Theresa May – 2014 Speech to Reform

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Below is the text of the speech made by Theresa May to Reform on 3 September 2014.

Thank you, Andrew. This is a busy time for the Home Office and for those working on national security. It’s a pleasure to be here again with this country’s leading think tank on public service reform.

When I hear people say there isn’t much difference between the political parties these days, I always think about an announcement made by David Blunkett when he was Home Secretary. In March 2002, he created five “policing priority areas”. These places were as small and specific as Camberwell Green in Southwark, the Grange estate in Stoke, Little Horton and Canterbury in Bradford, the West Ward in Rhyl and Stapleton Road in Bristol. The police in these places, Labour decided, couldn’t cope with high levels of crime and anti-social behaviour. So the solution was obvious. If the police couldn’t do the job, the Home Office would. If you lived on Stapleton Road in Bristol, you could stop worrying because help was at hand. A civil servant sitting in Queen Anne’s Gate in London was ready to take charge.

The “policing priority areas” were not an aberration. The 2002 Police Reform Act required the Home Secretary, at the beginning of each financial year, to prepare a “National Policing Plan”. The Act said the National Policing Plan must set out “the strategic policing priorities generally for the … police areas in England and Wales for the period of three years beginning with that year”. You heard me correctly. The Home Secretary and officials weren’t just expected to know how to fight crime on Stapleton Road in Bristol, they were expected to know precisely what local needs would be for every other community in the country, and – more than that – they needed to know what those needs would be three years into the future.

That was, of course, complete nonsense, and it couldn’t be further removed from the approach we have taken to police reform in the Home Office since May 2010. So today I want to talk to you about my programme of police reform. I want to use it to show that it is possible to deliver more with less. And I want to use it to talk about how we meet an even tougher challenge – the challenge of how we can reduce demand for public services through smarter policy.

Police reform proves you can do more with less.

I just told the story about the policing priority areas and the National Policing Plan, but I want to say a little more about what we inherited in policing back in May 2010.

The institutions of policing were hopelessly inadequate. In theory, unelected police authorities were supposed to hold local forces to account on behalf of the public. In practice, only seven per cent of people even knew they existed. The Serious and Organised Crime Agency – which according to rumour Tony Blair wanted to call MI7 – failed to get to grips with organised crime because it lacked the powers and clout to do so. Police training and standards were in the hands of a £400 million-per-year quango called the National Policing Improvement Agency. The Chief Inspector of Constabulary was as a matter of course always a former chief constable, which meant the Inspectorate was too close to the police to do its job properly.

There was an unaccountable, centralised, corporatist system of governance, known as the tripartite, in which policing across the whole country was run by the Home Office, the Association of Chief Police Officers and the Association of Police Authorities.

Police productivity was held down by the targets, performance indicators, reporting requirements, regulations and red tape made necessary by a system of bureaucratic accountability as the Home Office tried to keep tabs on everything forces were doing.

Police procurement was a pitiful joke. 43 police forces buying different sets of uniforms and running separate and uncoordinated procurement policies. £1 billion per year spent on inadequate ICT, with 4,000 staff working on 2,000 separate systems across 100 data centres. Each police force in the country trying to run its own air service, or at best collaborating with just a couple of others.

There was a pay structure worth £11 billion – three quarters of total police spending – that was designed more than thirty years before. In those three decades, policing changed dramatically while the pay system failed to keep up. But every attempt to change terms and conditions were resisted bitterly by the Federation and successive Home Secretaries were forced to back down.

So that was policing as we inherited it just a little more than four years ago. And yet, when I first launched our programme of police reform, the response from ACPO, the Police Federation and the Labour Party was to deny the need for change. Likewise, when we announced that we would cut central government police funding by twenty per cent in real terms over four years, the same people were united – the frontline service would be ruined and crime would go shooting up. Labour called it “the perfect storm”. The Federation predicted that the cuts and our reforms would destroy policing as we know it. But no such thing happened. According to both recorded crime statistics and the independent crime survey, crime is down by more than ten per cent since the election. Police reform is working and crime is falling.In addition to our work to improve ethical standards in policing, which I spoke about at the Police Federation conference and will not repeat today, police reform amounts to a sustained assault on each of the five problems we identified upon arrival at the Home Office. Inadequate institutions and structures. An unaccountable system of governance. Poor productivity undermined by bureaucracy and centralisation. Wasteful procurement. And a hopelessly out-of-date system of pay.

So we have systematically reformed the institutions of policing. Invisible police authorities have been abolished, and police forces have been made accountable – through beat meetings, crime maps and elected police and crime commissioners – to their local communities. The Serious and Organised Crime Agency is gone, and replaced by a National Crime Agency which has the power to task and command other law enforcement assets and a capability that reaches from local to international crime networks. The NPIA has been scrapped, and the College of Policing has been established to develop an evidence base, set standards and deliver training. HMIC, the Inspectorate of Constabulary, has remained – but it’s now led by the first ever chief inspector not to have served as a chief constable.

The tripartite system of police governance has been consigned to history. The Home Office no longer believes it runs policing. The Association of Police Authorities is no more, while the membership of the Association of Chief Police Officers has just voted overwhelmingly in support of its closure whilst many of its responsibilities have passed to the College. Meanwhile, the Police Federation, for years the roadblock to police reform, has also voted to reform itself.

Police productivity has improved and the frontline service has been reconfigured in different ways in different forces across the country. We’ve scrapped all government targets and much of the bureaucracy created by the Home Office. In doing so, we have saved up to 4.5 million police hours – the equivalent of 2,100 full-time officers.

We’ve got on with the gritty and unglamorous work of sorting out police procurement. We’ve still got a long way to go – the price forces are paying for items like boots and handcuffs still varies enormously and police ICT is going to take a long time to fix – but we are at least on the way.

And this Government has succeeded where others have failed before in successfully reforming terms and conditions. We didn’t get everything through the Police Arbitration Tribunal – which itself is a relic from the past that we are scrapping – but at last, we will have a system of police pay that encourages and rewards skills and frontline service, not just time served. Police forces will soon be able to recruit talented outsiders to senior ranks. And PCCs will be able to recruit chief constables from other common law jurisdictions.

There is still a long way to go but our reforms are already bearing fruit. Chief constables have responded to the freedom we have given them by reshaping their forces and maintaining the frontline service. Police and crime commissioners have shown their reforming power by sharing core services with other forces, other emergency services and other parts of the public sector.

The police leadership is becoming more accountable to the public. The National Crime Agency has made a good start going after organised criminal groups. The College is building a proper evidence base. HMIC has shone a light on the abuse of stop and search powers, the poor response to domestic violence and the under- recording of crime. Police productivity has improved and the proportion of officers in frontline roles is up to 91 per cent. Police procurement is gradually getting smarter and more collaborative. Direct entry and schemes like Police Now are opening up policing to new people and new ideas. And the new system of police pay will give chief constables more flexibility to lead their forces into the future.

What’s striking is that we have been able to make many of these changes not despite spending cuts but because of them. This is important, because the need to go on reforming will not end with this parliament. With a still-large deficit and a record stock of debt, there will need to be further spending cuts, as even Labour acknowledge. So in policing in the future, I believe we will need to work towards the integration of the three emergency services. We should use schemes like the Police Innovation Fund to promote capital investment that produces efficiency savings. We should go further with direct entry. We should use technology – like body-worn video, smart phone apps and other mobile devices – to save time and improve outcomes, and it remains our aim to make all forces fully digital by 2016.

And while we should continue to bear down on bureaucracy we should come up with more transformative solutions – like drastically reducing the unnecessary use of stop and search, reforming the wider criminal justice system and improving how we care for people with mental health problems – to save police time.

The drivers of crime

As I told the story of police reform you might have noticed that I omitted to mention the role of the Home Office. If responsibility for operational policing now lies squarely with chief constables, unimpeded by the Home Office, if responsibility for providing accountability now lies with police and crime commissioners, unimpeded by the Home Office, if HMIC scrutinises police performance and the College of Policing provides training, sets standards and develops an evidence base, what is the role of the Home Office? The answer is emphatically not to duplicate, cut across or undermine chief constables, PCCs, HMIC or the College. The answer, I believe, lies in three parts.

First, when it comes to the fight against serious and organised crime, the Home Office needs to build a relationship with the National Crime Agency similar to its relationship with the Security Service in the fight against terrorism. That means the department needs to provide a combination of policy work, operational support such as the provision of legal warrants, and oversight of the NCA. The Government’s Serious and Organised Crime Strategy – which is the first of its kind and is modelled on our Counter Terrorism Strategy, CONTEST – is evidence of this kind of approach.

Second, the Home Office has an important duty to make sure national systems like the Police National Computer work effectively, and an equally important role in coordinating things like police procurement.

But it’s the third responsibility for the Home Office to which I want to turn now. And that is the responsibility to develop genuine knowledge and harness existing expertise on matters of crime and policing. Home Office officials need to know in detail about specific crime trends, about policing methods and about what I call the drivers – not causes, as somebody once called them – of crime.

Overall, crime is down and it continues to fall. The Crime Survey for England and Wales – regarded by most academics as an international gold standard in measuring crime trends – shows that crime has fallen by sixty-two per cent since it peaked in 1995. And I note that the debate in the media has now mainly shifted from whether the crime figures are true to the reasons why crime is falling.

Some crime types – including sexual offences, shoplifting and fraud – have shown increases in the most recent recorded crime statistics. The truth is that the experts can come up with partially informed explanations as to why these crime types might be increasing – the increase in recorded sexual offences is likely to be driven by historical allegations coming to light while the increase in recorded fraud is likely to be caused by better recording – but we do not know enough about why crime overall is falling, why certain crime types are rising or why there might be different crime trends in different parts of the country. And if we can understand those things better, then we can come up with smarter crime prevention policies.

That is why I have set up a team called the Crime and Policing Knowledge Hub inside the Home Office. Understanding that overall crime levels are only the net result of millions of individual decisions in millions of different contexts, officials have been working to identify and understand the six main drivers of crime in this country. We believe they are alcohol, drugs, opportunity, the effectiveness of the criminal justice system, character and profit.

If we can understand each of these drivers better, if we can understand how they relate to one another, we should be able to devise better policy to prevent crime occurring in the first place.

In the light of police reform, I believe that this is now the most important responsibility for the Home Office on matters of crime and policing.

We already know that alcohol-related crime is believed to cost around £11 billion per year in England and Wales, while in half of all incidents of violence the victim believed the perpetrator was drunk. Labour liberalised licensing laws and promised us a café culture, but all they did was unleash booze-fuelled violence. So we have radically reformed Labour’s Licensing Act, empowered local communities to tackle problem drinking and banned the below-cost sale of alcohol. We did not proceed with the introduction of a minimum unit price for alcohol or banning multi-buy discounts because we were not satisfied that it would reduce alcohol-related violence without penalising sensible drinkers and responsible businesses. But a better and deeper understanding of how drinking and crime relate to one another will enable us to take targeted action to prevent alcohol-related crime.

Drugs are also a significant driver of crime. For example, the number of opiate and crack cocaine users is believed to have risen by a magnitude of ten between 1982 and 1992. New Home Office research, published in July, suggests that these people had a much greater impact on the increase in acquisitive crime up until 1995, and the fall since, than we had realised and we still believe that opiate and crack cocaine users are responsible for as much as 45 per cent of acquisitive crime in England and Wales. There remains a long term downward trend in drug use, but understanding in greater detail the effects that drugs can have on crime rates is vital as we develop our drugs strategy, as the debate about legalising and regulating drugs continues, and – when 95 per cent of the heroin on our streets is from Afghanistan – as our military is in the process of withdrawing from that country. This is, incidentally, a very good example of why the National Crime Agency needs a powerful international reach – because more than ever crime is a cross-border phenomenon.

I called the third driver of crime ‘opportunity’. This does not mean that given the opportunity anyone would commit a crime. Rather it means that those who do lead a life of crime are likely commit a greater number of offences when there are more opportunities to offend.

I’m talking about things from product design to town planning and architecture, but the most obvious and pressing example is the criminal opportunities provided by new technology. I want to emphasis again that the role of the Home Office in fighting cyber crime is not to cut across what law enforcement does, or try to do the job of the College by setting standards or targets. The Home Office must develop an understanding of cyber crime in its entirety and develop a policy response. For example, working with the Metropolitan Police we have discovered that more than a third of vehicles stolen in London do not involve taking the owner’s keys. Instead, car thieves might break into a car and programme a new electronic key. They might use sophisticated devices to ‘grab’ the security coding when the owner uses their key so they can use it themselves. And there have been reports that they could even use ‘malware’ to commandeer vehicle systems via satellites and issue remote demands to unlock doors, disable alarms and start car engines. Because we have this understanding, we can now work with industry to improve electronic resilience, include this kind of resilience in the vehicle’s overall security ratings, and work out the extent to which the same threat applies to other physical assets such as building security systems.

Then there is the role of the police and criminal justice system. And here, if we think of Operations Yewtree, Pallial, Bullfinch and others, it is clear that there have been systemic failures over the years to protect vulnerable young people from sexual exploitation. My colleagues in the Home Office, Mike Penning and Norman Baker, are leading work with ministers from other departments to improve the response not just of the police but the wider public sector. The solutions will be a mixture of legislation – we have already supported in Parliament Nicola Blackwood’s campaign to protect vulnerable children– and operational improvements – for example we need to make sure we have Multi-Agency Safeguarding Hubs across the whole country – but the solutions will all be based on a detailed grasp of the facts.

The fifth driver of crime I mentioned was character. I should be absolutely clear here that there is nothing inevitable about criminality and most people who grow up in circumstances exposed to what criminologists call ‘risk factors’ do not go on to commit crime. But – remembering in the end the only cause of a crime is a criminal – there are still common factors that make it more likely that somebody might become a criminal. Of course there are many ways of looking at this, and Government policies including school reform, welfare reform and the troubled families programme are all relevant. So too is our work to prevent domestic violence. It is well known that children who are brought up in violent households are more likely to become violent themselves later in life, so domestic violence – as well as being a serious crime in its own right – is also a significant driver of crime. But unfortunately, we know from the HMIC inspection I commissioned last year that the police response to domestic violence is not good enough. So I have written to every chief constable making it clear they must have a domestic violence action plan in place this month, and I am chairing a national oversight group to make sure HMIC’s recommendations are implemented quickly.

The last – but perhaps most important – driver of crime is profit. The more we understand the nature of organised crime and organised criminal gangs, the more it is apparent that the majority are motivated by money, they act rationally and they seek and exploit commercial opportunities.

Police forces tell us that recent rises in theft from the person, for example, were in part driven by the theft of smart phones by organised criminal gangs. These gangs targeted specific venues, like concerts and festivals, to steal smart phones on a massive scale. The phones were then often sent overseas where they are reactivated and sold. There is of course an operational response to this kind of criminal activity, which should be left to the police, but the Home Office has also been working with industry to find new ways to stop the reactivation of phones overseas, thereby killing the criminals’ export market.

And we can go further. More than 15 years ago, the Car Theft Index contributed to a fall in vehicle theft by allowing consumers to make informed choices about which models of car to buy based on their likelihood of being stolen. Today I want to announce my intention to do the same with mobile phone theft.

Working with industry and the Behavioural Insights Team at the Cabinet Office, the Home Office is developing proposals to further prevent mobile phone theft. These include steps that consumers can take to improve personal security, industry innovation to develop new security features – such as the new iOS7 operating system introduced by Apple – and the publication of a new Mobile Phone Theft Ratio to inform the public about the handsets which have been most at risk of being targeted by thieves. We will publish further details of this work imminently, but I am encouraged that the security improvements that industry has already introduced have contributed to recorded theft from the person falling by 10% in the last year, according to the most recent crime statistics.

The examples I have just given are very specific and there are of course many other ways in which the Home Office, having developed this expertise, can work to prevent crime. This work is in its infancy and I expect it to become much more sophisticated over time. But the point is clear – it must surely be better to prevent crime occurring in the first place than responding to it afterwards. But if we are to do that, we need a deep understanding of what the drivers of crime are. And that is precisely what we are doing in the Home Office.

What is true in the Home Office is true in other departments too. Chris Grayling’s reforms in the Ministry of Justice are about breaking the cycle of reoffending and therefore reducing demand in the criminal justice system. Andrew Lansley and Jeremy Hunt have been clear that the role of the Department of Health is not to run the NHS but to develop better public health policy. Iain Duncan Smith’s welfare reforms are all about helping people out of benefits and into a life of work, which in the end is the only sustainable way to reduce poverty. And we must think in creative terms about how we take this approach not just within individual departments but across government as a whole.

In the last four years, we have achieved something no modern government has achieved before. We have proved that, through reform, it is possible to do more with less. We will need to go on doing more with less for many years into the future. But, looking ahead to the next Parliament, the next great challenge will be the need to reform to reduce the huge demand for public services in the first place. And I look forward to Reform leading that debate.

Thank you.

Theresa Villiers – 2014 Statement on the Hallett Report

Below is the text of the statement made by Theresa Villiers, the Secretary of State for Northern Ireland, in the House of Commons on 9 September 2014.

With permission, Mr Speaker, I would like to make a statement on follow up to the Hallett report into the on-the-runs administrative scheme which was laid before this House on 17 July.

In response to the recommendations in the report and on the basis of all the advice I have received, I have decided that the statement I make today is the fairest, promptest and most effective way to reduce the risk to future prosecutions, and to provide the clarity called for by the Hallett report.

I make this statement on behalf of the Government, having consulted with the independent police and prosecuting authorities who have seen this statement and agree that it represents the best way forward.

Lady Justice Hallett emphasised on a number of occasions in her report that the letters, however phrased, were not an amnesty.

They were not a commitment by the state that individuals would not be prosecuted, whatever the strength of the case against them.

They were only ever at statements of the facts, as they were believed to be at the time, as to whether an individual was wanted for questioning by the police or not.

They were not intended to preclude investigation or prosecution on the basis of new evidence emerging after they were sent or on the basis of fresh assessment of the existing evidence.

But in the light of her report, and in the light of the Downey case, it is clear to me that urgent clarification is needed as to what, if any, comfort can be derived from those letters now.

There are 2 key points which it is important that all concerned should be clear about:

First, the letters described by the Hallett report, issued in whatever form (and any similar or equivalent statements not made in letters) do not represent any commitment that the recipient will not be investigated or prosecuted, if that is considered appropriate on the basis of the evidence available now.

Those who received individual or composite letters (or any other form of indication) stating that they were ‘not wanted’ and who derived comfort from that, should cease to derive any such comfort.

In short, the letter recipients should cease to place any reliance on those letters.

Secondly, decisions about investigation and prosecution will be taken simply on the basis of the intelligence and/or evidence relating to whether or not the person concerned committed offences.

That means that in any of their cases (and whatever was said in the letters sent to them or statements made in the past) decisions today and in the future will be taken on the basis of the views that are formed about investigation and prosecution by those who now have responsibility for those matters.

Their views may be the same as the views that led to the letters being sent in the past, or they may be different.

It is the views of those who are taking the decisions now (or in the future) that matter.

All the evidence will be taken into account, regardless of whether it was available before the letters were sent or whether it has emerged subsequently.

This does not mean that all those who received ‘not wanted’ statements in the past are now considered ‘wanted’.

It simply means that they are in the same position as any other member of the public.

If there is considered to be evidence or intelligence of their involvement in crime, they will be investigated by the police and if the evidence is sufficient to warrant prosecution, they will be prosecuted.

This was always the intended status of the scheme but the issues raised by the Downey case and highlighted in the Hallett Report have made today’s clarification necessary.

I regard this as being the appropriate position to take, and not an unfair one, for the following general reasons.

The implementation of the scheme was highly unsatisfactory and suffered from a series of systemic failings, as set out in the Hallett Report.

It was developed piecemeal and without appropriate direction.

There were various different forms of letters and the content of a number of those was unsatisfactory.

We know that errors of fact were made and it may well be that errors of judgment were also made when cases were considered under the scheme.

It is now clear that at least some of the letters were issued on an unreliable basis.

The defects in the scheme identified by the Hallett Report mean that there is a serious risk that this will turn out to be the case in relation to other letters as well.

The public interest in investigating and prosecuting serious crime is too important for there to be a risk of it being undermined by a scheme which, it is now clear, suffered from such significant flaws in its implementation.

There is a particularly strong public interest in decisions about investigation and prosecution being taken on the basis of the current views, based on assessment now of all the evidence, of those responsible for investigating and prosecuting serious crime.

The letters have generated a serious degree of confusion as to precisely what their legal effects might be, whether alone, or when set alongside other facts (as in the John Downey case).

It is very important, particularly in the context of serious crime, for there to be clarity.

It is to be recognised that, correctly or not, some of the recipients will have derived some comfort from a ‘not wanted’ letter.

It may be that some ‘not wanted’ letters were issued in error or were based on flawed judgements at the time and that recipients of such letters were given a degree of comfort that was in fact unwarranted even on the basis of the information at the time.

That is greatly to be regretted.

Such errors should never have occurred.

But two points are to be noted in any such cases (in addition to the more general points I have just made):

First, the public interest in mounting an investigation or prosecution, if the evidence warrants it, would remain very powerful.

It should be a rare case indeed in which such an error should prevent such a prosecution, all the more so if the crime in question is a very serious one.

And second, those who have received such statements now know in clear terms what position the Government takes.

They now have fair and clear warning that such comfort as they may have derived from the statements can no longer be taken.

There is no continuing basis for any reliance on the past statements.

This scheme is at an end.

All those who sought or received statements through the administrative scheme should take note of this statement today.

I have deliberately made it in the public setting of Parliament, recognising and intending that it should be widely publicised as a result.

I will take further steps to disseminate it.

I will be drawing it to the attention of each of those who made requests on behalf of named individuals, reflecting the channels through which the communication of the original letters was made.

In these ways, I can be confident that fair and proper notice will have been given to those affected by this statement, including those to whom letters were sent under the scheme.

I commend this statement to the House.

Eric Pickles – 2014 Statement on Rotherham Council

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Below is the text of the speech made by Eric Pickles, the Secretary of State for Local Government and Communities, in the House of Commons on 10 September 2014.

One of the most important duties of local authorities is the protection of vulnerable children. Professor Jay’s recent inquiry into child sexual exploitation in Rotherham has painted a horrific and awful picture that the council utterly failed its children.

As Professor Jay noted:

No one knows the true scale of child sexual exploitation in Rotherham over the years. Our conservative estimate is that approximately 1,400 children were sexually exploited over the full inquiry period, from 1997 to 2013.

In just over a third of cases, children affected by sexual exploitation were previously known to services because of child protection and neglect. It is hard to describe the appalling nature of the abuse that child victims suffered. They were raped by multiple perpetrators, trafficked to other towns and cities in the north of England, abducted, beaten, and intimidated.

There were examples of children who had been doused in petrol and threatened with being set alight, threatened with guns, made to witness brutally violent rapes and threatened they would be next if they told anyone. Girls as young as 11 were raped by large numbers of male perpetrators. This abuse is not confined to the past but continues to this day.

Following the publication of the Jay report, my Rt Hon Friend the Home Secretary announced to the House on 2 September 2014 that I was minded to use my powers to commission an independent inspection of the council. In parallel, I would also be considering the implications of the report’s findings for all local authorities in England.

With clearly documented failures by the council on so many levels, the rare step of a statutory inspection is in the public interest. I have now decided to exercise my powers under section 10 of the Local Government Act 1999 to appoint Louise Casey CB to carry out an inspection of the compliance of Rotherham metropolitan borough council with the requirements of part 1 of that Act, in relation to the council’s exercise of its functions on governance, children and young people, and taxi and private hire licensing.

In undertaking her inspection, I have directed her to consider whether, in exercising its functions on governance, children and young people, and taxi and private hire licensing, the local authority:

– allows for adequate scrutiny by councillors

– covers up information, and whether “whistleblowers” are silenced
took and continues to take appropriate action against staff guilty of gross misconduct

– was and continues to be subject to institutionalised political correctness, affecting its decision making on sensitive issues
undertook and continues to undertake sufficient liaisons with other agencies, particularly the police, local health partners, and the safeguarding board

– took and continues to take sufficient steps to ensure only “fit and proper persons” are permitted to hold a taxi licence

– is now taking steps to address effectively past and current weaknesses or shortcomings in the exercise of its functions, and has the capacity to continue to do so

As the statute allows, I also intend to appoint on her recommendation, assistant inspectors to ensure that she has all the skills and experience available to her which she believes are necessary for her to fulfil her remit. Louise Casey will report to me by 30 November 2014, or such later date as I may agree with her, whether or not the council is meeting this duty to secure continuous improvement in respect of its governance, the services it delivers for children and young people, and taxi and private hire licensing.

I have appointed Louise Casey to carry out this sensitive task rigorously and independently. I am confident that with her track record of working in public service and particularly in challenging established practices in regard to the most vulnerable – for example, in reducing rough sleeping, as Commissioner for Victims and Witnesses and in her current role as head of the Troubled Families programme – she has the experience and skills to undertake a robust and independent inspection which will provide a full and comprehensive report on these matters.

Beyond the terms of reference I have set out in this statement, it is for Louise Casey, with any assistant inspectors I appoint on her recommendation, to decide how to carry out this inspection, and her findings and conclusions will be a matter for her alone.

Louise will continue to lead the Troubled Families programme. While she is carrying out the inspection in Rotherham, arrangements are being put in place to ensure that progress on troubled families is maintained.

If I am satisfied that an authority is failing to comply with its duty under part 1 of the 1999 Act, that Act gives me the power to statutorily intervene in that authority. Intervention may take a number of forms, including directing the authority to take any action that I consider necessary or expedient to secure its compliance with the 1999 Act duty, or directing that certain of the authority’s functions be undertaken by me or by a person – a commissioner – appointed by me for that purpose. The inspection report that I receive will assist me in reaching my view as to whether or not Rotherham metropolitan borough council is meeting its duty under part 1 of 1999 Act.

As part of my consideration of the implications of the Jay report for all authorities in England, I shall be asking Louise Casey, in addition to and outside the scope of the statutory inspection, to explore the links between Rotherham metropolitan borough council and the police and justice system, and highlight issues that local authorities, police forces and the justice system should consider in their work on child sexual exploitation, and my Rt Hon Friend the Home Secretary welcomes this.

I will also ask Louise Casey to report to me on whether she considers, as a result of undertaking the inspection or otherwise, there are any further matters which might appropriately be drawn to the attention of authorities and other local service providers generally to assist them to improve the delivery of their services, particularly those relating to children and young people.

In order to assist Louise Casey and help my consideration of the wider issues I will be writing to all leaders of principal councils asking them to consider the implications of the Jay report for their own authority.

I will make a statement to the House in due course on the completion of this work and after due consideration of the report.

We cannot undo the permanent harm that these children have suffered. But we can and should take steps to ensure that this never happens again and make sure that all local authorities deliver on their essential duty to protect vulnerable children.

Edward Timpson – 2014 Speech on Adoption Support

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Below is the text of the speech made by Edward Timpson at Somerset House in London on 13 May 2014.

Thanks Sheila (Durr, Chair of the London Adoption Board), it’s good to be here.

Just a month ago, I was pounding the streets of London in the marathon, sporting a T-shirt with the words “I’d adopt” on it in the hope that if that got just a few people thinking about the possibility of offering a child a loving home, then it will have done the job.

Because, with 6,000 children – and around 800 in London alone – still waiting to be adopted, we must take every opportunity to bring them and prospective parents together – and to be there for them every step of the way.

And the good news is we’ve made really important progress this year.

Progress

The Children and Families Act is sweeping away many of the identified barriers to adoption and there’s been a much stronger focus on wider recruitment and better support for adopters.

And thanks to your hard work and dedication – for which I’m naturally hugely grateful – we can see this determined drive from government beginning to pay off.

Adoptions are at record levels following a 15% increase between 2011 to 2012 and 2012 to 2013. There’s also been a 34% increase in the number of adopter approvals.

Huge numbers – over 96,000 people in 12 months – contacted the First4Adoption online information service that we fund – and whose phone number was splashed all over my marathon T-shirt. And over 6,800 of these people went on to look at an adoption agency’s website – a vital next step to becoming an adoptive parent.

We’re already aware of one couple who have gone from contacting First4Adoption to being approved as adopters and having a child placed with them. It shows what can be done if we all pull in the same direction.

Three new voluntary adoption agencies also opened last month with a commitment to attract over 300 adopters and offer hope to more children – just the latest advance in a massive £217 million push to improve the system and boost recruitment.

And there have also been welcome developments on adoption breakdowns. Professor Julie Selwyn’s recent report showed that far fewer adoptions fail than previously thought – around 3% as opposed to a 20 or 30% breakdown rate.

But this very timely and important research also reveals that we need to do much more to support adoptive families who are struggling with the fallout from earlier abuse and neglect – something I’ve seen first-hand, whilst growing up with my own 2 adopted brothers.

So there’s a lot to do, but also a lot of great work that we can build on.

Good work in London

And, the reason I’m here today is because, in many ways, London is leading the way.

Research shows that Londoners – particularly single women and those aged over 40 – are more likely to adopt than people anywhere else in England. Londoners are also more likely to contact First4Adoption’s phone line than any other group.

And this is in the face of many of the same challenges as other parts of the country, particularly when it comes to finding matches for BME children.

As we know, black children spend, on average, a year longer waiting to be adopted than white children. I know that this is as unacceptable to you as it is to me – which is why, through the act, whilst continuing to recognise its clear validity as a factor to be taken properly into account, we’re ending the undue emphasis on finding an ethnic match between adopters and children whose chances of being adopted diminish with every day they have to wait.

And we can see some really excellent and innovative practice beginning to tackle this and wider recruitment challenges head-on.

Like Redbridge’s partnership with the children’s charity Coram, which, with its keen focus on reducing delays and on tracking children’s progress right through the process, has sent adoptions through the roof – by an astonishing 175% – and, in the process, attracted a wider pool of adopters.

Southwark too has excelled with its Find 40 Families campaign to attract BME adopters, driving up the number of adopters by 50% since its launch a year ago. A fantastic achievement.

Traffic to its website has also soared by 70% through a combination of work to raise awareness and myth-bust in local communities along with imaginative approaches to publicity – for example, by adding personal touches to its website, such as profiles of children waiting to be adopted.

We’re keen to do all we can to support these kind of inspirational ventures and see many more children gain from the wonderful gift of adoption.

Adoption reforms

Which is exactly what our adoption reforms aim to do, with a strong focus throughout on boosting recruitment as well as support for adopters at every stage.

There’s no question that the 2 things go hand in hand. People are far more likely to consider adoption if they’re confident they can count on good support – not just in the early days, but years down the line if needed, which I know from my own family, can often be the case.

So, through the act, through the new Adoption Support Fund, the new Adoption Leadership Board, chaired by Sir Martin Narey, as well as through the significant funding we’re injecting into the system, we’re simplifying and improving the process every step of the way. And, crucially, giving prospective parents much more choice and control over the support they get.

So what does this mean in practice? For adopters, it means they’ll get much clearer information about their entitlements, the same pay and leave rights as birth parents and will no longer face the ‘cliff edge’ of support provided while the child was in care suddenly being withdrawn.

We’re also giving them a more active role in finding a match by opening up the Adoption Register. We’ll start testing access to the register in the summer to see how this might help adoptive families come together much more quickly. And how it might highlight, at an earlier stage, what support is needed.

Adoption Support Fund

And this support is about to ramp up as families access much-needed therapeutic services through the Adoption Support Fund.

Last year, I announced that we’ll be contributing £19.3 million to help kick off this new fund. I launched this during a visit to the highly impressive Family Futures in Islington, an adoption support service where I met several adoptive families and heard from them how successful therapeutic interventions had been the difference between them sinking and swimming.

In fact I’ve recently received a letter from one of the parents I met on my visit updating me on the terrific progress her son is making after years of, as she put it, “firefighting.”

It’s one of the main reasons why we’re currently working with 10 local areas, including Lewisham, to trial a smaller version of the fund and using the insights gained to shape the national fund, which will be fully up and running in 2015.

We’ll also be testing personal budgets, with the input of social workers to really put adoptive families in the driving seat – families, for whom, these vital therapeutic services have often remained out of reach, despite their potential to change lives.

Adoption Leadership Board (ALB)

Better support is also a big focus for the new Adoption Leadership Board, which Mark (Owers, CEO, CVAA), of course, manages.

It’s early days for the ALB, but I’m confident that the board will thrive under Sir Martin Narey’s leadership and will galvanise real improvements by bringing together local and central government, the voluntary sector and academics as never before.

Its success will rest, in large part, on effective regional boards. London, with its regional set-up, is especially well-placed to take this forward. Indeed, the London model has been discussed at Adoption Leadership Board meetings and is likely to form the blueprint for boards in other regions.

Andrew Webb at the ADCS is currently setting these boards up. Each will have a designated lead ADCS member for the region, representatives from the voluntary sector and a ‘sponsor’ from the national board.

Universal services playing their part

It’s also, of course, vital that universal services like education and health play their part. Adoptive families rely on them as much as specialist services.

An Adoption UK survey from last year, for instance, found that two-thirds of adoptive parents felt that their children faced specific challenges at school due to past trauma and neglect.

And it’s with this in mind that we’re providing extra support for adopted children through our education reforms.

From 2014, children adopted from care will be eligible for the pupil premium plus and for free early education under the programme aimed at the most disadvantaged 2-year-olds.

This comes on top of our move to extend priority school access to children adopted from care.

And I can announce today that, from now on, this will apply to all children adopted from care, not just those adopted under the Adoption and Children Act 2002.

We’ve issued new guidance about this and have asked admissions authorities to apply it with immediate effect. We will amend the School Admissions Code at the earliest opportunity.

There’s also significant work underway to improve the understanding of adopted children’s needs among health professionals. Their support is critical for adopted children, given their known high level of mental health needs.

So it’s great to see pioneering approaches like the work being done at The Maudsley, where specialist services are provided for young people who are fostered or adopted. These are highly rated by parents who report improved relationships with their children, a reduction in difficult behaviours and improved wellbeing – things we want to see many more parents achieving through improved support.

But there’s clearly more to do.

Which is why we’ve commissioned the National Institute for Health and Clinical Excellence (NICE) to produce clinical guidelines on attachment.

And why we’re encouraging national and local health service commissioners to consider adopted children’s needs when developing integrated services for vulnerable groups.

Adopted children are now recognised as a key group by the NHS Commissioning Board and in statutory guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies – which are important steps forward.

Improving the access that adopted children – indeed all children – have to CAMHS is high on the agenda across government at the moment and we’re working closely with the Department of Health to see what more we can do.

I have to say that this is a particular priority for me, as is ensuring that social workers are well-equipped to meet the needs of looked after and adopted children.

Which is why we commissioned Research in Practice (RiP) to produce new training materials for social workers who work in these areas. These are currently being rolled out and are now available on the RiP’s website – so would encourage you to take a look.

Conclusion

So we’re on the right track. And, together, are overturning expectations of what can be achieved when the ambition and commitment is there.

But we need to keep up the pace and continue to push the boundaries to drive up performance even further.

Adoption scorecards that show how long it takes for each local authority to place children for adoption are vital to this endeavour.

As is access to real time performance data by region – and I’m hugely grateful to the north London consortium of local authorities for helping the Adoption Leadership Board develop its new data collection arrangements to provide continued focus and insight into what works and how we can do better.

Because it’s only by continuing to inspire, support and challenge each other that we can really raise our game – on both adopter recruitment and also improved support for adoptive families.

I know just how critical this support is from seeing how my elder adopted brother Oliver continues to struggle with issues stemming from the mental and physical abuse he suffered before he came to live with us, over 30 years ago, as a 6-year-old foster child.

In those days, therapy was neither well-known, never mind easy to access. And while Oliver has gained a great deal from his adoption – as we all have in our family – I’m sure that these issues wouldn’t be affecting him as much if he’d had the therapeutic support he needed.

Which is why I’m so determined to ensure that other adopted children and their parents get the help they need, when they need it.

They deserve our utmost support, so let’s continue to work together to make sure that’s exactly what they get.

Thank you.

Alistair Carmichael – 2014 Speech at All Energy Conference

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Below is the text of the speech made by Alistair Carmichael, the then Scottish Secretary, in Aberdeen, Scotland, on 21 May 2014.

It’s a pleasure to be here today at the start of the All Energy Conference.

This is a fantastic opportunity to get together at the UK’s largest renewable energy gathering – to share experiences, see new technologies and celebrate the success of this ever-growing industry.

Because as we all know Scotland is fast becoming a world energy hub – not just in oil and gas, but in renewables too.

Scottish renewables are now providing enough electricity to meet roughly 40% of Scotland’s consumption. A third of all renewable generation in the UK is now in Scotland.

The latest figures show that between the third quarter of 2012 and the third quarter of 2013, renewable electricity generation is up 20% on the previous 12 months.

Together we are now around half way to our ambition of meeting 30% of the UK’s electricity needs from renewables by 2020.

And our prediction is that with the framework we are putting in place, we’ll do even better than 30%.

Investment

Between January 2010 and February 2014, we saw private sector investment in large scale UK renewable electricity projects exceed £34 billion. This investment supports over 37,000 jobs.

Over £14 billion of this is in Scotland, supporting around 12,000 jobs, here at home.

And our reform of the Electricity Market will ensure the UK remains a leading destination for investment in the electricity sector and could support as many as 25,000 jobs in the power sector in the UK.

This record is in stark contrast with the rest of Europe, where renewables investment halved between 2012 and 2013.

The UK Government is committed to supporting and investing in our renewables technology to make sure that we retain our position as Europe’s renewable investment hotspot.

Projects such as the Dorenell Wind Farm in Moray which is estimated will generate at least £93 million in direct benefits for the Scottish economy.

And The Speyside Biomass Combined Heat and Power Plant at the Macallan Distillery, which would represent an inward investment of £60 million to the local area.

I am delighted to confirm today that the Eskdalemuir Working Group has progressed very well. Through constructive discussions, the MoD’s concerns on wind farm development have been met and opposition to the project will be removed, opening up extra capacity for renewables deployment.

Renewable potential

And for the first time we have created a tailored strike price for Scottish Islands which will help to unlock their renewable potential as cost effectively as possible, and increase the likelihood of a number of Scottish offshore wind projects coming forward.

As MP for Orkney and the Shetlands I can tell you that enthusiasm for exploiting renewables potential on the islands is very high.

The UK Government is currently in talks with Shetland, Orkney and the Western Isles ‘our islands out future’ campaign in recognition of their incredible potential and to overcome obstacles to development.

This whole positive picture, right across Scotland is down to your hard work – and collaboration.

The Energy Act 2013 – supported by all parties in the UK Parliament: Labour and SNP as well as the Conservatives and Liberal Democrats has put in place the legal, financial and political framework that is designed to last.

Not just for the next few years, but it reaches out ten, twenty, thirty years into the future. Certainty, stability, predictability.

Going green

By creating the world’s first low carbon electricity market, we are going green at the lowest cost.

Demonstrating that carbon reduction and economic growth can go hand in hand.

Let me be crystal clear, the government’s commitment to renewables as part of our diverse energy mix is undiminished.

But to succeed we need to keep showing that this vision of a competitive low carbon market isn’t an ideological, or even just an environmental one. We can keep energy bills as low as possible as we decarbonise.

We need to provide certainty, stability and fair returns for investors, generators and suppliers

So the positive case for Scotland’s energy future in the UK is the protection of the integrated market. Sharing support, sharing benefits and sharing costs.

Scottish renewables, just like renewables in other parts of the UK, are an integral part of our vision for a low carbon future.

Investment, consent, construction and generation.

Scotland – a world-leading renewables hub. The United Kingdom – the best place to do business.

Nick Gibb – 2014 Speech on Education Autonomy

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Below is the text of the speech made by Nick Gibb, the Minister of State for Schools, on 12 November 2014.

The government’s education reforms over the past 4-and-a-half years have been the most far-reaching for a generation. Our reforms to the curriculum, making it more knowledge-based and academically rigorous – and our focus on raising standards of pupil behaviour in the classroom, enabling teachers to spend more time teaching – are both key elements of this reform.

But today I want to talk about our structural reforms that have delivered professional autonomy. At the centre of these is academisation, making schools free from local authority control. Accompanying this were numerous smaller reforms, designed to pass powers back to teachers and heads – the aim, to let a thousand flowers bloom.

We are now in the enviable position of being able to see which of these flowers have bloomed the brightest. I first became Shadow Schools Minister in 2005, and after 9 years of witnessing some of the most gifted educators in England, I am repeatedly struck by a new vibrancy and excitement in the English education system.

Schools are, with no shadow of a doubt, improving.

As of this summer, the proportion of schools judged ‘good’ or ‘outstanding’ by Ofsted at their most recent inspection reached 80%, compared with 70% in 2012.

Our reforms to GCSEs are helping reverse the decline in the number of pupils taking rigorous academic qualifications. The number of pupils taking challenging EBacc subjects has risen dramatically under this government. In 2010, only 22% of pupils in state-funded schools entered all EBacc subjects. In the most recent academic year, this rose to almost 39%. Over the same period, entries to history or geography have risen from 48% to 65%, and entries to languages from 40% to 50%.

My mother was a primary school teacher, so early years education has always been a key concern for me. I am delighted that the number of 6-year-olds able to decode simple words and pass the phonics screening check at the end of year 1 has increased from 58% in 2012 to 74% in 2014. That’s 102,000 more 6-year-olds on track to be reading more effectively as a direct result of this policy.

The number of persistent truants has fallen from 433,130 in 2009 to 2010, to 300,895 during the last academic year.

Autonomy is not about government directives, committees of experts, quango worthies or national strategies costing hundreds of millions of pounds. It is about associations of like-minded people, bound by a common purpose – academy trusts, teaching school alliances, independent training organisations, charities, social enterprises and online communities. Call it civil society – call it the third sector. It is with these little platoons of idealistic people that the future of our school system lies.

This was why this government launched the free schools programme in 2010. We wanted to provide outlets for idealism – opportunities for dedicated groups of individuals who believed they could improve school provision.

Such groups of individuals have exceeded our expectations. The best academy chains, such as Ark Schools and the Harris Federation, have expanded and replicated their proven success. Ark Schools have opened 3 free schools, with 8 more in development. Likewise, the Harris Federation has opened 8 free schools, with 5 more in development.

And we have seen, much older institutions play a new role in educating our young people. The London Academy of Excellence sixth-form college was established 2-and-a-half years ago by a collection of independent schools including Brighton College, Eton College and Highgate School.

Situated in Newham, the LAE’s ambition was to channel the brightest pupils from London’s most deprived borough into top universities. 2 years later, its A level results beat those of several well-known public schools. 68 pupils from its first cohort gained places at Russell Group Universities, including 5 at Oxford and Cambridge. This year, more London Academy of Excellence pupils were offered places at Oxbridge than has ever been achieved by the entire borough of Newham in any previous year.

Since 2010, this government has also pioneered university technical colleges, a new type of school geared towards providing technical education for 14- to 18-year-olds. Known as UTCs, they bridge the gap that too often exists between educational provision and the local job market by linking with a nearby university or employer. We now have the Silverstone UTC, Liverpool Life Sciences UTC and UTC Sheffield.

Leading this innovation in vocational education has been Kenneth Baker, a truly inspiring public servant. Now in his ninth decade, Kenneth works tirelessly as chairman of the Baker Dearing Trust and has helped establish 30 UTCs already, with 26 already approved to open.

In the same period, our academies programme has ensured that over 1,200 of the worst-performing schools have been taken over by successful sponsors or headteachers – the majority of which are already leading other schools with a proven track record of academic achievement. We have given the very best heads control over many more schools, with the freedom they need to ensure that the children in their care receive the education they deserve and need.

And they have succeeded. Underperforming schools taken into the academies programme and placed under the leadership of great heads are improving more rapidly than those schools which remain in the hands of local authorities.

This element of the academies programme is a deliberate continuation of an approach begun under the previous government, which we have championed and expanded.

But the government firmly believes that the autonomy previously available to sponsored academies should be available to all schools.

I am delighted that since 2010 more than 3,000 schools – including many of our highest-performing schools – have chosen to become academies. These schools have seized the opportunity to raise standards by using the freedoms we have given them. They can now vary their curriculum, extend the length of their school day and employ the best teachers – regardless of whether they have received formal qualified teacher status.

In each of these cases, parts of civil society – be they teachers, school leaders, employers, philanthropists, universities or parent groups – are empowered to decide how future generations should be educated.

There are now 646 sponsors, 550 chains of 2 schools or more, and 40 chains of at least 10 schools – of these, 9 are responsible for 30 schools or more. All of these rightly compete to raise academic standards for their pupils. And within and between chains, this spirit of competition is accompanied by a culture of collaboration – professionals working together to improve children’s education.

Surveying today’s educational landscape, I derive enormous optimism from other organisations that are being established to support schools. Since Teach First was founded in 2003, 38 social enterprises have been set up by former participants in the programme – all examples of what can be achieved when real autonomy is delivered.

Take one of these – the National Orchestra for All. Founded by Marianna Hay in 2011, the NOFA takes 150 musicians each year from schools in London and the west Midlands and forms a full orchestra, rehearsing throughout the year and giving pupils from these schools the opportunity to play in such venues as the Royal Albert Hall, the Southbank Centre and the Royal Academy of Music.

Similarly, the Brilliant Club was formed in 2011 to bring fruits normally preserved for the more privileged within the reach of the less advantaged. It places postgraduate students in challenging schools to run university-style tutorials for groups of promising pupils. So far, the Brilliant Club has worked with 150 schools around Britain, connecting over 250 doctoral and postdoctoral researchers with 5,000 pupils.

In September this year I had the privilege of attending a ResearchEd conference. These events have brought fresh thinking and new energy to debates about teaching practices in English schools. ResearchEd was founded in 2013 by teachers – not by the government or university education faculties. These teachers, led by Tom Bennett, are determined that what happens in their classrooms should be informed by evidence, not fad.

And Teach First alumni such as Robert Peal, Kris Boulton, Katie Ashford and Joe Kirby are challenging current education orthodoxies. Their passionate iconoclasm, which refuses to accept mistaken and damaging conventional wisdom, is inspirational.

Similarly, the Institute of Ideas – run by Claire Fox – has long been arguing that children deserve a curriculum which is more knowledge-based and rigorous. Its debating competition – Debating Matters – has reinvigorated formal debating in state schools. It was founded in 2002 by a physics teacher from south London called David Perks, today the principal of a free school in east London. Likewise, the debating competition Debate Mate brings 350 undergraduates from top universities to train young debaters in 220 challenging, inner-city schools around England. We are seeing the beginnings of an academic renaissance in our education system.

Autonomy is at the heart of that renaissance. The great liberal politician Lord Beveridge is often invoked as the father of the British welfare state. Less often cited than the 1942 Beveridge report is a report he wrote in 1948 entitled ‘Voluntary Action’. In it, Beveridge specifically warned against monopolistic state provision, in which new ideas and new institutions are quashed instead of nurtured.

Beveridge contrasted a totalitarian state, or a state monopoly, with a free society. He wrote that in a free society, ‘discontented individuals with new ideas can make a new institution to meet their needs. The field is open to experiment and success or failure; secession is the midwife of invention.’

In that passage, Beveridge offered the best-possible articulation of what this government’s school reform agenda has aimed to achieve.

Beveridge was a liberal in the truest sense of the word. He believed that whilst services such as education can be paid for by the state, they should be provided by civil society. Our reforms have unleashed a previously untapped educational idealism within English civil society engaging thousands of groups and individuals, from millionaire carpet salesmen to Premiership football clubs, from high-tech companies to medieval guilds.

As Minister for School Reform, I delight in seeing the fruits of this autonomy in all their vivid abundance. It reaffirms my belief that good government does not improve public services. It enables public services to improve themselves.

Nick Gibb – 2014 Speech on Education Textbooks

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Below is the text of the speech made by Nick Gibb, the Minister of State for Schools, at the Publishers Association and the British Educational Suppliers Association Conference held in London on 20 November 2014.

Thank you – it’s a great pleasure to be here today and I’d like to thank the Educational Publishers Council and the British Educational Suppliers Association for inviting me.

Last May at the Kettner’s Educational Publishers’ lunch I said that the government’s new approach to education policy, designed to foster the autonomy of the teaching profession and sweep away the prescriptive and ideological National Strategies, meant that there is now an important leadership role for educational publishers. And that role is not to pander to the lowest common denominator in the scramble for market share, but to develop in young people the academic knowledge and the scholarship skills that the old curriculum has driven out of too many schools.

This time last year my predecessor Liz Truss issued a call to arms to publishers to introduce high-quality textbooks to support the new national curriculum.

Curriculum

Today’s conference is called ‘Delivering quality in changing times’. There is a lot of change in our schools. This term has seen the introduction of the new curriculum, modelled on those in the very best education systems around the world:

– in maths, this means a greater focus on getting the fundamentals right, with children becoming fluent in times tables at an earlier age and studying formal, efficient written methods of arithmetic – we’ve removed calculators from primary tests to ensure this focus is maintained throughout primary school.

– in English, we have increased the level of demand from an early age, with greater emphasis on grammar and vocabulary throughout the curriculum – we have embedded the use of systematic synthetic phonics in the curriculum because evidence shows that it is the most effective approach to the teaching of reading the new knowledge-rich science curriculum focuses on the big ideas.

– in science the new computing curriculum emphasises the hard elements of computer science, including how computers work and programming.

– it equips pupils to design their own computer programs
and all primary school children in maintained schools aged 7 to 11 years are now required to study a foreign language to help prepare them for life in our globalised economy.

Our reforms to qualifications will also help to drive up standards:

English GCSEs will require the study of a range of intellectually challenging and substantial texts – whole books, not just extracts – the new qualifications will encourage students to read widely and reward those that can demonstrate the breadth of their reading
maths GCSEs will be larger qualifications – they’re more challenging and provide assurances of a firm grasp of the fundamentals while stretching the most able redesigned A levels will provide a stronger basis for transition to higher education any young person who doesn’t reach a good level in English and maths by age 16 will need to study those subjects in post-16 education and we have taken the important step of introducing ‘core maths’ qualifications for post-16 students who achieve at least a C at GCSE maths but don’t go on to take AS or A level maths.

Our education plan will underpin a transformation of the education system by setting out and increasing the essential knowledge and skills the next generation will need to compete successfully for jobs in the global jobs market.

But these changes are only part of the story. They will not deliver quality in themselves.

They are necessary but not sufficient to raise academic standards. That’s because behind every document setting out content to be taught – every sample assessment question – there is inevitably scope for interpretation. The real transformation always depends not on rules, but on people – and this transformation is in the hands of schools and teachers, in what happens in the classroom.

That is where the skills of teachers and the resources they use are so important. That is where a great textbook can help teachers to transform their classes – critical indeed for raising academic standards.

Why textbooks count

In 2010 Tim Oates, who chaired the national curriculum expert review panel, examined the international research and evidence around curriculum design and published his findings in his seminal paper ‘Could do better’. It said that only by learning from the very best around the world could we hope to design a world-class curriculum, and this philosophy underpinned all the work that followed and has led to the rigorous curriculum we have today.

Today Cambridge Assessment has published ‘Why textbooks count’, which analyses the use of high-quality textbooks around the world. Its message is clear – once again England has fallen behind. ‘Why textbooks count’ should rightly send shockwaves through the education system and the publishing industry.

In the controversial search for the reasons why a range of key nations have improved their systems so dramatically and so quickly, the role of high-quality textbooks has been seriously neglected. Well-focused, forensic study of these nations highlights the extent to which good teaching and high academic standards are strongly associated with adequate provision and widespread use of high-quality textbooks.

In Finland, 95% of maths teachers use a textbook as a basis for instruction, and in Singapore it’s 70%. Compare that to England, where only 10% of maths teachers use a textbook for their core teaching. And in science the story is even worse – only 4%.

What is important about this research is the quite astounding gap between this country and high-performing jurisdictions. However one measures textbook usage, it is this huge gap that matters – and it is this huge gap we need to overcome.

The paper shows us that textbooks work:

– excellent textbooks are central to education in Singapore, where they are closely linked to pedagogy

– in Shanghai, as we also know from the recent China-England maths teacher exchange, textbooks are used extensively to provide structure to lessons and progression – helping to ensure that all pupils keep up and achieve

– and at the time that Finland’s education system improved so strongly, use of textbooks was central – what were the key elements in that transformation? To quote the paper: ‘high-quality teachers and high-quality materials’

But despite these examples we know that there is, in some quarters, a distinct ‘anti-textbook’ ethos.

Where does this ethos come from? The research found that it originates not from teachers but from teacher training providers and educational research communities. Teachers themselves understand the benefits of a good textbook:

– firstly, it saves time – producing worksheets is immensely time consuming, as is endlessly trawling the internet for suitable resources – this is time that could be better spent by teachers in planning the perfect lesson or supporting their pupils to master particularly tricky elements

– it can provide a far better experience for pupils – a well-designed textbook provides a coherent, structured programme which supports a teacher’s own expertise and knowledge as well as a pupil’s

– and it helps parents support their children – good textbooks have workbooks which support homework in a positive way by providing well-structured practice exercises linked to clear explanations, which parents can understand and use to help their children

Criticisms

I doubt that anyone here will disagree with any of these points. But some people argue that textbooks hark back to the past, as though textbooks are from a bygone era. This view is based upon a misconception, an out-of-date idea of what textbooks are. The books used in Singapore, Shanghai, Finland are state of the art, tried and tested – firmly based on solid evidence of what works.

Others say that textbooks are too expensive, that schools can’t afford them. But if you think about the amount a school will spend on photocopying worksheets, and factor in the time teachers waste and how they could be using that time to support pupils, then a set of good textbooks can only be seen as the right investment.

Digital resources

Other critics said: ‘the future is digital – why bother with textbooks when online resources are clearly superior?’

I put this point to Lee Fei Chen and Joy Tan, representatives of Marshall Cavendish, one of the largest publishers in Singapore – not a country noted for shying away from technological advances. They told me that yes, Singapore is introducing digital resources, but with thought and care when there is clear evidence that those resources are as effective as their outstanding paper-based textbooks.

The very best digital resources can be powerful, providing teachers with resources and extra tools to do their job better, but they are no replacement for a good textbook – instead they should complement it.

Singapore has no plans to stop producing textbooks, of course not – they have been crafted, tested and refined with great care, and are proven to build deep understanding and support solid progress in the subject.

Whether electronic textbooks can play a similar role is an open question. Features of the physical form should not be underestimated – for example being able to easily flick backwards and forwards, quickly reminding yourself of past lessons and easily skimming what’s coming next.

In my view, clearly a future which includes digital should not exclude the textbook.

The quality of textbooks in England

But the bigger failure is a one of quality.

In this country textbooks simply do not match up to the best in the world, resulting in poorly designed resources, damaging and undermining good teaching.

Today’s paper sets out an analysis of a typical GCSE textbook – and what did it show? Incoherent presentations, little signposting of key concepts and an approach focused more on preparing for GCSE-type questions than understanding the subject.

In comparison, a secondary maths textbook from Singapore has a clear structure, strong explanations of key ideas, helpful worked examples and plenty of opportunity for essential practice to increase fluency and understanding.

And this isn’t just a problem at GCSE – most new primary curriculum textbooks fall far short of the high standards we find in Singapore, Shanghai and other countries. The best-quality text books in the world are based on rigorous research and drive high attainment, pupil enjoyment of the subject matter and higher outcomes for children from all backgrounds. These textbooks have left this country behind.

In Tim’s view there is a fundamental market failure in this country which has led to the narrow focus we find in too many GCSE textbooks.

And whilst it can be argued that accountability systems for too long encouraged a focus in schools on getting young people to a C, our changes now place much greater emphasis on progress for every child – not just those at the C/D borderline. From 2016 school performance measures (Progress 8) will, crucially, reflect GCSE point scores, not just the number of C grades.

Schools will look to publishers for solutions – for higher-quality resources which truly support every young person to reach a higher standard than ever before.

Eighteen months on from my last encounter with the textbook industry, and 1 year on from Elizabeth Truss’s call to arms, I wish I could say that the challenge has been met.

Sadly, we’re not there yet.

This government would be happy to promote textbooks, to rebut the arguments that have driven them from classrooms for too long, to challenge the anti-textbook ethos.

But we can only do that when it’s clear that the textbooks on offer in England match the best in the world.

This is my challenge to you.

Good examples

There has already been some progress.

To support high-quality phonics teaching – which is key to success in early reading – we provided over £23 million of match funding for schools to help them purchase high-quality phonics training and resources. Over 14,000 schools benefited from this funding, buying thousands of top-quality textbooks and resources and putting much greater focus on phonics, and we have seen the percentage of pupils reaching the expected standard in the phonics screening check rise from 58% in 2012 to 74% in 2014.

Since last year’s conference 2 UK publishers – OUP and Maths No Problem – have joined forces with leading Singapore publishers to develop versions of their world-class primary maths textbooks for England.

It is excellent news that pupils in England will now be able to benefit from this carefully constructed, rigorous approach in line with the new curriculum.

Textbook project

Which is why it’s equally good news that our new network of 34 maths hubs around the country intend to trial the use of these new Singapore-based textbooks, supported by the NCETM, through this academic year and beyond. That’s a great development, and a chance to learn how textbooks can be used to drive up the quality of primary maths teaching.

Conclusion

All the evidence shows that high-quality textbooks are good for teachers, students and parents. For teachers, well-structured textbooks reduce workload and the perpetual ritual of producing worksheets; for students, knowledge-rich textbooks mean they can read beyond the confines of the exam syllabus, and using textbooks helps to develop those all-important scholarship skills; and for parents, textbooks are a guide to what their children are being taught in school. I would like to see all schools, both primary and secondary, using high-quality textbooks in most academic subjects, bringing us closer to the norm in high-performing countries.

I strongly believe that textbooks need to play an important role in pushing up academic standards. Ministers need to make the case for more textbooks in schools, particularly primary schools. But the industry needs to provide the type of textbook that policy makers can be proud to promote. I am sure that’s what every individual in this room is intent on providing and I hope that together we can deliver on that intent.

Thank you.

Jeremy Hunt – 2014 Speech on Waiting Times

jeremyhunt

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at the Royal Surrey County Hospital on 4 August 2014.

Introduction

I am really pleased to be here at the Royal Surrey this morning – and many thanks to you Nick for hosting us.

I was delighted and honoured to open the Margaret Eaton wing of your ICU in June – and even more delighted to spend time with your brilliant A & E staff before Christmas where for the first time ever I took someone’s blood pressure as part of a frontline shift.

I try to go out somewhere on the NHS frontline most weeks and I can honestly say I have learned more from those visits than I ever do from sitting behind a ministerial desk in Whitehall.

What I know from my visits here is that you deliver superb care and under Nick Moberley’s leadership have the ambition to be the very best in the country. I want to wish you every success in that, and put on record my thanks – both as MP for South West Surrey and Health Secretary – for the dedication and hard work of the brilliant staff who work here.

Progress over the last decade

Every month, more than a million patients start specialist treatment. Keeping up with this demand is crucial: patients tell us all that timely access to treatment is one of the most important things they want from our NHS.

Keeping waiting times low is therefore a key objective for any government. And it is right to acknowledge that the last government made welcome progress in bringing down the number of people waiting a long time for their treatment, progress this government has sustained.

It is also right to pay tribute to the hundreds of thousands of NHS staff who have worked so hard to make that possible over the last 10 years.

Thanks to their efforts, access to NHS healthcare is now amongst the best in the world.

When the target was announced in June 2004, patients could expect to wait more than a year for treatment.

Since then we have seen spectacular improvements for patients: no longer do we read about the scandal of people routinely dying on waiting lists because access to the life-saving treatment they need comes a year too late. No longer are families suffering the pain of watching elderly relatives slowly lose their mobility, becoming trapped and isolated at home because the NHS can’t provide a simple hip operation for 2 or 3 years.

Delivering timely access to treatment has become part of the DNA of the NHS – and that is something we should all welcome.

A tougher context

It is also worth pointing out something everyone in this hospital will be acutely aware of: delivering that objective has been much tougher in the last 4 years than previously.

Until 2010 NHS funding generally rose faster than the demand for its services. We have had to deal with the deficit we inherited, and we have made some very tough choices to protect the health budget. Despite that, since 2010 funding has risen by around 1% a year even though demand for NHS services has risen by 3.6% a year.

Which makes the achievements of the last four years even more astonishing: every year, compared to 2010, 6,000 more people receive knee operations, 9,000 more people receive hip operations, and 10,000 more people have cataract procedures. Overall we are delivering an extraordinary 850,000 more operations year-in year-out.

And this increase in volume has not been at the expense of quality. A couple of months ago the independent Commonwealth Fund said that in the last four years the NHS has risen to become the top-ranked healthcare system across the 11 richest countries in the world – top for quality, top for efficiency, top for access, and top overall.

Targets can be dangerous

But – and there is a ‘but” to this – targets, as we also saw under the last government, can create the wrong behaviour too. What happened at Mid Staffs and many other hospitals was that targets distorted behaviours, changed clinical priorities and led to appalling care, sometimes with tragic outcomes for individual patients.

When the NHS started measuring performance against the 18 week target in 2007, something perverse happened. If faced with a choice between treating a patient who had missed the 18 week target or someone who had not yet reached it, the incentive was to treat the person who had not yet missed the target rather than someone who had – because that would help the performance statistics, whereas dealing with the long waiter would not. So a target intended to do the right thing ended up incentivising precisely the wrong thing.

And that in a nutshell is the problem with targets: unintended consequences.

Under huge political pressure, managers inevitably gamed the system to make their organisation look good – and patients suffered the consequences. Suddenly, real people with real illnesses and real needs find themselves treated like a number or a statistic, there not to be looked after but to be manipulated to show organisational performance in the best light.

So this government has made a determined effort to change that culture. Not by abolishing targets altogether – all organisations need priorities – but by making sure they are implemented more humanely and sensibly.

When we came to office in 2010 there were a shocking 18,500 people who had been waiting not 6 months, not 9 months but over a year for treatment.

I am pleased to say that even though none of those people count towards the standard 18 week target, we have none the less reduced that number to just 500.

But today I want to say that even 500 is too many.

A year is a very long time to wait if you are immobile, in discomfort or in pain. If a single one of those patients is waiting not out of choice, or for proper clinical reasons, but simply because the NHS has not been able to provide the treatment they need for a whole year then that is unacceptable.

So today I want to announce a new ambition for the NHS: I want this number of people waiting more than a year for their operation to be not in the thousands, not in the hundreds, but as close to zero as possible.

There will, of course, be exceptions to this which is why I do not want to fall into the trap of making this “another target”: there will be patients with multiple conditions where one condition needs to be treated first; there may be highly complex treatments which are particularly difficult to source; and sometimes the patient may choose to wait for personal reasons.

Unless there are those good reasons, no-one should have to wait more than a year for treatment.

So from today NHS England will review all 500 cases, and working with CCGs and local hospitals, ensure that any patients who can be treated will be treated as rapidly as possible.

Nor should this just be about people waiting for more than a year.

I want the NHS to put particular focus on anyone who has been waiting more than 18 weeks since being referred for treatment, so have asked NHS England to commission 100,000 additional treatments over the summer including 40,000 additional inpatient admissions.

This focus on long waiters may mean we undershoot the 18 week target for a temporary period, although we will return to meeting it before the end of the year. Indeed as the many NHS target experts will know we could ensure we met the 18 week target every month by focusing those 100,000 additional treatments on shorter rather than longer waiters. But that would be an indefensible betrayal of those who have been waiting the longest and not one I would be prepared to sanction as Health Secretary.

The truth is we need to ensure both that 90% of people get their treatment within 18 weeks – the official target – and that people who are not treated within that period are not neglected. So I have set a timeframe of this calendar year to deliver on both of those objectives.

An NHS about more than targets

Let me conclude with a broader point. Targets matter, but they should never be the only thing that matters. Patient safety, compassionate care, clinical effectiveness and efficiency are also vital.

Robert Francis hit the nail on the head in his report on Mid Staffs when he said “targets were often given priority without considering the impact on the quality of care”.

Even before Mid Staffs, the Healthcare Commission attributed one of the causes of over 30 C diff deaths at Buckinghamshire Healthcare NHS Trust as an over-focusing by the Trust on meeting government targets. Many of you here will have had experience of similar pressures and conflicts in your own daily work.

Which is why last year we introduced a new inspection regime for hospitals that looks at performance more broadly than just targets. We must never go back to the bad old days where targets seemed to matter more than people – so where we do have targets they should implemented sensibly and in line with the clinical needs of patients.

And where there is poor care, it should never be swept under the carpet.

As well as identifying good hospitals such as this one, the new Chief Inspector of Hospitals has recommended a number of hospitals go into special measures – indeed 10% of all NHS hospitals have been put into special measures in the last year alone. But far from leading to despair, the resulting transformation in both quality and financial discipline at those hospitals has been striking.

But it isn’t just at failing or struggling hospitals we have seen improvements. Across the NHS we now have more than 6,300 additional nurses in our wards than in 2010 as we finally put behind us the scandal of short-staffed wards. At the same time we have become the first healthcare system in the world to publish key safety data on a single website for every major hospital in the country.

We have also become one of the first healthcare systems in the world to make a determined national effort to embrace the safety culture of airlines, where there is a much stronger culture of reporting safety concerns and near misses than there is in medicine. That means supporting people on the front line who have concerns about safety or care – and stamping out the bullying and intimidation that is still too common in many hospitals.

These are big changes – changes designed to increase clinical accountability and make sure we always put patients first.

Conclusion

Let me conclude by returning to the new ambition I am announcing for the NHS today.

Let’s continue to make sure we treat the vast majority of patients within 18 weeks of being referred. But let’s also make sure we don’t forget the minority who don’t. So let’s commit that no one – except in exceptional circumstances – should have to wait more than a year.

Targets that help patients get treatment when they need it – not targets followed blindly with no regard for the impact on individuals.

An NHS confident that – in the end – it will continue to meet the huge challenges ahead if it leaves room, amongst many loud, competing pressures, for the quietest but most important voice of all: that of the patient.

Thank you.

Jeremy Hunt – 2014 Speech on Good Care

jeremyhunt

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at Birmingham Children’s Hospital on 16 October 2014.

Let me start by saying what an enormous pleasure it is to be here today at Birmingham Children’s Hospital. This hospital is rightly proud of its record on quality and safety and has led the way in bringing the safety agenda to paediatric care, not least with its work on improving patient handover and on developing a safety thermometer for children and young people.

Indeed this hospital is powerful proof of the case I want to make today: that world class care is not just better for patients, it reduces costs for the NHS as well. And in doing so creates a virtuous circle where ever more resources can be invested in improving patient care rather than wasted on picking up the pieces when things go wrong.

A turning point

With huge financial constraints and the pressures of an ageing population, we are at a critical moment in the history of the NHS. So today I want to challenge head on those who say that the future will be about cost and not quality; who suggest that it is time to ‘move on’ from Francis and the lessons of Mid Staffs and want to focus on the ‘next thing’ – which they usually say is about money and nothing else.

“The path to safer care is the same one as the path to lower cost”. Those words were spoken to me earlier this year by Dr Gary Kaplan of Virginia Mason Hospital in Seattle, recognised as one of the safest hospitals in the world.

As a result of his hospital’s journey to safer care, which started with the tragic death of a patient in 2004, his costs for acute diagnoses are between 20 and 60% lower than his major competitors. Shorter hospital stays, more motivated and productive staff and lower litigation claims have led him to believe that hospitals could double their output on the same resources simply by eliminating the waste of resources associated with harming patients.

Not just in the US, but here in the UK too where Salford Royal is recognised as a leader in patient safety and quality improvement. Chief Executive Sir David Dalton says the focus they have had on quality improvements has yielded productivity improvements of around £5m each year, which they continue to reinvest in frontline care.

Across the hospital sector, the enormous progress made in recent years to prevent hospital acquired infections is showing how quality improvements save money. We have reduced C. diff infections by 45% and MRSA infections by 56% in the last four years, saving patients untold trauma but also an estimated £22.5 million in costs for the NHS.

The extraordinary ‘Sign up to Safety’ campaign that David Dalton leads has so far signed up over 100 trusts, including this one, to help spread good practice – making it one of the biggest hospital safety initiatives in the world. Indeed the enthusiasm for ‘Sign up to Safety’ is a remarkable testament to the commitment of the NHS to learn the lessons of Mid Staffs.

But my message today is that learning those lessons is not a one-off: it’s a permanent process of constant questioning and continual improvement in which the elimination of waste and the elimination of harm walk side by side as part of the same process.

Variation and lost value

Today the CQC are publishing their annual ‘State of Care’ report. Inevitably there will be media focus on examples where care is sub-standard. Indeed, shining a light on poor care is essential if we are to have the highest standards.

But the biggest lesson from today’s report is not actually the existence of poor care – it is the unacceptable variation in care outcomes across the system. And it is my job as Health Secretary to ask why it is that similar levels of resourcing, similar values and similar numbers of committed staff can produce such differences in quality.

My conclusion is that too many people still think that providing the best care is something you do only when you can afford it – and fail to appreciate that improving care is one of the best ways to control costs in financially challenged circumstances.

Which is why the report published today by Frontier Economics is so revealing in its analysis of the cost of poor care.

They estimate that it could be costing the NHS up to £2.5 billion every year.

And they highlight some of the shocking costs of poor care – from the £1.3 billion spent every year on litigation costs, to the cost of not ‘getting it right first time’ in orthopaedic care – which Professor Tim Briggs’s excellent work shows could save between £200-300 million every year.

These are large sums of money which the NHS is potentially wasting. But we should be careful not to anonymise their impact by sticking to large numbers. So today we publish further work to look at the cost of individual episodes of avoidable harm.

A single fall in a hospital is a tragedy – potentially life threatening – for the patient affected. It also costs the NHS on average £1,200 because of the extra care needed and longer hospital stay.

Likewise a hospital-acquired bedsore is very dangerous for a patient. But it is also dangerous for the NHS, costing on average £2,500. And we had 19,000 of them across the NHS in 2013 to 2014.

Catheter-acquired urinary infections are unbelievably painful. They also cost the NHS £67 million in 2013 to 2014 – which could pay the salaries of 1,300 nurses.

So I want every director of every hospital trust to understand the impact this harm is having not just on their patients, but also on their finances.

And I want every nurse in the country to understand that if we work together to make the NHS the safest healthcare organisation in the world, we could potentially release resources for additional nurses, additional training, and additional time to care.

So today a poster and leaflet will go out to all NHS hospitals to display this vital message to their staff.

If you’re short of money, poor care is about the most wasteful and expensive thing you can do.

Good care costs less.

The right model of change

But it is one thing to identify lost value, quite another to develop practical strategies to release it. So how do we reduce variation and improve safety?

In the best of NHS traditions it would be very tempting to set up a new target. Or issue a new ministerial decree.

But that would be a mistake.

Because the culture change we need to achieve has to come from inside, not because hospitals are being forced from the outside. What Gary Kaplan called ‘institutional culture change’ is based on listening to and valuing doctors and nurses on the frontline – the people who know more than anyone else what is needed to improve care.

So let’s take a moment to look at some of the traits shared by organisations that have excelled in improving patient care and eliminating waste.

The aggregation of marginal gains

The first trait is attention to detail.

When I was Secretary of State responsible for the Olympics I had the privilege of meeting Sir Dave Brailsford when he was training the Team GB cyclists. One of those cyclists was actually called Jeremy Hunt so I was just a tiny bit disappointed that despite their extraordinary medal haul – the best in British cycling history – Jeremy Hunt didn’t pick up a gold.

Sir Dave famously argues that the success he brought to Team GB cyclists was not about a new big bang approach, but what he called the ‘aggregation of marginal gains’. Paying close attention to the detail, to things which, on their own, seemed insignificant – but when added up mean the difference between winning and losing. At the Manchester Velodrome Chris Hoy told me about his first ever gold medal at the Copenhagen World Championships. He won by 0.001 of a second. His aggregated marginal gain set him on the path to being our greatest ever Olympian.

This is really important because we should not think we can unlock £2.5 billion in one go with a new policy. But we will unlock it in hospitals with a new culture. And it’s a culture that really cares about the details, the little things, all of which add up to better care and less waste.

Some of these gains will be in the form of money – in management jargon, ‘cash releasing’. But some will be in the form of increased value for patients and staff – freeing up resources in ways that lead to better patient care, greater staff motivation and long-term productivity gains. In high-performing organisations, these two things will go hand-in-hand.

The right relationships

Another trait in hospitals with world-class safety standards is proper collaboration between management and frontline staff. We have recently seen powerful evidence to support this from the joint work by the Academy of Medical Royal Colleges and the NHS Confederation. They explore what they call ‘Decisions of Value’ and conclude that good relationships between clinicians and managers is critical in securing value for patients.

Their report shows that over half of clinicians do not believe they are involved in the financial decisions that affect their service or team. But how can you break the dangerous nexus between poor care and higher cost if the clinicians responsible for patient care have no input into the financial decisions that affect their work?

Likewise we need to build better partnerships between commissioners and providers, not least in developing integrated care pathways that we know both improve care and eliminate waste.

Openness and transparency

What else characterises leading organisations? Along with a focus on detail and relationships, they have an obsession with openness and transparency based on high-quality data.

Not far from here, patients at Queen Elizabeth Hospital can log onto ‘My Stay@QEHB’ which allows them to see how their specialty performs compared to hospital expectations.

Transparency can also be about reaching out to patients and the public: it is fantastic that one of the first things you see on the Birmingham Children’s Hospital website is a section called ‘What’s it like here?’ that makes the strange world of hospital care more familiar for children.

The best organisations crave data as a vital tool to drive improvement. We are blazing a trail with the new MyNHS website, which makes the NHS by far the most open and transparent healthcare system in the world. Now with detailed and easily accessible information on hospital, local authority and mental health performance, I am confident that this project will demonstrate that in the modern NHS the best way to improve performance is transparency not targets.

The best example of the power of transparency has been the way the NHS has responded to the tragedy at Mid Staffs. I could have said as part of the government response that I intended to hire another 10,000 nurses – and it would have been a disaster. Not only would we have ended up with the wrong nurses in the wrong places, but the measure of success would have been meeting an input target, not improving care for patients.

Instead we did something far more powerful.

Firstly we asked every hospital in the country to collect and publish information from their patients on whether they would recommend the care they received to a friend or member of their family. Based on the net promoter principle, this was the first time anywhere in the world patient views had been sought comprehensively across an entire health economy.

Then working with Chief Nursing Officer Jane Cummings we asked every hospital to publish the number of planned and actual nursing staff for every single ward. Finally, we made patient experience a central part of the new independent CQC inspection regime.

And the result? Yes the NHS did hire 5,000 more hospital nurses to fill in critical gaps after Mid Staffs, often in elderly care wards. But more importantly a change in attitudes to the importance of quality of care – as opposed to simply quality of treatment – saw an 8% jump in just one year of the people who believed they were treated with compassionate care by the NHS. No target, no extra money, just transparency about performance.

And in some cases improving on this has not required more staff at all. For example, there are some Trusts – including Portsmouth, Coventry and Royal Surrey – that are using an electronic physiological surveillance system to improve the monitoring of vital signs, with impressive early impact on patient mortality that has not required large increases in staffing.

And consider the example of Guys and St Thomas’s where they have been looking at how redesigning basic processes and using technology can give nurses more time with their patients. With only a small increase in staffing of one extra nurse working on discharge and another at night, they were able to increase contact time with patients from 48% to 75% while also reducing length of stay. Hugely beneficial to patients, and better for staff too.

Cost and quality: challenging assumptions

These therefore are some of the traits of high-performing organisations.

And underlying all of them is the shared assumption that cost and quality are not alternatives to be traded off, but different aspects of the same ambition to provide safe, effective care on a sustainable basis. This directly challenges the conventional wisdom that ‘you get what you pay for’ – as does the CQC’s ‘State of Care’ report which shows massive variation despite similar input costs.

It also challenges the received wisdom that there is little value left to get out of the system now that the so-called ‘low hanging fruit’ has been plucked.

And it challenges the other commonly held view that only large-scale change will release significant value. Of course we will need to continue to make important changes to care pathways – but as we do that we need to support trusts in making the small improvements that, when aggregated, will make a big difference.

Conclusion

I hope therefore that from today in hospital board meetings up and down the country one simple change happens: patient experience and patient safety are not discussed separately to finances – but as two sides of the same coin. Wouldn’t it be fantastic if a hospital board was as focused on its ‘safety improvement plan’ as its ‘cost improvement plan’, and saw them both as part of the same objective of doing a better job for patients.

I am proud of the additional investment this government has provided and will continue to provide to the NHS. Nobody would pretend that the financial sustainability of the NHS will be ensured by improving safety alone. But it has a critical contribution to make.

The path to lower cost is the same as the path to safer care.

Hospitals that embrace one embrace the other too.

Hospital safety and hospital finances both improving and patients as the winner.

Jeremy Hunt – 2014 Speech on the Better Care Fund

jeremyhunt

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at the National Children and Adult Services Conference on 30 October 2014.

Let me start with a thank you.

All of you have been talking about delivering integrated, joined-up care for a very long time and I know sometimes it has felt like banging your head against a brick wall. And now it is happening, for real. Instead of people just talking about it, you are actually delivering it. And without your vision, your determination, and your passion to do better for some of our most vulnerable citizens it wouldn’t be happening.

I am also pleased to be saying these words in Manchester which has been at the forefront of joining up health and social care and proved beyond doubt that integrated care, driven not from Whitehall but by local enterprise and initiative, can support the transfer of hospital services to out-of-hospital settings by truly focussing on the needs of patients and service-users.

And the fact that this kind of project is not peripheral but now central to the change we want to see in our NHS and social care system was demonstrated last week with NHS England’s visionary Five Year Forward View. It talked about inspiring new models of out-of-hospital care, exactly the change that people here have been arguing for. That plan and your ambition is completely consistent with the government’s own view about the future of health and social care.

We all agree that change needs to happen. But to work it has to be locally led, tailored to local needs and designed by those who know those needs best. So the role for government is clear: no grand blueprints, no structural shake-ups, no one-size-fits all. But our role will be to enable, champion – and yes fund – your endeavor.

So I want today, as my first response to the NHS England Five Year Forward View, to outline the four pillars of our plan to prepare the NHS and social care system for the challenges of an ageing population. And as social service directors your role will be absolutely central to every element of that plan.

Funding backed by a strong economy

The first pillar of our plan concerns funding. A strong NHS and social care system needs a strong economy to support it. The last four years have been the most challenging ever for both the NHS and social care system – and they started because of an economic crisis. It is in all of our interests to make sure the economy continues to grow, create jobs and generate the tax revenues that allow sustained ongoing financial support for health and social care. In Portugal, Spain and Greece we have seen services cut as the price of economic failure – and we don’t want that to happen here.

And when we did have to tackle the deficit, we prioritised the NHS by protecting its budget – which meant tougher settlements for other departments including local government. But the interconnected relationship between the services we both offer to vulnerable people means that we in the NHS have a responsibility – as we move to fully integrated services – to help you deal with a tough financial settlement. If we operate in financial silos the costs will be higher for both of us – hence there is no sustainable NHS without the tremendous strategic importance of the Better Care Fund which we are celebrating today.

Transformed out-of-hospital care

But it isn’t just about money: it’s also about the way we deliver care.

The NHS was set up in 1948 in a very different world. The model was essentially if you were a little bit ill you went to your GP; if you were very ill you went to hospital. You were then patched up and sent home.

With an ageing population our challenges are profoundly different. By the time of the election we will have nearly one million more over 65s than at the start of the last parliament. Within the next two years, we will have three million people with three or more long term conditions. A few years after that we’ll have one million people with dementia. And a few years after that – by 2030 – the number of over 80s will double to 5 million people, 10% of the entire population.

Older people with complex conditions need a different type of care, one that is usually best delivered out of hospital settings. They’ll be frequent users of the health and social care system so they need one person taking responsibility for their healthcare. And they need to know that wherever they go they will be dealing with someone who knows about them and their family, knows their medication history, and knows about their other interactions in the system.

So if getting a strong economy is the first pillar of our plans for the NHS and social care system, getting this new model of care right for an ageing population is the second.

Better Care Fund

And on that front I am pleased to report today some remarkable progress with the Better Care Fund, which for the first time anywhere in the world is integrating health and social care across an entire health economy.

Building on the excellent work by Norman Lamb on the Integration Pioneers that many of you were involved in, local authorities and local NHS commissioners have joined together and painstakingly planned commissioning for adult health and social care with pooled budgets. Budgets from the local authority side are for the first time helping to reduce emergency hospital admissions and budgets from the NHS side are for the first time helping to reduce permanent admissions to care homes.

I want to thank my colleague Eric Pickles for making this happen, and thank the Better Care Fund Team and Andrew Ridley.

Sceptics said this wouldn’t happen. Critics said there wasn’t the appetite among local councils or the NHS. The papers criticised it and opposition politicians called for it to be halted and when they were proved wrong said it didn’t do enough.

Well they were all wrong. Because today I am delighted to announce the total amount of pooled budget for next year is even higher than the government’s original £3.8 billion. It has risen to a staggering £5.3 bn.

I can announce that 97% of the 151 plans have been approved.

And that as a result of these plans NHS England estimate that the Better Care Fund will be supporting at least 18,000 individuals in new roles delivering care in the community. This will be a range of social workers, occupational therapists, care navigators, doctors and nurses, deployed based on local needs and delivering outside hospitals care to some of our most vulnerable citizens.

Taken together, these plans will mean savings [to the NHS] of £500m in the first year alone. More importantly in terms of patient care, they will mean 163,000 fewer hospital stays or 447 fewer hospital admissions every single day; and 100,000 fewer unnecessary days spent in hospital in total through organising better delayed discharges

This is a great start and everyone here should feel very proud. But based on the same principles that we’ve learnt in the last year I want to ask why should we not go further?

Accountable care organisations

For me GPs, whose services are commissioned by NHS England, sit at the heart of NHS community care. We need them to be part of this change too. So this year, for the first time, CCGs have been offered for the chance not just to commission social care jointly with local authority colleagues, but also co-commission primary care with NHS England. I hope the result will be in many areas a single integrated approach to commissioning all out of hospital care, whether through community care, GP practices or social care, often using personal budgets to integrate care even better around the person.

I think we can go even further than that.

Should we not adopt the same partnership approach we have so successfully pioneered with the Better Care Fund for public health responsibilities as well? You have made a great start with your new public health responsibilities – alcohol recovery rates up, smoking down, teenage pregnancy down and health checks at an all time high. It would surely make more sense for local authorities to plan their smoking, alcohol, drugs and obesity strategies alongside NHS colleagues who have a direct financial interest in making them successful. In doing this we can turn CCGs, working alongside local government colleagues in accountable care organisations, responsible for commissioning end-to-end integrated care for their entire populations – including both care closer to home and proactive prevention programmes.

And in the same vein, should we not also consider joint commissioning of children’s services, building on our review of Children and Adolescent Mental Health services? That review highlighted the importance of different organisations working together – so as we move to integrated care we should consider what the benefits could be for this very important patient group.

Innovation

A strong economy and integrated community care are the first two pillars of our plan. The third pillar involves being much better at embracing innovation and efficiency.

The technology revolution means that now half of us bank online, nearly two thirds of us have a smart phone and three quarters of us access the internet every day. Yet still in the NHS we employ people whose main job is to input the contents of faxes from hospitals onto electronic health records in GP surgeries.

IT investment has had a chequered history in the NHS but in the last two years we have made some good progress. By the end of this year a third of A & E departments will be able to access summary care records, as will one third of 111 call centres and one third of ambulance services. This will then be rolled out to everyone.

I know electronic record sharing is a key part of the Better Care programme you have been working on – so let me give you one example of where I think it could make a huge difference. Shouldn’t residential care homes be able, with a patient’s consent, to update someone’s condition onto their GP record on a daily basis? We’ve introduced named GPs for all over 75s this year, rolling out to everyone next year. But we could make this much more meaningful if the responsible GP was able to check on someone’s condition on a daily basis just by looking at their record on a computer.

Cost tracking

But innovation is not just about electronic medical records.

One of the most common criticisms of the NHS is that it is a slow adopter of technology, even when adopting such technology earlier would save overall costs. This tends to be because we look at costs in financial silos so people are reluctant to invest in costs upstream that benefit another part of the system downstream.

We therefore need CCGs and local authorities to collect full real time total NHS and social care cost information by patient and service-user. Only when we can see that will commissioners invest properly in the preventative innovations that both improve health and contain cost.

Culture change

Innovation and efficiency is the third pillar of our plan. And then final pillar is the most difficult of all, because it is not financial, it’s not operational it’s cultural.

We need to change the culture of a system that has too often failed to put patients at the heart of its priorities.

Almost two years ago, after less than two months as Health Secretary, I made one of my most difficult speeches I’ve ever made when – in the wake of Mid Staffs – I talked about the normalisation of cruelty in the NHS. And we have sadly also seen at Winterbourne View the criminal abuse of vulnerable adults.

Since that time, thanks to the huge efforts of people across the health and care system, we have made great strides in improving quality and safety in hospitals. We have 5,000 more nurses in our hospitals, every patient being asked whether they would recommend the care they receive to friends or a member of their family and with the new Chief Inspectors of Hospitals, General Practice and Adult Social Care we probably have the most robust independent inspection regime of anywhere in the world. And we are doing more as well to help adults and older people live independently, with the appropriate support, rather than in residential care.

And these things are all important – but unless the culture changes as well they will be for nothing.

And the heart of the problem is that for too long in the NHS, perhaps less true in the social care system, but in the NHS we have relied on top-down targets as the main way to raise standards. Whilst there will always be a role for some targets in any large organisation, the danger with too many targets people focus their energy away from the vulnerable person sitting right in front of them – as we saw at Mid Staffs with tragic consequences.

We need to recognise that transparency of outcomes and peer review is a far more powerful way to improve care than yet more targets.

Transparency of outcomes was pioneered by Bruce Keogh and our heart surgeons a decade ago: since they had the courage to assemble and publish, surgeon by surgeon, mortality rates we have moved from having some of the highest heart surgery mortality rates in Europe to some of the lowest.

The MyNHS website now displays comparative performance by hospitals and local authorities on a wide range of indicators, from food to efficiency to safety and public health. I want this to be the engine that turns our NHS and social care systems into truly learning organisations.

And as part of that cultural change we need to see, which is to make sure the primary accountability of doctors and nurses is not to system goals but to the patient standing in front of them.

From next year every NHS patient will have a GP who is personally responsible for their care, with the GP’s name at the top of their electronic health record. Named, accountable doctors so that both patient and NHS know where the buck stops. And GPs supported to discharge that responsibility with more capacity in primary care, whether through additional GPs, practice nurses, district nurses or administrative support.

Conclusion

So I wanted to spend some time explaining the four pillars of our plan to transform our health and social care systems over the next parliament: increased funding backed by a strong economy; integrated, joined up out of hospital care; innovation and efficiency; and a culture where patients and service users always come first.

If it sounds ambitious, I think it is.

But we have a few trump cards to play.

A social care system that has succeeded in weathering perhaps the toughest financial challenge in its history.

We have an NHS that was rated this year by the independent Commonwealth Fund as the top-performing healthcare system in the world – ahead of America, ahead of France, ahead of Germany, ahead of France, ahead of Spain.

The commitment and values of not just NHS staff, but also colleagues in the social care system who have given their lives to the most noble cause of all, giving dignity and respect for our most vulnerable and disadvantaged citizens.

And we have a growing economy. But the litmus test for us as society is what we do with the fruits of economic success.

Today shows that with hard work, imagination and commitment we can pass that litmus test and rise to the challenge of an ageing population by making Britain the best country in the world to grow old in.

There’s a long way to go, but today the journey has started.