Alan Milburn – 2002 Speech to the NHS Leadership Centre Annual Conference

Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, on 12 April 2002.

I wanted to come to your conference today because the people here are actually the people who are changing the National Health Service. You are the people who are turning rising levels of investment in the NHS into real reforms and I hope real improvements for patients.

We’ve seen some of that progress reported just this week – with shorter waiting times in hospitals, for ambulances and in GP surgeries too.

Of course there is an awfully long way to go but these are real achievements. They are the achievements that you and your colleagues around the country have made. And I simply want to congratulate you for them and to thank you for the job you are doing.

I know you work under huge pressure every day. And I know that there are lots of problems as well as signs of progress in the NHS today. But I believe the best days of the NHS are ahead of us, not behind us. It’s about time that we, as a country, started to feel a little more pride in the achievements of the million or more staff who work in the NHS and a little more confidence in the health service they provide.

It should be a cause of national pride that health care in our country is free. That no-one asks for your insurance policy or your cheque book before you get the care you need.

The reason the NHS continues to command such affection in the hearts of the British people is that its values are actually the values of our nation – fairness and equality, compassion and community, a belief that we can achieve more together than we ever can alone.

But the NHS should be supported with our heads as well as our hearts. Its values – far from being the backward looking sentimentalism that our critics claim – are actually grounded in the needs of our society today.

Without the NHS the sophistication of modern treatments – and of course their cost – would put individual provision of health care beyond the reach of all but the very wealthiest in society. For me at least the sick paying for the privilege of being sick is hardly the mark of a fair or civilised society. In a world where health care can do more and costs more than ever before having an NHS based on need and not ability to pay is a real source of strength for our country and security for our people.

The truth is most patients – despite the problems the NHS still faces today – get good quality care. Where there are sometimes lapses in the quality of care our job is to tackle them. What we cannot allow is for the bad to detract from the good, for the isolated case to become the perceived norm. To read some of our daily newspapers you would sometimes think that the NHS is full of bad doctors, or bad nurses. It isn’t. It is full of good people – therapists and scientists, cleaners and porters, managers and paramedics as well as doctors and nurses – who come to work to care for others. It is about time we as a country got behind the people working in the NHS rather than trying as some now seek to do to actively undermine them.

It is now clear that those who are opposed to the NHS – including some of our political opponents – are embarked on a quite deliberate and cynical strategy of first undermining the NHS as a prelude to their real agenda of tearing down the NHS and forcing people to pay for the costs of their own treatment.

I say today to those enamoured of a private insurance alternative to the NHS: look to the USA where 40 million people have no health cover at all; see what happens with private insurance rather than community provision; and then ask yourself do we really want health care based on how much you can afford to pay rather than how ill you are? Do we really want doctors in this country reaching for your wallet before they reach for your pulse?

I think not.

Private insurance policies, even with all the exemptions they contain, are consistently more expensive and more bureaucratic for consumers and taxpayers than publicly funded health systems. Giving tax breaks to encourage more private insurance would involve the taxpayer subsidising people who already had insurance policies – a significant diversion of public resources from the NHS for the benefit only of a few.

The examination that we have made, that Derek Wanless has made, that the British Medical Association has made of different systems of funding health care have all concluded one thing: that a tax-funded NHS is a fairer and more efficient way of providing health care for our country than the alternatives on offer. The NHS should be supported with our heads as well as our hearts.

Of course there are bad things about the British health care system – whether it is staff shortages or bed shortages or long waits for treatment. But when people say to me: what about levels of health provision in France or Germany or Sweden, I say: these countries do not have a superior system for funding their health care, they have superior levels of funding for health care.

No-one can escape the simple reality that there isn’t a health care system in the World that is cost-free. Somehow or other it has to be paid for. In Britain we pay from general taxation. In some countries employers and employees pay more. In other countries individuals pay for themselves. No country provides health care for nothing.

As a government, we recognise that the limitations of Britain’s tax-funded health service have not been the system of funding from general taxation but the level of funding from general taxation.

In just a few days time there will be a choice for our country. To go back to the days when the approach on the NHS was one of cutting taxes, cutting spending, cutting services and in the end therefore forcing more people to pay for their own care. Or to continue to move forward with sustained investment matched by fundamental reform.

I believe passionately that the right way forward for our country is to continue investing and to press ahead with reform.

Health care has to be paid for – one way or another – and World class health care costs a little more. In a world of rising health costs and greater health possibilities the NHS is the best insurance policy you can have. Putting the health service on a sustainable footing for the long term will pay dividends for us all in security for ourselves and our families.

What we have started in the last few years we should see through. The NHS today is the fastest growing health care system of any major country in Europe. But there’s a huge amount of catching up to do. And huge problems to overcome. The waiting times are coming down but are still too long. The staff numbers are growing but there are still too many shortages. The system and the people working in it are still working under huge pressure.

What we know is that that when we put extra resources into the NHS that delivers results for patients. Not overnight, nor with a big bang but steadily, step by step. Sustained improvement is by necessity more about evolution than revolution. The only way to keep progress coming through is to keep the investment going in. And to use the resources to reform how health care is delivered.

Nobody I have ever spoken to in the health service – not the public, the patients or the staff – just wants more of the same. People today expect a different sort of service, a different level of service as well. People want services that are responsive, and which offer faster, higher quality care. Increasingly, and rightly so in my view, they want to make informed choices about how to be treated, where to be treated and by whom.

Some say that that sort of service can only ever happen in a private market. I say with the right level of investment and the right programme of reform the NHS can do that better than any private provider.

The NHS Plan that we drew up with people working in the service and patients using it is our ten year programme of reform. National standards and a tough system of inspection. New contracts for nurses, doctors and staff throughout the NHS to get more flexibility and to match pay with responsibility. More choices for patients and more partnerships between the private, voluntary and public sectors. And above all else to get the best from the investment the NHS must be run by the people delivering the care. It cannot be run from Whitehall.

I don’t treat patients. You do. So just as schools now have greater control over resources for education so local health services should have greater control over health resources. That is what the new Primary Care Trusts are all about – with frontline staff in the lead. More than any other change the PCTs signal that half a century of centralised health care in our country is drawing to a close. The old style NHS where everything was run from the top down rather than the bottom up must now be a thing of the past.

It will take time to complete the transformation but the direction is set. Power and resources will now move into the hands of frontline services and frontline staff. Three quarters of the NHS Budget, within just two years, will be controlled not at the centre but at the frontline. And let me just make one thing clear today: 75% represents the starting point not the finishing line in our drive for decentralisation and devolution in the NHS.

With the right level of investment we should be seeking to unleash a new culture of public sector enterprise in the NHS capable of rivalling any spirit of private sector enterprise. It means providing better incentives to get health and social services working more effectively locally as a single care system rather than as two separate systems. It means more discretion over how local budgets are spent and where they are spent. More information and more choice for patients. Greater freedoms and more rewards for NHS organisations which are doing best alongside more help, support – and where necessary intervention – for those that are not.

Above all else it means giving frontline staff the help you need to do the job you want to do. More staff. Fairer pay. Better childcare. Greater flexibility. A bigger sense of involvement in making change happen.

The simple truth is the NHS works best when it harnesses the commitment and know-how of staff to improve care for patients.

That’s why we are putting ward sisters in charge of ward budgets and giving health visitors a greater say over community health budgets. It’s why matrons are being given the power to get the fundamentals of care – like clean wards and good food – right for patients. It’s why nurses are being given new powers to prescribe drugs and discharge patients.

All of this is about unleashing the tide of innovation that exists among staff in every health centre and every hospital. Nothing should provide us with a greater sense of optimism and confidence about the future of the NHS than the Modernisation Agency’s Report that is being published today. In example after example it shows that where staff have been given their heads they have improved services for patients.

In North Hampshire, for example, pre-booked appointments for lung cancer scans have reduced the wait for an outpatients appointment from an average of 20 days to 2 days. In North West London new staff rotas and changed working practices have reduced waits for echocardiography from an average of 130 days down to just 7 days. In Wisbech, at the North Brink Surgery patients used to wait 16 days for a routine appointment. A month after the reform programme was put in place ‘did-not-attends’ had halved. The duty doctor emergency work was down by 85%. Today, 82.5% of patients see whichever GP they want when they want. The surgery has abolished waiting times and the duty doctor is an average of 55% quieter than 18 months ago.

What these examples – and countless others in the Agency’s report- demonstrate is that investment only really works if it is matched by reform. And the essential ingredient that is needed are strong local clinical leaders in charge of making the process of reform happen.

What we need to do is to support more staff through the reform process. Reform isn’t easy. It takes time and effort when on the frontline staff find that each day both are squeezed hard. That is why we will be looking at how we can give staff more protected time to improve services. How we can help more staff develop their skills and their personal potential. How we can use the introduction next year of the new NHS University and an expanded Modernisation Agency programme to develop more local clinical leaders.

What is on offer here is a partnership between the Government and the people working in the NHS. We are prepared to commit more investment for the health service but only if it is matched by a commitment to reform. The reforms are as vital as the resources. More money going into health budgets is conditional on getting more out for patients. In every community, every hospital, every surgery reform now needs to bite. The health service – all across the health service – will need to show that extra resources are producing reforms and results for patients.

Your leadership is vital. Without it reform will not happen. Frontline staff need to be in the driving seat to make the changes and improvements patients want to see.

In the end this is actually not about systems. It is about values. The NHS is the right system because it has the right values. I believe in it – and the people working in it – not out of some sort of old-fashioned sentimentalism but because in the modern world the NHS is more right and more relevant than it has ever been before. Without the health service millions could never afford healthcare. With the health service all of our people can. It is the best one nation policy our country has ever seen.

As a government we have made our choice. Our choice is for the NHS. For a reformed health service. For an NHS that enjoys higher levels of spending. Above all else our choice is for the patients who need the NHS. It is I believe the right choice for Britain.