Statement in the House of Commons, by Rt Hon Alan Johnson MP, Secretary of State for Health, 30 June 2008: NHS Next Stage Review
With permission, I would like to make a statement on the final report of the NHS next stage review and the first NHS constitution. Before I do, I should like to pay tribute to my noble Friend Lord Darzi of Denham, who has led the process. He has done so magnificently, bringing to bear his invaluable professional experience and expertise. I thank him and the thousands of front-line clinicians who have shaped and formed the conclusions of his review.
As we celebrate the 60th anniversary of the NHS this week, it is befitting that we should acknowledge its successes, secure its strengths and chart a path for its future. Created by fraternity to take the place of fear, the founding principle of the NHS was as clear as it has been enduring: that access to health care should be determined by clinical need rather than the ability to pay. The NHS has been a friend to millions, sharing their joy and comforting their sorrow. Today, the service sees or treats a million people every 36 hours, eight out of 10 people see their family doctor every year and a million more operations a year are performed than 10 years ago.
Then, the NHS was suffering from chronic under-investment. The challenges were too few doctors and nurses, poor equipment and crumbling infrastructure. Patients waited months, if not years, for treatment; waited weeks, not days, to see their GP; and measured their time waiting in accident and emergency in days and nights rather than in hours. A service whose promise was fair access to all had witnessed patients dying before they could even receive its care.
This Government resuscitated the NHS and reaffirmed its principles. Today, patients wait no more than four hours in accident and emergency, and by the end of the year they will be able to go from referral by their GP to treatment—with all the diagnostic tests in between—in no more than 18 weeks, and normally in nine. There have been considerable improvements in the quality of care received by patients and delivered by NHS staff. The improvements for cancer and heart disease alone have saved nearly a quarter of a million lives in the past 11 years. The NHS is now able to deliver the highest quality of care in many medical disciplines and settings.
The report published today heralds the next stage for the NHS: to deliver the highest quality care for all. It is underpinned by the service’s first constitution, which will empower patients by clearly articulating their many rights, bringing transparency to decision making, and securing its founding principles for generations to come.
The review has been led by front-line clinicians in every NHS region. Seventy-four local clinical working groups, made up of some 2,000 doctors, nurses and other staff working in health and social care organisations, have developed improved models of care for their communities, from maternity and new-born to end-of-life. They are based firmly on the best available clinical evidence and extensive engagement to ensure that they reflect the needs and preferences of local people.
In common with all health systems around the globe, the NHS faces some significant challenges: ever higher expectations; greater demand driven by demographics;
the transformational power of better information; the changing nature of disease and treatment; and rising expectations of the health workplace. The report puts the NHS on the front foot, seizing the opportunities that those challenges present, rather than simply reacting to their consequences.
Meeting those challenges demands that the NHS do more to help people stay healthy and to give them more information, choice and control over their health and health care. Every primary care trust will now commission comprehensive well-being and prevention services to meet the specific needs of their local populations.
Preventing vascular conditions such as diabetes, stroke and coronary heart disease has the potential to save thousands of lives. Today, some 4.5 million people are afflicted by vascular conditions, accounting for more than 170,000 deaths every year. We will launch a new Reduce Your Risk campaign to raise awareness and understanding as a precursor to the national vascular screening programme for everyone aged 40 to 74 that will begin next year.
Improving the health of individuals and families will become an increasing focus for GPs. We will work with professionals and patient groups to improve the world-leading quality and outcomes framework to develop better incentives for maintaining good health as well as providing good care.
As much as the NHS will do more to help people to stay healthy, it will also become a service that responds more rapidly and effectively to the people who use it. Patients will be given more rights and control over their health and care. They will have greater choice of GP practices, with better information to make the best choices for themselves and their families. That will be delivered by a fairer funding system that gives better rewards to GPs who provide responsive, accessible and high-quality services. Choice will not simply be a policy of Government but a right secured for all through the first NHS constitution.
The constitution will guarantee patients access to drugs and treatments approved by the National Institute for Health and Clinical Excellence. We will give greater support to NICE to increase the speed of its appraisals process so that new guidance is consistently issued more quickly. Primary care trusts will have a new duty to provide transparency in their decisions and clear explanations to the public. Those measures proclaim an end to the postcode lottery in NICE-approved drugs and treatments.
The rights will be accompanied by more personal control for patients, harnessing their ingenuity to improve their health and care. Every patient with a long-term condition will be offered a personalised care plan, jointly agreed by the patient and a named professional, so that services are organised around the needs of individuals. For the first time, we will pilot personal health budgets that give individuals and families the fullest control over their care.
All the measures announced here today are designed to improve the quality of care that patients receive. It is essential that quality is understood from a patient’s perspective. The measures pay regard to experiences as much as effectiveness, with safety as a given. Patients want to be treated in environments that are safe and
clean, and to be shown respect and regard, compassion and kindness. The highest clinical quality can be undermined by letting the simple things slip.
We must have an unwavering, unrelenting and unprecedented focus on quality. Our approach will be dedicated and disciplined, putting quality at the heart of everything that the NHS does. We will begin by bringing clarity to quality, ending the daunting and frustrating confusion that is caused by the morass of standards. NICE will be transformed to select the best available standards, fill the gaps and establish a new NHS evidence service, which will ensure that best practice readily flows to the front line.
We can only be sure to improve what we can measure. Information can unlock local innovation by showing clinical teams where their greatest opportunities lie. We will create a national quality framework, so that every provider of NHS services systematically measures, analyses and improves its performance. Front-line teams will be supported by a new set of graphically illustrated quality measures that will inform the daily decisions that lead to improvement, known as a clinical dashboard. [ Interruption. ] I did not invent the title; clinicians did.
The power of information will be provided to the public. We will legislate so that all providers of NHS services will be required by law to publish quality accounts, just as they publish financial accounts, which will detail the quality of care that they provide for each and every service, and easy-to-understand comparative information will be made available online. For the first time, improvements to quality will be recognised and rewarded. Patients’ own assessments of the success of their treatment and the quality of their experiences will have a direct impact on payments.
We will harness the expertise and experience of clinicians, to raise standards by ensuring strong clinical involvement at every level of the NHS. New medical directors will be appointed to join existing nursing directors in every NHS region. They will be supported by clinical advisory groups to sustain and support the strong clinical voice elevated through the review. Nationally, a new quality board will be formed to provide leadership, advise Ministers on top clinical priorities for standard setting and make an annual report on the state of quality in England compared with that of international peers. There will be strong safeguards for quality, with no hiding place for those who fail to get the basics right on issues such as infection. I have already announced that the Care Quality Commission will have tough new enforcement powers to tackle infections and other lapses in patient care.
Finally, we know that health care works at the edge of science, constantly creating new ways to cure and care for patients. The NHS has long been a pioneer, but too often too few NHS patients have benefited. We will create an environment in which excellence and innovation can flourish. That is why the report heralds new partnerships between the NHS, universities and industry to achieve the very best care for patients. This ambitious agenda to improve quality for patients can succeed only by unlocking the talents of the front line. We will ensure that NHS staff have the freedom to focus on quality, empowering them to improve services.
Clinicians have abilities that go beyond clinical practice alone. Our new expectations of professionalism redefine their role as practitioners, partners and leaders in and of the NHS. We will unlock clinicians’ creativity and innovation, give greater responsibility for the stewardship of resources and proclaim a new obligation to lead change where the evidence shows that it will improve quality.
These noble objectives will be supported by pragmatic action. Our journey of setting the front line free from central direction will continue, our commitment to foundation trusts remains strong and we will extend similar freedoms to community services. We will free up their talents by introducing a right to request to set up a social enterprise. All primary care trusts will have an obligation to consider these requests, and staff choosing to join such organisations and continuing to care for NHS patients will be able to retain their NHS pensions.
With greater freedom will come a newly enhanced accountability. The report sets no new targets; our approach will be openness on the quality of outcomes achieved for patients, meaning accountability for the whole patient pathway, from beginning to end. NHS staff are the service’s most precious asset. We will more clearly illuminate how highly we value them by making new pledges to all staff in the NHS constitution: on work and well-being; on learning and development; and on involvement and partnership. All NHS organisations will have a statutory duty to have regard to the constitution.
Furthermore, the system for education and training will be reformed by working in partnership with the professions. We will open a new chapter in our relationship with the medical profession by establishing Medical Education England. We will increase our investment in nurse preceptorships threefold, so that newly qualified nurses will be given more time to learn from their senior colleagues. We will pay higher regard to the contribution of non-clinical staff—the porters, administrators and others who are the backbone of the service—by doubling our investment in apprenticeships, and we will strengthen arrangements for learning and development so that all staff have access to the opportunities that they need to update and enhance their skills. Following today’s publication of the final Next Stage Review report, we will over the course of this week publish supporting documents that set out in more detail our proposals on primary and community care, for the work force and for informatics.
Finally, let me turn to the first NHS constitution. The changes outlined by the review will improve quality, but the best of the NHS—its enduring principles and values, and its defining rights and responsibilities—must be protected for generations to come. Patients and the public should be empowered by the clear expression of their rights in relation to the NHS, and the value of staff should be fully recognised. Decision making should be transparent and accountability strengthened. It is right and proper that a national health service, funded by national taxation, should remain accountable in and to Parliament. These goals are accomplished by our draft constitution that we will publish for consultation today.
Our proposal is to legislate so that all NHS bodies, and independent and third sector providers of NHS services, must take account of the constitution in their decisions and in their actions. The Government will be required to renew the constitution every 10 years, involving the patients who use it, the public who fund it, and the staff who work in it. No Government will be able to erode or undo the fundamental basis of the NHS without the consent of the people’s elected representatives.
Safe in the knowledge that the best of the NHS shall not perish, we will pursue our ambition to deliver the highest-quality care to all—not in some respects, not in many respects, but in all respects. On its 60th anniversary, after a decade of investment the NHS has the most talented array of staff in its history, united in their ambition. High-quality care for all is now within our reach. The report charts a path towards its achievement, and I commend it to the House.