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23 November 2010: NHS Employers

  • Last modified date:
    18 April 2011

Thank you Ed [Sturton].

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.

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.

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.

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.

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. 

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. 

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.

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. 

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. 

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.

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.

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. 

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. 

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. 

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. 

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. 

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.

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.

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. 

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. 

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.

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. 

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. 

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.

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. 

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.

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. 

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.

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.

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.

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.

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. 

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.

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. 

Our shared aim with staff and unions is to retain and re-train staff wherever possible.

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. 

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. 

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. 

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. 

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. 

That every penny saved, is a penny reinvested in front line care;

is a penny spent on new cancer drugs we couldn’t otherwise 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.

Thank you.

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