Andrew Lansley: 'Equity and excellence: Liberating the NHS'

Oral Statement on the NHS White Paper by the Secretary of State for Health, Andrew Lansley

(As delivered)

With permission, Mr Speaker, I would like to make a statement on the future of the National Health Service.

The NHS is one of our great institutions, and a symbol of our society’s solidarity and compassion. It is admired around the world for the comprehensive care it provides and for the quality, skill and dedication of its staff. I begin today by paying tribute to the staff of the NHS and the commitment they daily show to patients in their care.

This Government will always adhere to the core principles of the NHS; a comprehensive service for all, free at the point of use, based on need not ability to pay. This principle of equity will be maintained, but we need the NHS also consistently to provide excellent care.

The NHS today faces great challenges:

• It must respond to the demands of an increasing and ageing population, advances in medical technology and rising expectations;
• It remains stifled by a culture of top-down bureaucracy, which blocks the creativity and innovation of its staff; and
• It does not deliver outcomes in line with the best health services internationally – many of our survival rates for disease are worse than those of our neighbours.

The NHS must be equipped to meet these challenges – we believe it can do much better for patients. So today, I am publishing this White Paper, Equity and Excellence: Liberating the NHS:

• so that we can put patients right at the heart of decisions made about their care;
• to put clinicians in the driving seat on decisions about services; and
• to focus the NHS on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.

For too long, processes have come before outcomes, as NHS staff have had to contend with 100 targets and over 260,000 separate data returns to the Department each year.

We will remove unjustified targets and the bureaucracy which sustains them. In their place, we will introduce an Outcomes Framework to set out what the service should achieve, leaving the professionals to develop how.

We should have clear ambitions, and our approach to this will be set out shortly in a consultation document. For example, our aims could be:

• to achieve one and five year cancer survival rates above the European average;
• to minimise avoidable hospital acquired infections;
• to increase the proportion of stroke victims who are able to go home and live independently.
  In short, care that is effective, safe and meets patients’ expectations.

The Outcomes Framework will be supported by clinically established quality standards, and the NHS will be geared across-the-board towards meeting them. We will do this by:

• rewarding commissioners for delivering care in line with quality standards;
• strengthening the regulatory regime so that patients can be assured that services are safe; and
• reforming the payment system in the NHS, so that it is not just a driver for activity, but also for quality, for efficiency and for integrated care.

Patients will be at the heart of the new NHS. Our guiding principle will be ‘no decision about me, without me’. We will bring NHS resources and NHS decision-making as close to the patient as possible.

• We will extend ‘personal budgets’, giving patients with long-term conditions real choices about their care
• We will introduce real, local democratic accountability to healthcare for the first time in almost 40 years – by giving local authorities the power to agree local strategies to bring the NHS, public health and social care together. Local authorities will also be given control over local health improvement budgets. This will give an unprecedented opportunity to link health and social care services together for patients.
• We will give General Practices, working together in local consortia, the responsibility for commissioning NHS services, so that they are able to respond to the wishes and needs of their patients. This principle is vital, bringing together the management of care with the management of resources. With commissioning support, GPs collectively will lead a bottom-up design of services.

In addition, we will introduce more say for patients, at every stage of their care – extending the right to choose far beyond a choice of hospital.

Patients will have choice over treatment options, where clinically appropriate, and the consultant-led team by whom they are treated.

They will have the right to choose their GP practice.

And they will have much greater access to information – including the power to control their patient record.

We must also ensure that patients’ voices are heard, so we will establish ‘HealthWatch’ nationally and locally, based on Local Involvement Networks, to champion the needs of patients and the public at every level of the system.

To achieve these improvements in outcomes, we need to liberate the NHS from the old command-and-control regime. So:

• all NHS trusts will become Foundation Trusts – freed from the constraints of top-down control, with power increasingly placed in the hands of their employees; and
• we will allow any willing provider to deliver services to NHS patients – provided that they deliver the high-quality standards of care we expect from them.

Our aim is to create the largest social enterprise sector in the world. But it is not a free-for-all. Monitor will become a stronger economic regulator to ensure that the services being provided are efficient and effective – and that every area of the country has the NHS services it needs to provide a comprehensive service to all.  The Care Quality Commission will safeguard standards of safety and quality.

An independent and accountable NHS Commissioning Board will be established to drive quality improvements through national guidance and standards to inform GP-led commissioning. The Board will allocate resources according to the needs of local areas, and lead specialised commissioning.

Mr Speaker, in the coming weeks, detailed consultation documents will enable people to comment on the implementation of this strategy, leading to the publication of a Health Bill later this year.

I recognise that the scale of today’s reforms are challenging, but they are designed to build on the best of what the NHS is already doing.

Clinicians are already working to facilitate patient choice, giving patients the information they need to make effective decisions.

GP consortia are already established in some areas of the country, and are ready to go.

Local Authorities in some areas are already working closely with local clinicians to co-ordinate health and social care and improve public health.

Payment by Results already gives us a starting framework for building a payment system that really drives performance.

Foundation Trusts are already using the freedoms that they have to innovate.

We will build on this progress, not dismantle it.

With this White Paper we are shifting power decisively towards patients and clinicians.  We will seek out and support clinical leadership. That means simplifying the NHS landscape and taking a further, radical look at the whole range of public bodies:

We will reduce the Department of Health's NHS functions, delivering efficiency savings in administration costs.

• We will rebalance the NHS, reducing management costs by 45% over the next four years, abolishing quangos that do not need to exist, in particular if they do not meet the Government’s three tests for public bodies – and we will shift more than £1 billion from back-office to the front-line.
• Form will follow function. As we empower the front-line, so we must disempower the bureaucracy. So after a transitional period, we will phase out the top-down management hierarchy, including both Strategic Health Authorities and Primary Care Trusts.

Later in the summer, we will be publishing a report setting out how we see the future of NHS-related quangos. I can say now that this will mean a reduction of at least a third in the number of such bodies.

This is part of the wider drive, across government, to increase the accountability of public bodies and reduce their number and cost.

The dismantling of this bureaucracy will help the NHS realise up to £20 billion of efficiency savings by 2014 – all of which will be reinvested into patient care.

Mr Speaker, today’s reforms set out a long-term vision for an NHS which is led by patients and professionals, not by politicians. It sets out a vision for an NHS empowered to deliver health outcomes as good as any in the world.

I commend this statement to the House.

Last modified date: 12 July 2010

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