nhs reforms

8/2/2019 NHS Reforms

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Speech on NHS Monday 16 May 2011

1 | P a g e Tamuna Mekoshvili Documents

Prime Minister David Cameron has delivered a speech at Ealing Hospital restating the case for

change in the NHS.

Six weeks ago, we announced a pause in our plans for the modernisation of the health service.Since

then theres been a whole flurry ofdebate.Column inches have been written. Concerns aired.

Passions raised.That goes to show something Ive known all along: that the NHS is the most

important thing to Britains families.

Well, let me tell you this.Its the most important thing to my familytoo.Thats why, over four years

ago, I got up on a platform like this and said that you could sum up my priorities in just three

letters, N-H-S.Since then, if anything, the feeling has got stronger.

My determination to deliver a first-class, world-class health service thats got stronger.My

determination to make sure the poorest people get the best care thats got stronger.My

determination to protect the core principle of the NHSthat all have access to healthcare

regardless of their wealththats got stronger.Thats what fires me and I know thats what fires

everyone else.

We have an institution a precious idea that says we are in this together; looking out for each

other. So this government will never, ever take risks with the NHS. We will make it better. Thats

why, despite all the financial constraints, we are protecting the NHS budget from cuts.

This year, and the year after, and the year after that, NHS funding will increase in real terms.

Whats more, since weve come to office: We have introduced a new cancer drugs fund, helping

2,000 patients get access to drugs they would have previously been denied. We have cut the

number of times a patient has been placed in mixed-sex accommodation without justification by

half.

We have kept up the pressure on hospital-acquired infections, reducing the number of cases of

MRSA and C Difficile. And for the first time in a long time, we have made sure the number of doctors

in our NHS is growing while the number of bureaucrats is actually falling. But I know that some

people still have concerns. They might be listening to this and thinking

OK, but if you love the NHS so much, if you dont want to take any risks with it, why do you want

to change it? But this is the point: Its because I love the NHS so much that I want to change it

because the fact is the NHS needs to change. It needs to change to make it work better today and it

needs to change to avoid a crisis tomorrow.

Let me take each of those points in turn. Change needed today. First, we need change to make it

work better today. I know that as soon as I say this therell be people lining up, accusing me of

talking down the NHS.


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Ill say it again I love the NHS. And yes, in many ways the NHS is providing the best service it ever

has. Waiting times for tests and treatments have dropped dramatically and access to cutting edge

technologies like primary angioplasty is becoming common-place, saving thousands of lives. But Im

sorry I just do not think we do anyone any favours

not the patients who use our health service, the professionals who work in it or the taxpayers who

pay for it if we deny that there are problems with the way the NHS works today. Ive been to

hospitals and surgeries up and down the country Ive spoken to consultants, nurses, midwives,

physios, GPs .I receive a vast mailbag from patients, both as a constituency MP and as Prime

Minister and this is the resounding message Ive got: Yes, we love the NHS but yes, there are

some real problems.

Theres the problem of waste and inefficiency. This isnt just about the one-off cases weve all read

about like the 400,000 one health authority spent on a yacht. Its the way the system can

encourage over-spending. If a hospital doesnt balance its books, year after yearthen that

hospital will be bailed out and subsidised by the surpluses taken from other hospitals which have

kept within their budget.

If there is one health authority that invests money into the prevention of diseases like diabetes

and another that is poor at prevention, has poor quality outcomes and overspends then money

is snatched from the former to prop up the latter. Then theres the problem of too much top-down

control, stopping doctors and nurses from doing what they know is best. Today we have the

situation where a GP and an orthopaedic surgeon can both see an elderly person having problems

walking both recommend a knee operation and both be over-ruled by someone who has

never met the patient. We have a commissioning process where a tier of management, who sit

above doctors, are in charge. Yes, these managers do important and valuable work.

But theyre not on the frontline so sometimes, they dont know precisely what local patients need.

Dont take my word for it. Last year, the Health Select Committee said Primary Care Trust

commissioning is widely regarded as the weakest link in the English NHS, citing their lack of

clinical knowledge in particular. This is what top-down control is doing to our NHS and I believe

it should change. Then theres the inflexibility of the NHS and this is what frustrates so many

patients, and indeed nurses and doctors.

The mother who wants to give birth in the big county hospital but have her scans done more

locally shes told no because of the contracting arrangements between different hospitals shes

got to go where shes told. The woman who needs surgery, who knows theres a great private

hospital just down the road, where theyll do her operation at NHS standards and at NHS costs

but shes told no shes got to go to a specific NHS hospital, that could be miles away, because

thats where she was seen before.

I was sat in a surgery in Birmingham last week, listening to the doctor explain that he has world-

class physiotherapists in the same buildingbut he cant refer his patients to them because the

current system stopped it. This is frustrating enough, but add to it to the lack of co-ordination and

integration.


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Modern healthcare needs to be joined up, but we have a system today where different nurses and

doctors sometimes have to start from scratch when they each see the same patient. We have a

system where different elements of a patients care primary or secondary can occur in isolation

to one another. This doesnt just cause stress and inconvenience, its just not conducive to

delivering the best quality healthcare possible. And quite apart from these frustrations, patients

also have to tolerate disparities in the service offered in one part of the country to another.

Whether its the quality of care people experience, the type of treatment available, or the outcomes

achieved too much comes down to luck and where people live. In Britain today, we have some

great, world-leading, groundbreaking hospitals. Take the Royal Marsden, which will soon go live

with CyberKnife, the latest in radiotherapy technology. But in other hospitals, in other parts of our

country, patients are treated with much less sophisticated equipment.

And in some parts of the UK, you are three times more likely to die of a stroke than in others. I dont

think people should have to put up with this unfairness. We have a duty to do what we can to close

the gap between the best and the rest. As Lord Darzi, the last governments Health Minister, said:

we need to ensure high quality care for all. Now some people say that some inefficiency, some

hassle, some disparity in service are just the price you pay for a health system like ours.

But look abroad and youll see thats not the case. Ive listened to doctors and I know how much

they care about getting good outcomes and I know the statistics tell a better picture than we in

this country sometimes get credit for. Were getting better, and in some cases were closing the gap

with our European neighbours, but weve still got some way to go.If we had cancer survival rates at

the average in Europe, wed save 5,000 lives a year.

If we had respiratory disease care equivalent to the average in Europe, wed save 2,000 lives a year.

If we could prevent and treat chronic liver disease and cirrhosis as well as the European average,

we could save 550 lives a year. Were approaching the European average spending on health.

I just think its time we had the confidence to say we should have some of the best health outcomes

in Europe too. Saying this doesnt make you anti-NHS it makes you pro-NHS because you want

to make things better for everyone. Modernise today or crisis tomorrow. So thats the first reason

we need change to make the NHS better today.

The second reason is that if we dont modernise now, we face a crisis tomorrow. The NHS is facing

enormous financial pressures in the years ahead driven by rising demand and the cost of new

drugs and technologies.

Lets take demand first. Thats in part down to the achievement of our health system people are

living longer. For the first time ever there are more pensioners in this country than children under

16. And the number of people aged over 85 is set to double in the next twenty years.

Just think about what that will mean. Every hour the NHS deals with more than 25,000 people

think how many of them are elderly, and then consider with our population ageing at the rate it

is how those numbers could rise dramatically. And the type of care and treatment they need is

changing too. In the old days, healthcare was often about lifesaving treatment at a moment of crisis.


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So, responding medically to heart attacks and strokes. Treatments for diseases like cancer.

Today, the big killers of the past are becoming the lifelong conditions of the future. Between 1978

and 2008, the death rate from coronary heart disease fell by over seventy-five percent. That is

fantastic news for families indeed for our whole country but there are clear financial

implications. Already three quarters of the health and care budget goes on long term chronicconditions and the pressure is going to get bigger.

In just eight years, the number of people with three or more long-term health conditions is set to

rise by thirty per cent. Indeed, by 2050, the number of over sixty-fives with one or more long term

conditions is expected to rise by 252 per cent. But these demands on our health service are not just

driven by an ageing population.

For while we are living longer, in many ways we are also becoming less healthy.

Obesity and poor diets. Drug and alcohol abuse. These public health challenges are getting bigger

and bigger. Take obesity: it already costs our NHS a staggering 4 billion a year. But within four

years, that figures expected to rise to 6.3 billion. Already we can see the impact of all these rising

pressures. For example, 2, 700 more planned operations are carried out on a typical day than was

the case just four years ago. That is the truth of the rising demand the NHS is facing.

But its not just increasing demand. Its also about the rising cost of treatment. The overall cost of

medicines has been growing on average by nearly 600 million a year. A lot of this is driven by new

treatments coming on stream. Ten years ago no one had heard of the cancer drug Herceptin. Now it

is widely available for the women who need it at a cost of almost 100 million a year.

For diabetes, the cost of newer treatments meant drug costs rose by 200 million over five years

thats an increase of forty-two percent. Timely interventions with effective new drugs andtreatments can of course save money. But when a new gene test can costs thousands and when

robots costing millions are increasingly the right option for complicated surgery, the pressure on

costs far outstrips any potential efficiencies. And its not just the pressure from the increasing use of

existing technologies.

Right now scientists are working on artificial limbs that are controlled by thought alone.

Breathalyzers that can diagnose disease with one puff. Kidneys grown in laboratories from stem

cells. A world class health service demands these advances. Our NHS and its patients should get

them. But that will only happen if we find a sustainable way to deal with the rising costs .Sticking

with the status quo and hoping we can get by with a bit more money is simply not an option.

If we stay as we are, the NHS will need 130 billion a year by 2015 meaning a potential funding

gap of 20 billion. The question is, what are we going to do about that: Ignore it? No because wed

see a crisis of funding in the NHS, over-crowded wards and fewer treatments. Borrow more so we

can chuck more money at it? No because we cant afford to.


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Ask people to start paying at the point of delivery for it? No because as I said, the NHS must

always be free to those who need it. Theres only one option weve got and that is to change and

modernise the NHS to make it more efficient and more effective and above all, more focused

on prevention, on health, not just sickness. We save the NHS by changing it. We risk its long-term

future by resisting change now.Deep down even Ed Miliband knows this.

Thats why he said to create an ever better health service, change will be essential. Listening

exercise So this is the consensus: no change is not an option. But we have to make sure it is the right

change, delivered in the right way. Change needs to go to the heart of the current problems I have

described and the future challenges I have set out. It must tackle the waste and the bureaucracy

by reducing the overlapping layers we have today.

It must put the patient centre stage, giving them choices and chances that they are currently denied.

It must promote prevention and a healthier nation, which must mean giving GPs who are our

first contact with the system and have a good understanding of their areas health needs a wider

role.

It must tackle the longstanding and damaging divide between health and social care, including the

bed blocking that still afflicts so many of our hospitals. It must assist with the challenge to increase

efficiency, raise productivity and keep costs down so we can go on meeting everyones needs.

Change must do all these things but change if it is to endure, to really work should have the

support of people who work in our NHS. We have to take our nurses and doctors with us. They

provide the care, they know whats best for patients so we want to work with them, not against

them. Already, a significant number are on board with what we propose.

Last week, GPs representing 1,100 practices across England, caring for over seven million patients,

wrote to The Daily Telegraph expressing their wholehearted support for our reforms to

commissioning arrangements arguing they will benefitthe most vulnerable in society. But we

recognise that many doctors and nurses have concerns about what were doing. Thats why at the

beginning of last month, we decided we should pause, listen, reflect on and improve our NHS

modernisation plans. And since then, thats what we have been doing. In the past six weeks, Ive sat

with staff in hospitals in Frimley, Reading and Darlington have held events in the countrys

largest hospitals like the Queen Elizabeth in Birmingham and smaller ones like Chipping Norton

too and had meetings with voluntary bodies, community care providers and GPs.

Whats more the NHS Future Forum, the independent organisation charged with overseeing the

listening process and which is led by Professor Steve Field and includes other eminent

clinicians, patient advocates and voluntary sector representatives has met more than 4,000

people.

These meetings have been open, frank, productive above all meaningful. We are listening and

we will make substantive changes to improve the reforms, based on what we hear. I do not want to

pre-empt what those changes will be.


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The NHS Future Forum is due to report its recommendations at the beginning of next month, and

we will issue our response later in June. But it is clear for example, that when people working in our

hospitals hear the term GP commissioning, they worry its only GPs that are going to be involved in

making decisions. Now thats not the case, but I agree we need hospital doctors and nurses to be

much more closely engaged in commissioning.

But whatever the results from this listening exercise, let me be clear about the reform package that

will emerge: There will be choice for patients, not competition for its own sake. Innovation and

improvement, not breaking up efficient and integrated care. It will be evolutionary, not

revolutionary. Our changes are a logical extension of tried-and-tested policies initiated by

governments of all parties in recent years.

Clinical commissioning has existed in one form or another for the past two decades. Payment by

results, and Foundation Trusts, for the best part of the past decade. Working with others from the

independent sector too thats not new either. The NHS has a long history of this be it with social

enterprises, charities or private companies and the last government in particular understood

the importance of introducing an element of choice to drive up standards. The difference is that we

plan to make these changes effective across our NHS. As I said: evolution, not revolution.

Thats why, when I think about what our NHS will look like in five years time, I dont picture some

space-age institution, a million miles away from what we have now. Let me make clear: there will

be no privatisation there will be no cherry-picking from private providers there will be no

new upfront costs people have to pay to get care.

Absolutely not. These are red lines we will not cross. Instead, our NHS will be much like what we

have today. The values and ethos of our NHS that you care so much about and Andrew Lansley

and I care so much about they will still be there. Youll still be able to call your local surgery, and

speak to a receptionist you know to book an appointment with a GP you trust. Youll still be able to

go through the doors of an A&E in an emergency, and be seen by a nurse or doctor quickly and

effectively.

Your parents will still get the healthcare they need, from specialists and nurses on wards or in their

homes. And let me repeat: all this will still be free, to those who need it, when they need it. It will be

the NHS you love and recognise only better. You will have much greater choice of where you are

treated, and how you are treated. Youll also see much greater co-ordination and integration

between nurses and doctors and between surgeries and hospitals

So if you have diabetes, professionals will work closely together with you to manage your condition

from diagnosis onwards. In our NHS, nurses and doctors wont be passengers, they will be drivers,

supported by managers rather than in conflict with them. They understand the needs of patients,they know whats needed so they will have new powers to transform patient care in a way thats

simply never been possible before. they will have the money and the freedom to complement

their expertise and knowledge.


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So if local GPs see that there is a significant need for more respiratory services in their local area,

they will be able to organise local clinics for their patients rather than making them travel to a

hospital miles away. If nurses feel that they can deliver better care to autistic children in

partnership with a local charity, they will find it much easier to make this happen. Ours is a vision of

a stronger, more responsive NHS. An NHS with consistent, high quality care for all instead of just

pockets of excellence.

An NHS which addresses the full needs of each person of their physical and mental health

rather than offering a piecemeal or patchwork approach. An NHS free-from-political control,

where what matters is the care you receive notthe headlines governments get where a new and

independent National Commissioning Board, staffed with senior doctors and professionals, takes

responsibility for what services are provided, outcomes are achieved and how well money is spent.

A genuine National Health Service, rather than a National Sickness Service with a greater focus

on outcomes and on improving public health so people dont get sick and ill in the first place. A

NHS which makes people healthy and keeps them healthy.

Conclusion

Let me end by saying this. Its been a year since the coalition came together in the national interest.

And we take those two words national interest very seriously. We are two different parties, with

different identities, bound by one common cause to do what is good for the country. And we dont

just have the will with a full five year Parliament to work with, we also have the opportunity to

really tackle the long-term problems that have dogged our country. So thats what were doing.

Clearly cutting the deficit isnt pain-free but its in our countrys interest to bring sense to our

public finances. Reforming welfare isnt easy but its right that as we help those who genuinely

cannot work, we make sure those who can, do. Changing our education system isnt popular with

some parts of the establishmentbut we have to do it if were going to give every child the best

start in life.

And its that commitment to act in the national interest which means we will also modernise our

NHS. Believe me, it would have been so easy for me to stand on a platform like this and pretend

everything is fine, we can carry on as we are, nothing needs to change. But that would be a complete

dereliction of duty. It would run completely counter to the purpose of this coalition to act in our

countrys interest. Sticking with the status quo is not an option. That may not be easy on the ear, but

its the truth.

The NHS needs to change so thats what well do. Working with professionals, taking time to listen

and improve our proposals we will make sure we build a strong, sustainable and better NHS

free to all who need it.

Thats my commitment. Thats my promise. Thats what acting in the national interest means.