This has been a busy year for the NHS.

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Over this past twelve months, we’ve seen:
• breast and bowel cancer screening – expanding ahead of schedule,
• MRSA down 17% - C.diff down 15%,
• 19 out of every 20 women now seen by a midwife in their first trimester – up 8%,
• almost ¾ million more people accessing NHS dentistry
• national waiting times kept low – with the average time patients wait for their operations lower,
• And mixed sex accommodation – dramatically down by 83%.
All this in a year that saw one of the harshest winters in memory, and significant increases in demand:
• with over half a million more people treated in hospital,
• and over 100,000 more diagnostic tests year on year.

All this with spending up by just 2.2%, and while SHAs and PCTs have reported an overall surplus of over £1.3 billion.

During a time of change...
when every day brings new challenges...

the people of the NHS have – yet again – proved just how resilient, how dedicated and how determined they are to improve care for patients.
So I want to start by saying thank you.
The Pause

The last year has been busy for other reasons too.

• We published a White Paper in July,
• we held a full statutory consultation in October and responded to it in November,
• and we published the Bill in the New Year,

But while we were pressing ahead, there grew an increasing perception among some people – too many people – that the Bill could pave the way for things that they didn’t want.

At the same time, too big a gap had opened up between what was actually happening on the ground and what was perceived to be happening by the commentariat at Westminster.
We needed a way to reconnect, to reassure those with genuine concerns, and to learn from those already implementing the changes locally about how to make the plans better.

So in April we took the unusual step of pausing the progress of the Bill.

The Future Forum, under Professor Steve Field, enabled us to look again at the detail of the Bill and the issues related to it. Issues of implementation and things like education and training.

It gave us an opportunity to address head on the concerns that people had.

Some 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 this.

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 providers to flourish.

Some groups of clinicians, like the RCN, were concerned that the make up of local commissioning was too narrow.

The pause allowed us to ensure – rightly – that commissioning is about clinical leadership across and beyond health and social care, bringing people together to design better services.

And I know from the many letters we received from members of the public, that some people feared the Bill would undermine the values of the NHS.

I would never let that happen.

But we have now, I hope, reassured people of our commitment to the fundamental values of the NHS – of healthcare for all, free at the point of need. And to strengthening the NHS constitution as a basis for what we do.

The pause gave us the opportunity to build a greater sense of ownership - essential for proper implementation.

And it enables me to assure you that the Coalition Government is fully committed to the NHS and its modernisation.

The Future Forum did a fantastic job. And I would like to thank all the managers who worked so hard to develop its recommendations.

They recommended that the pause should end.

It has.

But that doesn’t mean we’ve stopped listening.

And on Monday I will discuss with members of the Future Forum what implementation challenges they might help us with next.

Principles

While there have been substantial changes, the guiding principles remain.

I said that to you last year that, “patients must be at the heart of everything we do, not just as beneficiaries of care but as participants in its design”.

That still stands.

Last year I said that we need a, “rigorous focus on outcomes with the ambition of securing results and healthcare services in this country that are amongst the best in the world.”

That still stands.

Last year I said we must set professionals free to, “use their clinical judgement to do their jobs to the best of their ability and on the basis of the evidence.”

That still stands.

And last year, I underlined the central importance of emphasising public health and modernising social care as part of a comprehensive set of long-term reforms.

That still stands.

Momentum

But my main message to you today is that, after the pause, it is now time to move forward and get on with improving services for patients.

Listening to GPs at pathfinder events or at the NAPC, I know that while our plans were in flux, some became less keen to commit to long-term changes. And some of them – some of you, I know – will have felt unsure about how to proceed.

Well it’s now time to regain the momentum.

To get back on the front foot.

To focus again on the challenges we all face.

Pathfinders

And to underline that return of momentum, I am pleased to announce today the fifth wave of Clinical Commissioning Group Pathfinders.

The 35 new Pathfinders bring the total to 257, covering almost 50 million people, around 97% of the population in England.

Some PCTs have already delegated budgets and commissioning responsibilities to pathfinders, and I hope the majority will by next April.

By October next year, the NHS Commissioning Board will begin to establish full Clinical Commissioning Groups, delegating budgets to them directly.

And by April 2013, Commissioning Groups will start to take statutory responsibility in their own right.

You will hear more on this tomorrow from David Nicholson, but it will be the mission of the NHS Commissioning Board to help local commissioning groups to get up and running as quickly as is sensible to do so.

Only when commissioning is both clinically-led and local can it bring about the transformation so critical to meeting the challenges of the next 10 years.

Challenges

And those challenges are great. As I see it, there are four major challenges facing the NHS, and facing you as managers.

• to increase productivity
• to improve patient care
• to reshape how care is delivered
• and to integrate care around the needs of patients.

The first then, is to dramatically increase productivity year after year.

We will do this by by providing better care.

• By treating more people closer to home,
• By focussing on prevention as much as on cure – like in Sandwell, where the PCT and the local authority are working together to improve sexual health,
• by eliminating errors and avoidable harm – like maintaining a zero-tolerance approach to MRSA and c. Diff,
• and by integrating and streamlining care.

Making big savings must not be about crude cuts to services.

Not when it can be about making them better.

The second challenge is to significantly improve the quality of patient care.

I know people are generally satisfied with the NHS. But if people were only aware of the variations in the quality, they’d be shocked!

Just look at the report on palliative care by Tom Hughes-Hallet and the variations he highlighted.

The NHS can be so much better. You know it. I know it.

We need to measure more, to publish more, to incentivise more.

In the coming years, we will give England the most transparent healthcare system in the world.

As the Prime Minister said this morning, transparency is a central tenet of this government’s approach to improving all public services.

Up to now, this approach has worked for waiting times.

In the coming years we want to publish far more data on clinical outcomes for public and clinical consumption.

Data like hospital mortality rates for bowel cancer surgery – published this year – rates that vary from less than 2% [1.7%] to more than fifteen [15.6%].

Every doctor, every nurse, every manager, every provider wants to be as good as they can be. In a transparent NHS, everyone will see just how good they are.

Professional pride, patient choice and financial incentives will drive outcomes ever upward.

The third challenge is to reshape NHS care.

More community based care – like how people in Whitstable no longer go to hospital for an endoscopy, they have one at their local GP surgery.

More specialist care in centres of excellence.

Like the new Centre for Surgical Reconstruction and Microbiology in Birmingham, which brings together trauma surgeons, research scientists and others from the military and the NHS – pushing the boundaries of major trauma care.

Every provider – especially hospitals – needs to take a deep and profound look at the services they provide and at how they provide them.

The best hospitals no longer think of themselves as a physical place – as bricks and mortar – but as providers of excellent health care.

Not so much a Hospital Trust, or a Mental Health Trust, but a Healthcare Trust.

Like Croydon Health Services, which provides both hospital and community services through a number of community and specialist clinics throughout the area.

This flexibility makes adapting creatively to change far easier.

But change, even when clinically justified, will be difficult.

People form a strong emotional bond to the places that may have saved their life or that of a loved one.

So it is incumbent upon us to make the argument for pressing forward.

Change must be – and seen to be – clinically, and never politically led.
Of course, the NHS will always be political to an extent.

Government sets the overall budget.

And we’ve amended the Bill, reaffirming that Ministers are accountable overall, with a duty to promote a comprehensive health service.

But the political balance needs to change, with no more interference in the day-to-day running of the NHS.

Now I know there is a lot of direction from the top at the moment, but I want it to be a transient step towards a truly liberated NHS.

An NHS accountable to patients more than anyone else.

For we know that 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 flourish.

The fourth challenge is to cut bureaucracy and to integrate services around the needs of patients.

Last November, my father died. While his care was good and, with the support of the NHS community services and Marie Curie Cancer Nurses, he was able to have a ‘good death’, it was not without its problems.

While the people in the NHS he encountered looked after him extremely well, in the early stages the service as a whole was fragmented and uncoordinated.
At one stage, I couldn’t work out who was in charge: his GP, his oncologist, his palliative care consultant or the hospice?

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 proper integration of services built around the patient.

You all know me as a critic of excess bureaucracy, of red tape, of an over-administering NHS.

And I know from long experience that many of you are among the most vocal opponents of excessive bureaucracy.
It must stop. We can’t afford it. It stifles innovation. And it gets in the way of providing the best patient-centred care.

Importance of managers

Without high quality management, we cannot hope to meet the challenges we face.

Without good managers, we can’t achieve the efficiency gains so vital to the NHS.

Without good managers, we can’t take the leap forward we want in patient care.

Without good managers, we cannot re-shape NHS services.

And without good managers, we cannot create a streamlined, integrated NHS.
Modernisation is every bit as much about organisational leadership as they are about clinical leadership.

Conclusion

These challenges, these changes, will have a significant impact on each and every one of you. There is a huge amount to do, a huge amount to get to grips with.

I know this is a tough time for many of you.

I understand the difficulty of the position some of you find yourselves in.

But patients need you to keep at it. To do what is necessary to make the transition to the new system a smooth one.

So it is time now to look these challenges in the eye.

To do what’s necessary to meet them.

To regain the momentum.

So I ask you to return to your organisations with one simple message.

The pause is over.

It’s now time to act.

Thank you.