Alan Johnson, Secretary of State for Health, speech to the NHS
Confederation Annual Conference, in Manchester
18 June 2008
Check Against
Delivery
I’m delighted to be able to
address NHS Confederation’s Annual Conference, particularly here,
in Manchester, where on 5 July, 1948, just a few miles from here,
Nye Bevan opened the very first NHS hospital.
It marked the beginning of the
remarkable adventure that we are still engaged
in.
It’s an adventure I am honoured to
be part of, particularly in the NHS’s 60th
year.
Just under a year ago, when I was
appointed Secretary of State for Health, I was asked what the NHS
meant to me. The answer I gave was serenity – although the NHS was
created in living memory, we can no longer imagine a time where you
had to worry about whether you’d be able to afford treatment if you
became ill. A world without the peace of mind provided by universal
healthcare is inconceivable to people today.
I am passionate about tackling
health inequalities because the disparities undermine the concept
upon which the service was created. This has nothing to do with
class warfare. At education, the cause was to improve our schools
to a standard of investment, attainment and extra-curricular
activity that matched public schools and encouraged parents who
were wealthy enough to access private education to send their
children to a state school.
In health, the goal is similar. We
have no interest in creating a system that simply concentrates on
improving health of the poor. The great doyen of social policy
Professor Richard Titmuss was right to point out that poor public
services become public services for the poor. So improving the
health of people from all social classes, whilst seeking to improve
the health of the poorest the fastest, makes the gap harder to
close, but ensures that people from all backgrounds use the NHS
because it’s as good or better than anything on offer in the
private sector.
Our great achievement in tackling
health inequalities is that the health of the poorest, whether
measured by the life expectancy or by infant mortality, is now at
the level that the rest of the population enjoyed when we first
came into government. It demonstrates what can be done when you
make tackling health inequalities a political
priority.
I can offer more personal
reflection as I approach my first anniversary as Health Secretary.
I have a huge respect for the good ship NHS and all who sail in
her, but it’s not born out of any kind of sloppy sentimentality and
I do recognise that the role of politicians is not to pretend
they’ve become instant experts on the complex and diverse nature of
healthcare and medical science. Neither is my role to protect the
vested interests of various professional bodies who, from time to
time, dress their self interest in the clothes of patient
concern.
My role is to use the power vested
in me sensitively, collegiately and effectively, to ensure that
people of this country, to whom I am indirectly accountable, get
the properly resourced, high quality healthcare that they are
entitled to expect.
I don’t claim that we’ve reached Nirvana yet, but I think it’s fair
to say that when the service was approaching its golden
anniversary in 1997, it was a very sick patient.
People didn’t wait weeks for life-saving
operations, they waited months, even years, many dying on waiting
lists. They didn’t wait days for an appointment with a GP, they
waited weeks. They didn’t wait just four hours to be seen in
A&E, they sometimes waited 24 hours or more.
The health inequalities
gap actually got progressively wider.
The mortality rate among men of working age in the early 1970s was
almost twice as high in unskilled groups as for those in
professional groups. But by the early 90s, the gap was three times
higher.
Eleven years ago, the NHS was not so much in
need of repair as resuscitation. Increased investment has obviously
been a major element in the treatment. The transfusion of money
heralded by the NHS Plan in 2000 has seen spending on health rise
to within touching distance of the European
average.
Today, 99 per cent of patients with suspected
cancer are seen by a specialist within two weeks, compared to less
than two thirds in 1997.
Mortality rates for cancer have fallen by 17
per cent, saving 60,000 lives and for cardiovascular disease, by 40
per cent, saving 178,000 lives.
More people with long-term mental health
problems are being supported at home and in the community, with the
addition of 760 new community mental health teams providing home
treatment, early intervention or intensive support for people who
might otherwise have been admitted to hospital
Major investment in facilities means that from
the beginning of this year, one new building has been opened every
week for primary and social care, and there will be 122 new
hospitals open by the end of 2010.
The structural changes of the last eleven
years have been difficult but essential reforms to improve how the
NHS works and support good leadership.
Whilst health has unquestionably been the
overwhelming priority for this government, its transformation has
nothing to do with political fervour. All we have done is enable,
encourage and support those who work in the NHS to do what they
have always wanted to do – improve patient care.
Managers in the NHS are as important in this
transformation as anyone else. Better services for patients and
greater financial stability require excellent leadership. The
commitment and dedication of managers and leaders to deliver change
has played a significant role in these
achievements.
Rudolph Klein, the great historian of the NHS
pointed out that in the 1970s, that waiting lists had remained
stubbornly at around 600,000 and every successive Minister pledged
to reduce them. In his words, “The captain shouted his orders from
the bridge and the crew carried on as before.”
Ten years ago, reducing waiting times looked
like Mission Impossible. Five years ago, it seemed we’d never be
able to stop the rise in hospital acquired infections. Eighteen
months ago, the idea that we could turn a deficit into a surplus
seemed unrealistic. Managers, leaders and staff have achieved what
many believed was impossible and I’d like to thank you for that
today.
The fundamental principles of the NHS are as
valid today as they were 60 years ago, but the world has
changed.
The NHS was conceived, in a time of austerity,
when rationing was getting tighter – in 1948, when London hosted
the Olympics, British athletes were dependent for their nutrition
upon food parcels from Australia and other commonwealth
countries.
It was an age of acute and infectious disease,
where as today, we battle with lifestyle and chronic disease. Even
Nye Bevan could not predict that the first generation of children
to grow up with universal healthcare would be the longest lived in
this country’s history – something we should celebrate, but that
also presents new challenges.
Binge drinking among the young was unknown.
The only people who did drugs were aristocrats and debutants.
Sedentary lifestyles were confined to the elderly.
Televisions were becoming increasingly common
in people’s homes, but no one would have imagined a device that
avoided the exertion of having to get up to switch it
off.
Today, we lead lives that are more hectic but
less active. New technology has not only brought us unimagined
medical advances, it has also changed the way we work, and
communicate and make choices. We are consumers of information about
health in general and our own health in particular, in a way that
was inconceivable 60 years ago.
The NHS is fitter and stronger than it has
been at any stage in its history. Yet it still struggles to keep
pace with rising expectations and with growing threats such as
obesity. Bevan himself drew attention to the inevitability of these
developments, saying in the week before the NHS was launched that:
“This service must always be changing, growing and improving; it
must always appear to be inadequate.”
The reforms of the last
eleven years have been in every sense a prelude to the Next Stage
Review. I can’t lift the veil on the final report today but I can
show a bit of leg, so to speak and say what it won’t contain. As I
said a year ago, it will not introduce structural change. There
will be
no more top-down reorganisations of primary care trusts or
strategic health authorities. There will be no new national
targets.
I’m not usually in to management
consultant speak books, but I recommend Jim Collins’s “Good to
Great,” which examines how good companies can improve their
performance. The Next Stage Review is about how we move the NHS
from good to great. From world class in many aspects to world class
in every aspect.
As Jim Collins says, you can mandate “good” but greatness can only
be unleashed, which is why the content of this report will be
determined by the local visions published in each Strategic Health
Authority, which set the direction of health services in every
region of the country. They have been developed locally because
local clinicians, patients and managers are best acquainted with
the specifics of improving patient care and the knowledge and ideas
necessary to shape Ara’s national enabling
framework.
Existing national targets on tackling
infection, reducing waiting times and reducing health inequalities
will remain essential drivers of performance. Investing in primary
care, particularly in areas where provision is scant, will remain a
national priority and despite noises off stage we will continue to
advocate nationally in the interests of patients for improved
access and higher quality.
Integration is the great strength of the NHS.
It needs to be enhanced, not diminished, so it is right that there
are national standards determining good quality care and ensuring
that it is available to all. But the system relies
fundamentally on strong local leadership that enables clinicians to
deliver the best possible care to patients.
Ninety per cent of all contacts with the health service happen in
primary care. The Primary Care Strategy
we publish with the Next Stage Review will present a vision that
puts primary and community care centre stage, with a relentless
emphasis on promoting good health and wellbeing.
Our understanding of how disease develops and how to detect and
treat illness has vastly improved since 1948. We can screen for
more conditions, we can vaccinate against more deadly diseases, and
advances in genetics mean we can predict and prevent to a far
greater degree. The NHS was created several years before scientists
confirmed the connection between smoking and lung cancer. We now
have a profound and unprecedented understanding of how diet,
exercise and smoking can affect people’s health.
And it is in primary care that we
must put this understanding to good use. Primary Care Trusts will
have a unique role to play as local leaders, working in partnership
with local authorities, schools, employers and children’s centres
to promote good health and wellbeing. Incidentally, a recent survey
in London showed that over 50 per cent of the public don’t know
what a PCT is or does.
Just as the North West Strategic
Health Authority refers to itself as NHS North West, there is no
reason why Trafford Primary Care Trust shouldn’t call itself NHS
Trafford - it would certainly better reflect the wider role
expected of them and the public would understand their work much
better than if it continued to be described as a primary care
trust.
Irrespective of titles, they will
have to be champions of good health, not just providers of health
services and to listen and respond to the needs of local people –
as indeed the best primary care trusts already
do.
Rising expectations, an ageing population,
lifestyle epidemics, the focus on health promotion and the need to
shape change locally to respond to patients concerns will place
different demands on staff.
Sixty per cent of the NHS staff who will be
delivering services in ten years’ time are already working in
healthcare – many will have been working there for a decade or
more. As advances in medicine come thick and fast, the need to
improve and update clinical care is constant.
The Workforce Strategy that forms part of the
Next Stage Review will set out how we can support nationally the
excellent training and development and workforce planning we need
at local level, to meet the priorities that each strategic health
authority has identified.
The overwhelming emphasis of the
Next Stage Review is on quality. Managers and leaders need to be
the champions of quality in all aspects of care - this is how success must be
measured. It is important that we measure not only the
effectiveness and safety of patient care but also how
compassionately that care is given.
It is often said that the NHS is
data-rich and information poor. One of the challenges of the next
few years will be to find better ways of converting that data into
intelligence that can improve patient care.
The Interim Report said there
would be a quality framework that would establish a clear framework
and standard ways of measuring performance.
We have already started working
with NHS staff and professional bodies to identify ways of
measuring the quality of care that staff provide for patients. We
are developing these measures – or metrics, as they are more
usually referred to – in partnership with staff. They will
primarily be used by clinicians themselves to benchmark their
performance and lead improvement.
It is expected that they will encompass patient experience, safety
and
clinical and patient-reported outcomes.
They will include, for example, measures of the
effectiveness and safety of nursing care, and also, crucially, how
compassionately that care is delivered.
Excellent clinical care and clean hospitals
are what patients expect of the NHS. But they also have the right
to be treated with dignity and respect – to be treated as people,
not just as symptoms of disease. It should come as no surprise that
patients and the public are dismayed when staff fail to get the
little things right - not closing curtains properly during an
examination, failing to help patients eat at mealtimes, leaving
patients and family unaware of what’s happening to
them.
The most clinically skilled doctors, nurses
and surgeons in the world will inspire little confidence if
patients feel ill-informed, if they are ignored, treated
dispassionately or without sensitivity.
This is something that most staff know
instinctively. When over 700 nurses at this year’s RCN national
congress were asked what single factor could best measure the
quality of care, the most popular response was respect and dignity,
closely followed by communication. Nurses involved in the clinical
working groups for the Next Stage Review all said that how we
measure the success of what nurses deliver needs to reflect whether
patients were treated with compassion and sensitivity and how well
their dignity was protected.
So the Workforce Strategy element of the
Review will set out how we will work with the RCN, UNISON, and
other leaders of the profession to better define and measure the
quality of nursing care – not just its effectiveness and safety,
but also taking into account the crucial area of patient
experience.
Almost exactly sixty years ago, on
4th July, the eve of the birth of the NHS, speaking at a
rally in this very city, Nye Bevan said that the eyes of the world
were turning to Great Britain. It took another 20 years for the
Swedes – world leaders in social progression – to copy our
system.
Many aspects of the National Health Service
are still admired across the globe. But the NHS has no divine right
to be admired and respected. It’s not a constitutional necessity
for citizens to treat it as the most cherished of British
institutions.
Rudolph Klein remarked that the
NHS provided the paradoxical spectacle of contented consumers and
disgruntled producers. I want to ensure that the NHS continues to
earn the public’s affection and for those who work in it to feel
that they have a role in shaping the high quality services they
provide.
With the Baby Boomer generation becoming more
frequent users of the NHS, it will be subject to even greater
scrutiny and more sophisticated and knowledgeable interrogation.
The Next Stage Review will be the most important development in the
history of the NHS and the successful implementation of its
conclusions, with your support and advocacy, will further secure
its future.
| 
