Alan Milburn – 2002 Speech to the Allied Health Professions and Healthcare Scientists National Leadership Conference

Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, on 13 March 2002.

Since Nye Bevan created the health service, there have been 23 health secretaries. I think I am right in saying I am the first to address a conference of your professions.

I wanted to be here today for a simple reason: to acknowledge that the work you do has not always received the attention it deserves and that it is time to put that right.

So I want to start by thanking you for what you do day in day out in the service of others. I know that many of you are working under real pressure.

It is invariably doctors and nurses who grab the headlines in the NHS but without you they could not do their jobs. Without your dedication and professionalism the NHS could not do its job. The work you do – whether as a scientist, therapist, radiographer, podiatrist, chiropodist, dietician, paramedic, orthoptist, prosthetist or orthotist – is absolutely key to unlocking an NHS where services are designed around the needs of individual patients.

In my view it is no coincidence that where reform is taking hold in the health service it is often people from the allied health professions who are leading the process of change. Today I want to set out how I believe you can play a bigger role still in delivering services that are fast and convenient and which promote people’s security and their independence.

We meet today at a critical point in the history of the NHS. When the NHS is not only going through a period of greater change than ever before but when it is subject to greater public expectations than ever before. When there is more scrutiny and where from some quarters there is more hostility than the NHS – and those working for it – have ever faced.

To read some of our newspapers you would think no patient ever got good treatment. Or that the NHS is full of bad therapists, bad doctors and bad nurses when it is actually full of good people doing their best for others sometimes in difficult circumstances.

People working in the NHS deserve fair coverage for their efforts. We as a nation owe the porters, cooks and cleaners, scientists, therapists and paramedics an enormous debt of gratitude. People in the NHS work well beyond the call of duty for something they passionately believe in. I believe your commitment to the ethos of public service is a huge strength in our country and that it must be preserved at all costs.

Of course there are bad things about the NHS – whether it is staff shortages or bed shortages – and there are sometimes lapses in the quality of care. Where there are problems our job is to tackle them. But what we cannot allow is for the bad to detract from the good. The truth is most patients – despite the problem the NHS faces today – get good quality care. Most staff do a good job. And I believe that most patients know it.

So alighting on problems and using them to damn the whole system should be exposed for what it is: denigration for a purpose. There are those who are deliberately talking down the public services as a prelude to their real agenda of running them down and then cutting them back.

In these weeks ahead there will be a choice for our country. To return to the days when the approach on the NHS was one of cutting services, cutting taxes and getting more and more people to pay for their own care. Or to continue to move forward with sustained investment matched with fundamental reform.

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

Our purpose as a government is to break through the barriers that hold too many of our people back: to provide opportunities for all in our nation. To give every child the best start in life through good education. To give communities hope by tackling the causes and the consequences of crime. And above all else to give people in our country the opportunity of good health through decent health care.

For me an NHS that is funded by all and used by all makes for a stronger society for all. I think the values of the NHS are the values of our nation -fairness and equality, compassion and community, a belief that we can achieve more together than we ever can alone. And that these values – far from being the backward looking sentimentalism that our critics claim – are actually grounded in the needs of our society today. The case for collective provision of health care in my view has never been more compelling. Health is not just another commodity. It cannot be bought and sold in a market place. By definition our need for health care is unpredictable. And today the sophistication of modern treatments can put individual provision of health care beyond the reach of all but the very wealthiest in society. My very strong personal belief is that the ill paying to be ill is not the right way forward for Britain.

It is time to remind the public that the fundamental ethos of the NHS is sound. It is a fair and efficient way of providing health care. The NHS providing care according to need not ability to pay is the right way forward for the country.

What the NHS needs is more investment and fundamental reform.

For too long as a nation we have pretended that somehow or other we can have world class health care on the cheap. We can’t. There is no such thing as a free lunch when it comes to health care. If we want world class health care it has to be paid for – one way or another. I believe that investing in the NHS is the right priority for our country.

We have made a start. The NHS today is the fastest growing health care system of any major country in Europe. 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 shortages.

Our opponents would like to pretend that the NHS is a bottomless pit. That isn’t true. What is true is that it will take time for improvement to fully come through. The NHS Plan is a ten-year programme not a programme for one or two years. But where we have put resources in it produces real results. You can see that in heart services for example. A year ago people were waiting up to 18 months for an operation. By the end of this month the maximum waiting time for a heart operation will be 12 months – still too long but moving decisively in the right direction. In primary care the prescribing of cholesterol lowering drugs is up by one third in just one year. 1,000 GP surgeries are being modernised. The biggest hospital building programme is underway. Last year saw a record increase in the number of nurses working in the NHS. For the first time in thirty years it saw more beds in hospitals, rather than fewer.

I don’t say every problem has been solved. Far from it. There will be ups and downs along the way but the NHS is now on the road to recovery. The NHS Plan is on course to be delivered.

Delivery depends on over one million people – NHS staff. The biggest obstacle to faster delivery is shortages of staff. That is why we need more of your professions working in the NHS.

Here again we have made a start. Since 1997 OT and dietitian numbers have risen by over 20%, speech and language therapists by 17% and physiotherapists by 14%. But because there are still shortages of the precious skills that you have we now plan to drive forward the efforts to recruit and retain staff in your professions.

First, we will be increasing training numbers. We have reversed the cuts in training places that took place in some of your professions during the mid-1990s with increases of over one third in healthcare scientist, radiography, OT and physiotherapy places. We estimate that over 1,500 more therapists and other health professionals have entered training over these last two years. I am now expecting these numbers to increase by at least a further 1,000 from April this year.

Second, we will be targeting allied health professionals and healthcare scientists in an extended recruitment campaign. On top of our existing efforts in this area I can announce a new £1 million recruitment drive which will start this summer specifically to get more of your professions working in the NHS. I expect that at least 500 more staff who have left the NHS will return in the next year as a result.

Third, we will want to discuss with leaders and representatives from your professions how we can build on the momentum that is underway in expanding staff numbers. What we cannot have is people coming into the NHS through the front door only to find more leaving by the back door. Retaining existing staff is as important as recruiting new ones. Here a fairer deal on pay will play a part. Negotiations on a new pay system have been going well and I am determined to see them through. I am equally determined that the NHS should become a more flexible and modern employer offering staff the support and childcare they need to balance their family and their working lives. So I can tell this conference that in June I will be hosting a summit to discuss how we can not only recruit more allied health professionals but how we can retain more too.

What is on offer here is a partnership between the Government and people working in the NHS. We are prepared to commit more investment for the health service. What we seek in exchange is more reform.

Indeed, the case for more investment will only be won if resources are matched by changes to the way the NHS works.

Nobody I have ever spoken to in the health service – neither staff nor patients – 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 it can happen in the NHS.

The NHS Plan we published 18 months ago is our programme to renew the NHS. In essence it is based on four key principles.

First national standards and proper accountability. In a public service patients rightly expect services in one part of the country to be delivered to similar standards as another part of the country. That is what the national service frameworks for heart disease, elderly care and mental health and the National Cancer Plan are all about. It is why we have the NICE. And it is why we have introduced for the first time a strong independent inspectorate for the NHS, the CHI.

What having national standards does not mean, however, is that the NHS should be run nationally. I do not believe a million strong service can be run from Whitehall. Half a century of experience shows us that this approach limits local leadership and stifles local innovation. Ideas and initiatives developed within the local NHS have too often played second fiddle to circulars delivered from the centre. For patient choice to thrive it needs a different environment. One in which there is greater diversity and plurality in local services which have the freedom to innovate and respond to patient needs.

Where our first term in office was concerned with putting a national framework in place, this second term is about introducing new incentives encouraging greater local innovation and stimulating more patient choice. It is these reforms that will make the most telling contribution to improvements in services. In the weeks and months ahead we must be bold in developing these NHS Plan reforms.

So the second principle involves the devolution of power to frontline services. We are at the start now of a transition where day to day management of the health system will move from Whitehall to the 28 new strategic health authorities in England. They will oversee the work of local NHS Trusts, PCTs and private and voluntary sector providers. The real power and resources in the NHS will move to the NHS frontline with from next month locally-run primary care trusts – involving professionals and patients – up and running in all parts of the country. Within a few years they will control three quarters of the total NHS budget. They will be able to choose from which hospitals – public or private – care is commissioned. The best hospitals are likely to be those where they too, practice the philosophy of devolution and empowerment.

Every year CHI will rate local health services according to their performance. Those that are performing best will earn not just more rewards but greater freedom. The better the performance of the organisation the greater the freedom it will enjoy. Where the Commission decides that an NHS organisation is in trouble it will recommend special measures are taken. In the small minority of local health services where there are consistent problems for example new management could be brought in.

Third, devolution will be accompanied by more choice for patients. From July heart patients waiting for six months or more for an operation will be able to choose in which hospital they would like to be treated. In time patients will have the information and the NHS will have the capacity to offer more people the chance to make informed choices about their treatment and care. Where the NHS can use the private and voluntary sector to benefit NHS patients and to extend choice it should do so. Nobody says this is a panacea – but it can make a contribution. The old barriers between the public and private sectors cannot be allowed to get in the way of improving care for NHS patients.

That brings me to the fourth principle and the one that I really want to concentrate on today – securing greater flexibility between services and between staff. The old demarcations between staff and the old barriers between services need to go. This where you can make the biggest contribution to reforming our system of care.

Indeed, your professions were modernising NHS services long before it became fashionable. Whether it is occupational therapists working in A&E to prevent inappropriate hospital admissions, or paramedics delivering clot-busting drugs to heart attack patients or physiotherapists running orthopaedic outpatient clinics – there is a huge effort going on throughout the NHS to maximise how we use the skills of clinical professionals to improve care for patients. These reforms are about liberating the commitment and know how of staff in order to transform the quality and speed of treatment for patients.

And they are delivering results. I know that waiting times for therapists can be far too long but for example in Huntingdonshire the PCT has been testing a physio-direct service for patients so they can call and speak direct to a physiotherapist. After triaging by the physio less than one third of patients actually need to be seen but those who need treatment can have an appointment the same day. The patients get seen quickly. The physiotherapists save time. And the burden on family doctors is reduced.

Now we need drive these sort of reforms – this local leadership and local innovation – still further – and we want to help you lead the process. For too long there has been a vicious cycle where the NHS has not been able to perform to its full potential because it has failed to support staff to perform to their full potential. It is simply absurd in my view that in some hospitals therapists can run outpatient clinics while in others they can not. Or that while some radiographers are able to prescribe painkillers others are unable to do so. Limiting the roles you play and the talents you have not only makes your professions and the medical profession the losers. The patient loses out too.

So I can say that next month I will be bringing together leaders from your professions, from nursing and from medicine – and from NHS management too – to agree a programme of action to break down demarcations still further across the whole NHS. The programme will be underpinned by new training and career opportunities for staff. Within the next few weeks for example I expect the first generation of therapist consultants to be appointed in the NHS. Within two years there will be at least 250 of them working as equals alongside nurse consultants and medical consultants. I can also say today that the NHS Leadership Centre will be introducing next Spring a new programme to develop leadership skills for middle managers across all professional groups including AHPs. This is about breaking through the glass ceiling to put you as clinical leaders in positions of authority throughout the NHS.

And there is one further leadership challenge I believe that you can help us meet: to break down the Berlin Wall that for too long has divided health from social care. Health and social services are two sides of the same coin. The one relies on the other. The patient relies on both.

Inevitably the focus of public and media attention is on what happens in hospitals. And there is no doubt that we need to build hospital services up, not least to get waiting times down. But tackling waiting cannot be achieved by more investment in hospitals alone. It needs more investment in social services – alongside primary and community services – too.

We need to stop thinking about the NHS as though it were only about hospitals and acute care. The health service is as much about the call to NHS Direct, about the child receiving speech and language therapy, the elderly person helped to keep mobile by the chiropodist as it is about the life-saving operation or the emergency service in the hospital.

Indeed I believe we need a bigger drive to help more people to avoid going into hospital and provide more help for people to leave hospital. The taxpayer will benefit because hospital based treatment is often the most expensive form of care. And the patient benefits because it helps people – especially the old – maintain or regain their independence.

Securing these changes requires more investment in social services. Again here we have made a start. Compared to the mid 1990s when the resources made available by the Government for social services were growing by only one tenth of 1% a year today the resources being made available are growing by more than 3% a year.

Nonetheless social services are under real pressure and more investment still is needed. That is necessary not least to stabilise the care home market and to develop new rehabilitation, intermediate and home care services that can promote people’s independence. Here the evidence is that putting in resources delivers results. Last October I provided an extra £300 million to help councils reduce the number of patients whose discharge from hospital was being delayed. Even though delayed discharges are down compared with five years ago, about 6% of hospital beds were needlessly blocked. Since then the extra resources have helped free up 1,000 beds that would otherwise be occupied by people who are ready to move on from hospital.

Sustained investment will be needed to maintain this progress. But there can be no question of simply pouring more money in. In social services as well as in the health service, extra investment is conditional on more reform. If more money is available for social services as well as for health services – as I believe there needs to be – there must be no more excuses for shuffling responsibility for people who are old, or disabled or mentally ill backwards and forwards between the two services. Joint working must become the norm for all and not just for some. The powers to pool budgets and to form Care Trusts so that health and social care functions are merged must be taken up. And we will need to explore new incentives to get health and social care working as one to end the decades-old culture of buck-passing and cost-shifting. Reform will mean giving patients what they need – one care system, not two.

Here you can play a leading role. Many of you are already working across health and social care boundaries. In the way you work with your colleagues in social care you can develop a joint approach so that the user of the services can no longer distinguish between what is health and what is social. Use the opportunities of your role in the new PCTs to put in place a single process for assessing a person’s need, led by one professional rather than a multitude of agencies. And you can help develop new community-based services across the traditional divide that has separated the NHS, local government and private and voluntary sectors.

Greater investment and radical reform – this is the path to better public services we are travelling together. It is sometimes difficult. There are competing claims for funding and dilemmas about priorities but resources and reforms are already bringing results. There is no easy route to better public services. No silver bullet which delivers improvement without it being paid for or without there being change.

But there is I believe a real appetite across the public services – from the people running them, working in them, using them – for higher standards to accompany higher spending.

Your role as health professionals – in leading change and improving services – is crucial to the success of our programme of investment and reform.

Your contribution to patient care and recovery – in the community and in hospital – is central to the work of a modern health service.

Your commitment to the NHS – to its values as well as its patients – is the rock on which a better health service is being built.

Quite simply I believe that if we combine the right level of investment, with the right programme of reform, with the commitment of the healthcare professionals, we can continue to move the NHS along the road to recovery.