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25 November 2010: NHS Medical Directors Conference

  • Last modified date:
    19 April 2011

Simon Burns speaks at the NHS Medical Directors conference


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. 

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. 
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.

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. 

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.

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. 

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.

And we will reform the NHS as we will reform other public services, by stepping back and handing power to patients and to you. 

Go back as long as you like and the trend in government has been to centralise. 

• To gradually, almost imperceptibly, undermine local democratically elected councils by pulling ever more power to Westminster. 

• 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. 

• To undermine individual people by taking away their freedoms, clocking their every move and treating them like children rather than adults.

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.

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.

So across the public services, we are determined to reverse this trend.  We’re going to give power back.
• Back to local authorities so they can exercise their democratic mandate. 

• Back to individuals to they can enjoy their lives free from unnecessary intrusion from the State. 

• 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. 

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.

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.

Operating Framework

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&E waiting time threshold to a more clinically relevant 95%. 

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. 

We will end this pointless and wasteful obsession with process-based targets and focus on what patients really care about – health outcomes. 

Other White Paper reforms

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. 

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.

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. 

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.

Patients and their GPs will be able to choose from any willing provider. 

Money will follow the patient. 

And because of patient choice it will flow to the very best providers.   

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.

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”.

The challenge for Chief Executives, will be to lead their organisations in a spirit of openness and collaboration. 

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.

The reward for meeting these challenges will be a more vibrant, dynamic and entrepreneurial NHS.

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. 

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.

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.

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.

This tool, essentially a series of maps, shows unexplained variations in activity, spend, safety and outcomes across the country. 
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. 

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.

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. 
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. 

What do you want the NHS to be like? 
How do you want your hospital, your community service, your GP consortium to operate? 

What are the things that you always wanted to change but were prevented from doing by the heavy hand of central control? 

Now is your opportunity to act. 

To stand up and take control. 

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.


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.

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.

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. 

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.

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