket approach, an obsession with speed can actually get in the way of good patient care.  An example is the target for reaching all Category B calls – calls that may involve injuries, illness or the exacerbation of an existing medical condition – within 19 minutes.</p> <p>The fact is there is no clinical evidence to support the ‘B19’ target.  A recent study by Sheffield University found that just 5% of Category B calls could actually be described as serious, with half requiring no intervention by ambulance staff at all. <br />Is this really the best way of driving change in Ambulance Services?  I’m not sure it is.  That is why we are looking at things like the B19 target to see if there are things we can do differently, things we can do that will demonstrably improve patient care.</p> <p>Across the NHS, we are developing a range of clinical outcome indicators, quality standards designed by those on the ground delivering the care. </p> <p>And while we are removing targets that don’t count, like the 4 hour wait in A&amp;amp;E, we will strengthen those that genuinely improve patient outcomes, such as the Category A, 8-minute target. </p> <p>We all know there are some problems with the A8 target.  Sometimes, because of the target, an ambulance may be sent to an emergency before the exact nature of the call is understood.  The result is that many vehicles are dispatched only to be ‘stood down’ as further information comes to light.  Clearly not a good or effective use of crucial ambulance resources.  But these are problems we now have an opportunity to fix. </p> <p><strong>Outcomes Framework</strong></p> <p>The clinical quality indicators are a part of a fundamental change in how we do things in the NHS.  They will promote excellence and equality, they will be clinically not politically led.  They will be focussed on outcomes, on actually improving the care we give to people. And they will be integrated, so for example the indicators for A&amp;amp;E will mesh with those for Ambulance Services.</p> <p>And while the NHS will no longer jump on the every word of ministers or the Department, it will be very much accountable to the patients and public it serves.  It will be for local commissioners and providers, working with an increasingly wide group of partners, to determine the most appropriate performance levels based on the clinical needs of their patients.</p> <p>And it’s happening already.  I am particularly pleased at how ambulance services are working with us to develop these indicators, and on behalf of the millions of people who will benefit, I thank you for your support.  The agreed set of indicators will be set out in the NHS Outcomes Framework, due in December. </p> <p><strong>24/7 integrated urgent and emergency care</strong></p> <p>But it is not enough to say what the expected level of performance will be and then be done with it.  We need to do more than that.</p> <p>As I said before, the approach to urgent care and out of hours services has sometimes been a bit confusing.  We need to sort this out if the public are to retain confidence in the care they receive.  And we need to sort this out if we want to change people’s default dialling of 999.</p> <p>Responsibility for commissioning urgent and out of hours care will lie with GP Consortia.  While GPs may not themselves deliver that care, they will ensure that its design and operation meet the highest standards of safety and quality.</p> <p>We need to end the confusion over what different services provide.  People today are presented with a bewildering range of urgent care centres, walk-in-centres, minor injuries units, GP-led Health centres and GP practices.  Even of some A&amp;amp;E departments that, despite the name, aren’t actually A&amp;amp;E departments!  Organisations can help by being clear as to the services they provide so that people don’t put themselves at risk by turning up expecting treatment that isn’t available.</p> <p>And we need to do more to make the complex web of NHS services easy for people to navigate.  Who do you call at 3 in the morning when your child is sick?  What do you do if you’re away from home and have forgotten your medication?  If it’s an emergency, you dial 999.  But what about when it is not an emergency, what then?</p> <p>Of course, there is NHS Direct, which does an excellent job.  But more than 8 out of 10 people don’t know the number.  If you are at home you could call your GP.  But out of hours, depending on where you live, you might be sent all around the houses before you actually speak to someone who can help.  Not what you need when you are looking after a sick child.  Despite the excellent work of so many people in the NHS, the system itself gets in the way of providing excellent care.</p> <p>This is why we are rolling out a new number – 111.  With the vastness and complexity of the National Health Service, its beauty is in its simplicity.  111 is as instantly memorable as, and I hope will become as deeply ingrained in the national psyche as, 999.  If it is an emergency, dial 999.  If not, dial 111.  It’s as easy as that.</p> <p>111 will help patients find the right care, in the right place, right away.  It also means that you can focus ambulance services on patients with the most serious conditions.  It will be a more joined-up service.  Patients won’t have to endlessly repeat information or be assessed multiple times.  And if a patient does need an emergency response, because of the consistent clinical assessment used across the system, 111 can send the call directly to the ambulance control room for immediately dispatch.</p> <p>It has already been launched in County Durham and Darlington, working closely with North East Ambulance service.  By the end of the year, it will be available in Nottingham, Lincolnshire and Luton.  Learning and adapting the service as we go, it is casting its net wider and wider across the country. </p> <p>When 111 is rolled out across the whole country, it will replace the NHS Direct phone number.  Until then, NHS Direct will continue to provide its current service.  In the long term, while the phone number will no longer exist, I do expect that NHS Direct will continue to have an ongoing role, alongside other providers, in delivering the new 111 service.</p> <p><strong>Conclusion</strong></p> <p>The White Paper heralds an exciting time of change for urgent and emergency care.  But they will not be changes imposed on you from the centre.  The changes are about empowering you to work with colleagues across the NHS and to shape the services you provide to the best of your ability.</p> <p>This is about enabling ambulance services to be as good as they can be.  It’s a challenge for you to work with your colleagues in primary, secondary and community care, with local authorities and with patients to develop high quality, integrated local services.  Not compromised by distorting targets but freed to shape and design services for the benefit of patients.</p> <p>This conference is an opportunity to talk through a lot of what is happening and Matthew Cooke [National Clinical Director for Urgent and Emergency Care] is here to join in and reflect on today’s discussions. </p> <p>I am under no illusion that this will be a challenging time for ambulance services.  But it also an exciting time.  One that has the potential to unlock real improvements for staff and patients.  One where you will be in control.  One where we can transform services for the better.<br /></p> None Simon Burns MP Ambulance Service Network Department of Health 2010-10-13
<p><strong>Introduction</strong></p> <p>Almost 10 years ago, the last Government came up with a genuinely good idea – Foundation Trusts.  These new, autonomous, locally accountable institutions would be let loose to innovate, to run themselves as they saw fit, to borrow money and to use the income they generated privately for the benefit of NHS patients. </p> <p>Sadly though, the original proposal was diluted by Gordon Brown as the legislation passed through Parliament during one of his interminable battles with Tony Blair.<br />However, the concept was excellent.  A real success story.  Across the country, Foundation Trusts have generally demonstrated that they can operate independently, with boards taking responsibility for delivering high-quality care. </p> <p>I believe they are proof that when Ministers take a deep breath and let go, far from everything collapsing in a heap, the innate professionalism and expertise of the people inside the NHS can scale new heights.  Within an environment of robust, economic and quality based regulation, the more freedom we devolve to Trusts, and to you, the people who work within them, the better the patient care.</p> <p>So first I want to thank you for everything you have done already to improve the NHS. </p> <p>But, as I have already said, Foundation Trusts have been an excellent idea only part realised.  Let loose to innovate, but only within limited parameters.  Free to run themselves, but only to an extent.  Free to borrow money, but with tight restrictions.  And able to keep funds raised privately but, for most, capped at below 1% of income. </p> <p>When Enzo Ferrari dreamed of creating the perfect racing car, he didn’t limit the engines to 35mph, he let them fly.  This is what we want to do with Foundation Trusts.</p> <p><strong>The government’s mission</strong></p> <p>This government’s highest priority is the Health Service.  That’s why, recognising the impact this will have on other departments as we reduce the budget deficit, we guarantee that health spending will rise in real terms in each year of the Parliament. </p> <p>But a protected budget does not mean protection from change.  Far from it.  In order to preserve the and improve the NHS, to meet the increasing demands of an aging population, to cope with the ever growing costs of new drugs and new treatments, inefficiency must be rooted out.  And in return, every penny saved with be reinvested back into the Health Service to improve patient care.</p> <p>For too long - and here I’m not only talking about the last government, although they certainly accelerated the trend - the flow of power has been towards the centre.  Ministers in Westminster and civil servants on Whitehall have taken ever more control over public life. </p> <p>Local authorities, the professions and individual people have been increasingly disempowered.  It is perhaps understandable then that people have also become increasingly disengaged with the political process.</p> <p>So across the public services, this government is reversing that trend and giving back power.  We’re overseeing a fundamental shift, away from Westminster down to councils, communities and homes across the nation.  A radical localist vision that is turning Whitehall on its head. <br />And leading the way are the NHS reforms set out in the White Paper, Equity and Excellence: Liberating the NHS.</p> <p><strong>Operating Framework</strong></p> <p>We’re putting an end to the pointless and wasteful obsession with process based targets.  Instead, we’re focusing on what really matters - health outcomes.  We’ve already made a start with this year’s revised Operating Framework. </p> <p>We’ve stopped performance managing the 18 Week target; we’re making primary care a local rather than a Whitehall issue; and we’ve changed the A&amp;amp;E waiting time threshold to a more clinically relevant 95%. </p> <p>And next year we’ll go further.  We’re looking at all current indicators and if they are not clinically relevant, if they are not about improving health outcomes, then we’ll ditch them too.  Replacing them with a series of performance measures that actually work to improve performance.</p> <p><strong>Other White Paper reforms</strong></p> <p>The White Paper sets out other major structural changes.  We will abolish Strategic Health Authorities and Primary Care Trusts and their £1.5 billion a year administration costs.  We will hand power for commissioning to general practice through the new GP consortia, a partnership lead by GPs but encompassing professionals from across primary, secondary and community care. </p> <p>So far, most of the publicity around the White Paper has been focused on GP Commissioning.  About how commissioning will be re-drawn with a new, clearer clinical focus. </p> <p>But GP Commissioning is not uniquely radical.  Across the whole of the NHS, our reforms are about a new partnership between management and clinicians jointly leading for excellence.</p> <p>Increasingly, money will follow the patient.  And because of patient choice it will flow to the very best providers.   </p> <p>The challenge for Chief Executives, freed from the remaining shackles of central control, will be to lead their organisations in a spirit of openness and collaboration. </p> <p>The challenge for senior healthcare professionals will be to stand up and be counted, to put their heads above the parapet and take decisions jointly with management to improve the services they offer.</p> <p>The reward for meeting these challenges will be a more vibrant, dynamic and entrepreneurial NHS.</p> <p>What does all this mean in practical terms?  It means that there is a genuine opportunity to deliver clinical excellence and to be rewarded for it.  As the money flows to the best providers, they will be able to develop and grow their services as they see fit.  The State will no longer stand in the way of spreading excellence.  Instead we will do everything we can to encourage it.</p> <p>For this to happen, we need to do two things.  First we need to make every NHS Trust a Foundation Trust, and then we need to free Foundation Trusts so they can finally realise their incredible potential.</p> <p>Both aspects of our policy towards Foundation Trusts - expanding their number and their freedom - will require a great deal of thought, work and cooperation.  And while we may set the direction from the centre, we do not flatter ourselves to think that we have all the answers when it comes to implementing our plans.  That is why we’re consulting with you and others on a wide range of issues. </p> <p><strong>Every Trust a Foundation Trust</strong></p> <p>When it comes to making all Trusts Foundation Trusts, there are a number of bridges we need to cross.  Already, more than half of Trusts have Foundation status [130 of 234, or 56%].  But that still leaves more than 100 [104] that don’t enjoy that status. </p> <p>To focus minds, we have set a deadline of 2013 to make the transition.  Many will make the deadline with ease.  But some will find it more difficult.  The simple and easy answer would be to just lower the bar.  To make it easier to become a Foundation Trust.  That might hit the target, but it would entirely miss the point.  To earn Foundation Status, Trusts must have strong boards, good governance, robust business plans and deliver high standards of care.</p> <p>That is where we need your help.  What are the problems and the solutions involved in making this dramatic change?  What incentives will be most effective?  And beyond 2013, what can the system do to protect patients should things go wrong?  How do we best deal with failure?  These are big questions.  We’re only going to find the answers if we work together.</p> <p><strong>Increasing the powers of FTs</strong></p> <p>The same is true of our plan to increase the powers of Foundation Trusts.  We want to create the largest, most vibrant social enterprise sector in the world, with providers free to innovate in the pursuit of ever better care for patients.  But this isn’t going to be easy.  There are many practical obstacles to overcome too.  Let me list a few examples.</p> <p>Subject to consultation, we propose to abolish the cap on the amount of private income Foundation Trusts can raise themselves.   </p> <p>This is about using the entrepreneurial spirit of Foundation Trusts to generate new sources of income that will benefit NHS patients. </p> <p>The core legal purpose of a Foundation Trust will always be to provide high quality services to NHS patients.  This will not change.  But we want to free Foundation Trusts to pursue commercial opportunities that will ultimately result in better care for NHS patients.</p> <p>Similarly, we propose to abolish the limits on borrowing.  Foundation Trusts need to be treated like adults and trusted to manage their own finances.  Now, because of the newness of this market, private finance may be expensive, so we will keep a mixed market of public as well as private funds available.  And there are issues of equality of access to address, like ensuring that Foundation Trusts don’t have preferential treatment compared to private hospitals.</p> <p>We also propose to make it easier for Foundation Trusts to merge without having to obtain permission from Monitor, the Department of Health or the Secretary of State.  Where this leads to better patient care and better value for money for the tax payer, it is surely ludicrous that bureaucratic rules should get in the way.</p> <p>And while the broad framework of Foundation Trust governance will remain the same, I believe we should give them the flexibility to govern themselves for the benefit of their patients as they see fit. </p> <p>The role of Monitor will change.  While the Care Quality Commission will focus on quality and safety, Monitor will become an economic regulator for all of health and social care.  But we need your help. <br />Monitor must avoid any possible conflict of interest within the system or risk being undermined from the start.</p> <p>There are many questions to be answered around the period of transition from the present system to the new one.  And I am looking forward to working with you to answer these questions together.</p> <p><strong>Education and Training</strong></p> <p>And vital to all of these reforms will be to ensure we have a workforce with the most appropriate, high quality education and training.  It will be for individual providers to decide on their own education and training system. </p> <p>But it will also be up to them to ensure that appropriate investment is made in the workforce to ensure better outcomes for patients and value for money.  We want to work with Foundation Trusts to shape the system and so we will be consulting on this separately, later in the year.</p> <p><strong>Patient Choice</strong></p> <p>So far I’ve spoken of how the framework will improve.  About how we want all trusts to become Foundation Trusts and how we will expand what it means to be a Foundation Trust. </p> <p>But none of this really means anything, none of the real benefits can be fully realised, unless we make sure that the right incentives are in place.  And that the money really does follow the patient and that patients, with the help of their GP, can and do make informed decisions about their care.  Here, the White Paper heralds a new era of patient power.</p> <p>As all good professionals know, the outdated, paternalistic caricature of Dr. Finlay’s “doctor knows best” attitude is out of keeping with the modern provision of healthcare.  The patient must be central to all decisions taken about their care.  To put it another way, there must be “no decision about me, without me”. </p> <p>This isn’t just cosy sentiment.  The evidence from around the world shows that involving patients in their treatment improves the effectiveness of that treatment, it increases their understanding of their condition and boosts their satisfaction.</p> <p>Importantly, with the support of their doctor, they will be able to choose their provider, their named consultant-led team, their GP practice, and their treatment where clinically appropriate.  We will shortly be consulting on opportunities to increase choice in maternity services, in mental health services, in end of life care, the provider of any  diagnostic tests and any further treatment needed after a diagnosis has been made. </p> <p>And to help them make these decisions, and to help clinicians respond to their decisions, they will have access to a huge amount of easy-to-understand data, published online.  Over the next few years, patients will experience an information revolution. </p> <p>This will do two things.  As well as helping patients to make informed choices about their care.  It will also show hospitals, departments and even groups of consultants how they are performing in relation to their peers. </p> <p>If you ask people if they would like their local hospital to be as good as the very best in the country, of course they will say yes.  I would, and I’m sure you would too. </p> <p>But the public aren’t fools.  If they can see for themselves, or if their GP shows them, how one hospital will give them a far better standard of care than another, even though it’s further away, most people will go for the best care.  To pretend otherwise is, I think, somewhat patronising.</p> <p>And as I said before, this will be an incredible incentive for everyone in the system to strive for greater quality.  For as patients opt for the best care, so the money will follow them.  The best hospitals, the best departments, the best consultants will be free to invest that money in even better services, or to expand them across the region or even across the country.</p> <p>And the hospitals that don’t fair quite so well will have a very strong incentive to examine what they might do to improve their performance.</p> <p>However, the White Paper is not only about the autonomy of providers.  It is also about putting patients at the centre of decision-making and about helping people to make informed choices about their care. </p> <p><strong>Conclusion</strong></p> <p>These are, I’m sure you’ll all agree, exciting times for the NHS.  I believe we stand at the beginning of a potentially golden age for healthcare in this country.  An explosion of clinically-led innovation and creativity that will produce some of the best health outcomes anywhere in the world. </p> <p>But for this to happen we need to get these reforms right.  And for that we need your help and we are very much in listening mode.  While we have set the destination, we need you to help lead us there. </p> <p>Alone, government doesn’t have the answers.  But by working closely together, and by trusting each other, I believe that we can overcome anything in our path.<br /></p> None Simon Burns MP Foundation Trust Network Department of Health 2010-09-15
<p><strong>Reform: More for Less in the NHS: Saving Money and Improving Quality<br /></strong></p> <p>I am delighted to be here today with such a distinguished audience and to share the bill with such eminent fellow speakers.  But I am also pleased to be here to talk about one of, if not the most, radical devolutions of power in the history of the NHS; away from the State and down to doctors and nurses on the front line, and down to patients in consultation rooms.</p> <p>This government was elected on the principles of freedom, fairness and responsibility.  Last week’s White Paper set out how we will bring these principles to life in the National Health Service. </p> <p>The combination of the Conservative’s belief in the power of personal choice and empowering patients blended with the Liberal Democrat belief in local democracy will create an NHS that focuses on quality, on patients and on value for taxpayers money - and an NHS that delivers outcomes for patients that are among the best in the world.</p> <p><strong>The Economy</strong></p> <p>Before I turn to the detail of how we will liberate the NHS, I want to deal with the one issue that casts its shadow over everything: and that is the economy.</p> <p>We have set ourselves the ambitious, but desperately needed goal of slashing the budget deficit so that by the end of this Parliament, debt is falling and not rising.<br />The Prime Minister and the Chancellor have set out clearly the scale of the financial challenge.  This year’s budget deficit is projected to be £155 billion – about as much as we spend on the NHS, defence and transport combined.  [£110bn+£37bn+£13bn=£156bn]</p> <p>But think for a moment about our total debt.  If we include the money used to bail out the banks, the UK’s net public debt is currently £903 billion or almost two thirds of the UK’s entire economic output [62.2% of GDP].  That is why we’ve got to act.</p> <p>If we delay, we only store up problems for the future.  If we delay, we only pay more – up to £70 billion in annual debt interest alone, more than the entire education budget in this country.  But most importantly, if we delay, it will not be us that are left with the debt, but our children and our grandchildren. </p> <p>We have lived beyond our means for too long, and the time has come to face up to our responsibilities.  The budget has already set the direction and later this year, the spending review will provide the detail. <br />On average, government departments will need to make savings of around 25%.  Health, however, is protected. </p> <p>Some may question the rationale behind this.  But I passionately believe that protecting the NHS budget is the right thing to do.  To govern is to lead.  And in difficult times, leadership means making difficult decisions about the priorities of the nation.  We place health firmly at the top of that list of priorities.  Protecting patients is essential.  But protection for patients is not protection from reform.</p> <p>We do not equate Health’s protected status with an attitude of inaction.  It’s not a case of seeing the difficult decisions of how to save money, how to do things more efficiently or not at all as being somehow ‘not our problem’. <br />Nothing could be further from the truth as our White Paper demonstrates.</p> <p>The NHS is a demand-led service.  If you are sick or need help, the NHS will provide.  Need – not the ability to pay – is one of the fundamental tenets of the Health Service.  But the cost of providing this service is high and rising.  The price of new drugs, new treatments and the latest technology, on top of an ageing population mean that spending on health and social care has increased faster than spending on other public services.</p> <p>Since it’s birth, the National Health Service budget has risen by over 4% per year in real terms.  Such increases are, quite simply, no longer possible.  This means that the NHS – even within the context of a protected real terms budget – must find significant efficiencies simply to stand still.</p> <p>Sir David Nicholson, the NHS Chief Executive, estimates that, without reform, we could need up to an additional £20 billion a year by 2013/14 simply to meet expected demand to the same standards as today.  There is a practical imperative for the NHS to become dramatically more productive and efficient.</p> <p><strong>Health</strong></p> <p>As a consequence, the way we run the NHS is going to change profoundly in the coming years.  But one thing will remain the same: our commitment to the values of the National Health Service.  Healthcare available for all, free at the point of use and based on need, not the ability to pay - values that have guided the NHS since its birth. <br />We will not go down the path of paying for healthcare or an insurance system, with all the transaction costs and inequalities of access that that would result in.</p> <p>And for over sixty years, doctors and nurses, scientists and technicians, and civil servants, have breathed life into those values.  All have worked hard to deliver a Health Service we can be proud of. </p> <p>Their dedication and expertise is recognised and respected the world over.  And this hard work, coupled with the massive rise in investment, has brought significant improvements.  More doctors and nurses, more – and better equipped – GP practices and hospitals. </p> <p>But investment alone is not enough.  And the increases we have seen in the last few years have not, I’m afraid to say, been matched by a corresponding improvement in productivity or what is most important of all, health outcomes. </p> <p>While spending on healthcare has more-or-less now reached the European average, the standard of healthcare has not. </p> <p>Despite everything that the previous government did, survival rates for cervical, colo-rectal and breast cancer are among the worst in the OECD.  We are on the wrong side of the average for premature mortality from lung cancer, and heart and respiratory disease.  And you’re more than twice as likely to die from a heart attack in the UK than in France. </p> <p>Patients deserve better.  The NHS can be better.  And with the reforms we have set out, it will be better.</p> <p><strong>White Paper</strong></p> <p>The White Paper, Equity and Excellence: Liberating the NHS, will create an NHS with a single, clear-sighted mission – to lift health outcomes so they are among the best in the world.  It will achieve this through a radical shift in power away from Westminster and Whitehall down to patients and professionals. </p> <p><strong>Outcomes</strong></p> <p>We need a resolute focus – of attention and resources – on results.  Not on measuring inputs or processes.  But a rigorous, consistent and long-term focus on improving clinical outcomes.</p> <p>Far too often, the philosophy of emphasising process and output targets has distorted the clinical judgement of doctors.  We will focus on what is really important – clinical outcomes. </p> <p>Of course, processes are important to improve outcomes, but it must be the end result that we, on behalf of patients, measure and reward, not the means and mechanics of getting there.</p> <p>We will get rid of all politically motivated process targets not backed by clinical evidence.  We will focus on the outcomes that matter - those that support clinical results, not distort them.  And, in place of endless, prescriptive top-down targets, we will support high quality care and services.  A range of Quality Standards, prepared through NICE, will act both as a best practice guide for clinicians and as a means of holding them to account. </p> <p>NICE has already published the first three – for stroke, dementia and venous thrombo-embolism – and it will produce around 150 more over the next 5-years.  And these quality standards will cover social care as well as health.</p> <p>The care that is rewarded will be the best overall care for the patient, not simply the best care provided by a particular speciality.</p> <p>The impact of these quality standards will be felt throughout the NHS.  While services will be local, the quality standards mean the Health Service will remain National. </p> <p>They will mean that patients can expect the same high standards of care wherever they are in the country.  They will be used by commissioners when they plan and commission services.  They will feed into contracts with providers.  They will enable providers to be rewarded when the quality of their care is excellent, penalised if it is poor. </p> <p> <strong>Patient choice</strong></p> <p>But the change goes beyond a technocratic focus on clinically agreed ‘care pathways’.  For the White Paper also heralds a new era of patient power.</p> <p>As all good professionals know, the outdated, paternalistic caricature of Dr. Finlay’s “doctor knows best” attitude is out of keeping with the modern provision of healthcare.  The patient must be central to all decisions taken about their care.  To put it another way, there must be “no decision about me, without me”.  This isn’t just cosy sentiment.  The evidence from around the world shows that involving patients in their treatment improves the effectiveness of that treatment, increases their understanding of their condition and boosts their satisfaction.</p> <p>Patients will have more control over their own records.  With the support of their doctor, they will be able to choose their provider, their consultant-led team, their GP practice, their treatment where clinically appropriate, and a host of other things. </p> <p>And to help them make these decisions, and to help clinicians to respond to their decisions, they will have access to a huge amount of easy-to-understand data, published online.  Over the next few years, patients will experience an information revolution. </p> <p>And all the way, the voice of patients will help shape local services.  LINKs – Local Involvement Networks – will become HealthWatch, giving patients a far stronger voice. </p> <p>Funded by and accountable to local authorities, they will make sure the views of the public are heard when services are designed and commissioned.  They will help people, especially the vulnerable, to make the most of the choices available to them. <br />HealthWatch will be a new local consumer champion, supported by HealthWatch England within the Care Quality Commission.<br />Both will, for the first time, give patients and members of the public real powers of scrutiny over local health services.</p> <p> <strong>Autonomy, accountability and democratic legitimacy</strong></p> <p>The title of the White Paper is, as I said earlier, Liberating the NHS because that is how we will achieve the real gains.  We will liberate clinicians from top-down targets and endless micro-management from, well, from people like me.</p> <p>We will create an NHS run by empowered professionals free of the shackles of central government.  The NHS has received massive investment, but it is also drowning in bureaucracy.  We will cut the red tape and sweep it away, letting NHS professionals organise themselves locally. </p> <p>The responsibility of designing, commissioning and paying for local services will be given to groups of GP practices.  This will ensure that decisions are clinically led, involving all other healthcare professionals – hospital consultants, nurses, social care workers – to design services that put patients first and are focussed on improving clinical outcomes.</p> <p>When GPs commission services, they will be able to do so, where appropriate, from ‘any willing provider’.  This will introduce a new level of competition.  It will stimulate innovation and increase productivity within what will become the largest social market in the world.</p> <p>The way we pay those providers will change.  We are designing a new more transparent, comprehensive and sustainable system of payment.  One that incentivises efficiency, quality and integration.  Money will follow the patient, creating a huge incentive for providers to constantly improve the quality of care.</p> <p>As a recent report – ‘Reform, Competition and Patient Outcomes in the National Health Service’ – concluded, “The effect of competition is to save lives.”</p> <p>Within this new environment, the role of Monitor, as an economic regulator, will be vital.  It will act to ensure free and fair competition within the NHS social market – regulating prices and investigating both providers and commissioners who act in an anti-competitive way.</p> <p>Local government will also have a greater role, with local democratic accountability introduced to health service decision-making for the first time in almost 40 years.  Local authorities will help to join up the commissioning of local NHS, social care and public health services. </p> <p><strong>Culture of efficiency</strong></p> <p>The changes set out in the White Paper will have a profound impact on the way that healthcare is organised and delivered in England.  But as we improve health outcomes, we must also instil a new culture of value and productivity within the NHS.</p> <p>These reforms are necessary in themselves.  We would be making them whatever the financial circumstances.  But the economic backdrop will provide added impetus to them.<br />We need to fashion a vibrant, creative NHS, full of ideas about how to improve quality and, at the same time, reduce costs. </p> <p>The incentives in the system that I have already mentioned – a massive increase in information and patient choice, a move to any willing provider and transparent payment systems – will, over time, have a significant impact on NHS productivity.</p> <p>But in the nearer term, we can do a great deal to cut bureaucracy and increase efficiency.  Over the next 4 years, we will reduce NHS management costs by more than 45%.  Cuts on this scale don’t mean shaving off a bit here and a bit there.  It requires a whole new approach to NHS management.</p> <p>PCTs, along with their £1.5 billion a year administrative costs, will go with the arrival of GP consortia.  SHAs will be abolished.  The Department of Health’s NHS functions will be radically scaled back. </p> <p>Regrettably, this will mean unavoidable job losses.  But we are doing all we can to minimise their number.  The 2-year public sector pay freeze for everyone earning over £21,000, while difficult for some, will help us save around 150,000 jobs.  Jobs that will concentrate on the front line rather than in management and administration.<br />Public Health and Social Care</p> <p>This White Paper focuses specifically on the NHS.  But our ambition reaches far beyond it.  By the end of this year, we will publish a Public Health White Paper and next year a Social Care White Paper.  They will set out our plans to integrate the NHS and social care, and to create a Department of Public Health - changing the very shape and definition of healthcare in this country.</p> <p><strong>Consultations</strong></p> <p>Last week we set the goal – this week we have started the work.  We have now launched three consultations: on commissioning, the outcomes framework and local democratic legitimacy. <br />They will start the process of filling in the detail of our proposals and signal the way in which we will take reform forward.  Every step of the way we will involve the public, NHS and social care staff, local authorities and other interested groups to create an NHS that is genuinely responsive to people’s needs and properly grounded in the evidence of what works. </p> <p>And as leaders in your field, I urge each and every one of you to grasp this opportunity to contribute and help shape the NHS for a generation.</p> <p><strong>Conclusion</strong></p> <p>Let me be clear, re-organisation on this scale will not be easy.  It will not be painless.  But neither the NHS, nor the patient, nor the taxpayer can afford the costs of the current bureaucracy.  </p> <p>In the coming months, the Secretary of State amd I, other Ministers and Clinical Leaders will travel the country seeking, first hand, people’s views about our plans. </p> <p>Like all other public services, the NHS must re-examine every aspect of everything it does.  The only difference is that by protecting the NHS budget and reinvesting any savings, we will ensure that it is not the sick who are asked pay the massive debts left by the last government. <br /> <br />Our ambition remains undimmed despite the economic climate.  And we need to keep our eyes on the prize.  An NHS led from the front.  Patients in charge of their own care.  Every penny spent going to where it belongs, on front line patient care.  And most of all, healthcare as good as, or better than, anywhere in the world.</p> <p><br /> </p> None Simon Burns MP Reform: More for Less in the NHS: Saving Money and Improving Quality Department of Health 2010-07-22
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March 2011
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