Andrew Lansley – 2012 Speech on Smoking and Health


Below is the text of a speech made by the then Secretary of State for Health, Andrew Lansley, on the subject of ‘Smoking on Health’.

I’m very glad to be here today.  I’m grateful to the RCP for your work and this opportunity.

Smoking remains one the biggest public health challenges. And it has been for a long time.

Historical context

When the NHS started in 1948, 82% of men smoked.

Fourteen years later, in 1962, there was the RCP’s ‘Smoking and Health’ report. It set out an agenda for controlling tobacco that doctors and governments followed for decades to come.

So in 1965, after calls from the RCP, all TV adverts for cigarettes were banned.

In 1984, smoking was banned on tube trains, and banned on stations a year later.

In 1995, Virgin and United Airlines banned smoking on transatlantic flights.

Then of course, there was the smoke free legislation of 2007 which I was Conservative health spokesperson at the time.

I said it should be a free vote for MPs. By making sure it was a free vote in our Party, we pushed Labour to give a free vote to their MPs too – knowing that this would mean a full ban, not the partial one the Government had sought.

It turned out to be one of the most successful pieces of legislation any of us can remember. MPs voted for it, not because we were told to by the whips, but because we believed in it, because the evidence was there and because we knew we had a chance to reduce the cases of respiratory diseases and cancer, and also to reduce the number of heart attacks caused by secondhand smoke..

And now, I think our health reforms have the potential to be the next step on that path.

By devolving more power to doctors, nurses and health professionals, more influence will be given to those who know the harms of smoking, and are determined to reduce it.

Health professionals know their communities, they know their patients. They know the areas, they know the shops, they know the temptations, they know the pressures. And because they know all this, they also know something else – they know how best to get people to stop.

Our plans, for the first time, will place a legal duty on the NHS to reduce health inequalities. And when you think how smoking disproportionately harms people in the poorest areas, you begin to realise the opportunity these reforms create.  To focus resources and attention on what is a deadly habit and such a significant source of inequalities.

We’re not going to tell health professionals how to do their jobs. But I do want to see clinical commissioning groups working with local groups and their local authorities specifically to deal with problems like smoking.

And I do expect to see Health and Wellbeing Boards and leadership of Directors of Public Health backing them up, guiding priorities and providing advice and research, with a particular focus on public health issues like smoking.

This is a huge opportunity. And it’s one we have to grasp.

Because despite the medical consensus, the shift in public opinion and even progressive legislation, people still smoke.

And overall, smokers appear to be less motivated to quit than they were a few years ago. A survey by the Office of National Statistics in 2009 showed that only 63% of smokers wanted to stop altogether, compared to 72% at the turn of the millennium.

So we need to up our action.  As Healthy Lives, Healthy People set out, successful public health campaigns rely on cumulative interventions over time.  A constant push for positive change.

And that is what we will do. With central government, NHS and local government all helping people make healthier choices.

Tobacco cannot now be sold from vending machines inEngland.  That removed, at a stroke, a source of cigarettes that underage smokers could access as often as they liked.

It was estimated that inEngland, about 35 million cigarettes were being sold to people under age of 18 every year. That is why vending machines had to go.

It’s not window dressing, or fiddling around the edges. That’s a real development that will stop people, particularly young people, from smoking.  We went to court to fight the tobacco companies that didn’t want the laws, and we won.

And the tobacco industry was defeated on tobacco displays too. We were gearing up for another court case but they dropped their action just a few days before Christmas.  So in a month’s time, tobacco displays in supermarkets will end. And displays in other shops will end in 2015.

Of course we have some of the highest priced tobacco inEuropeand we will carry on with a high tax policy.  In the last budget, the Chancellor significantly increased the tax on rolling of tobacco.

And of course, we’re helping those who want to quit.

Since January, over a quarter of a million Quit Kits have been distributed.

Our local stop smoking services are amongst the best in the world.  It’s a fact that smokers trying to quit do better if they use them.

We will continue to work with clinicians, so every time a smoker sees a doctor, nurse or any other member of the NHS they should be encouraged to kick the habit. Making every contact count.  At the moment, clinicians in some parts of the country are already doing this, I want to see it adopted throughtout the NHS .

And the Tobacco Control Plan, published just a year ago, set out our strategy for comprehensive tobacco control.

It set out how tobacco control will be delivered as part of the new public health system. How decisions will be taken locally to target the particular problems that particular communities have. We know very well that smoking rates  do vary dramatically between communities.

And we will try especially hard to help two particular groups.

Firstly, we want to dramatically cut the number of pregnant women who smoke. Reducing rates of smoking at time of delivery from 14% to 11% by the end of 2015.

Secondly, children. Smoking is an addiction largely acquired by young people, so if we can make progress in this group then people’s health will benefit through their entire lives.

We have already reduced smoking rates among 15 year olds from 15% to 12%, four years ahead of schedule.

But we’re not going to let up. We can and will do more to stop young people taking up smoking in the first place.

So for example, we’re putting the finishing touches now to the consultation to come on tobacco packaging, which will be published soon.

We are the first country inEuropeto be giving that idea serious consideration, and that’s something I think we can be very proud of.

Obviously it’s only a consultation at the moment, so nothing’s set in stone. But that also means it’s a great opportunity to shape policy from here on in.

When it comes out, I want to see responses from everyone with an interest. From tobacco control experts, shop owners, to smokers to ex smokers, and even the manufacturers themselves.  But make no mistake – everyone who responds will be asked upfront about any links they have with the tobacco industry.

We will listen to the arguments and opinions people have, and we will not taking any options off the table just yet. It will be a real opportunity to make sure your opinion is heard.

So I do encourage everyone, when the consultation opens, to get involved.

Smokefree homes and family cars

Another thing we’ll be doing from the centre is running a marketing campaign about the dangers of secondhand smoke, to encourage people to take action voluntarily to protect the health of their families, particularly children.

This is one of the areas that we can all agree needs further action.

When the smokefree legislation came in, people used to make spurious arguments about how it would affect the atmosphere in jazz clubs, as if everyone had a better time if there was a pall of smoke clogging up the trombones.

Funnily enough, those same people didn’t mention the cars full of smoke that children have no option but to breathe. Or in their front rooms. Or the kitchens. Or anywhere children can be forced to inhale someone else’s smoke. That’s the reality of secondhand smoke, and it’s why smokefree environments are so important.

Even though more people are making their own homes smokefree, as the college’s 2010 report described, far too many children are still exposed to secondhand smoke.  We have to change that. We have to encourage as many smokers as possible not to expose their families to their smoke.

And in the next year, that will be one of the things our television-led campaigns will focus upon.

Harm reduction

We’ll also be looking at the best ways to reduce the damage that tobacco does to smokers’ bodies, even if they can’t or won’t break their addiction to nicotine.

As you know, although nicotine is an addictive substance in cigarettes, the damage  mostly comes from the inhalation of the smoke itself.

Anything we can do to reduce that damage is well worth doing, even if some smokers can’t kick the nicotine.

NICEis drawing up guidance on how that might happen.

And the MHRA has supported using nicotine patches, gum, inhalators and lozenges as alternatives to smoking, making it safer for the smoker themselves but also reducing secondhand smoke.

We are also encouraging manufacturers to come up with new types of nicotine replacement products that are cheaper, more socially acceptable and easy to get hold of and use.

That last point I think is an important one. For nicotine replacement treatments to be really effective, the safest forms of nicotine should also be the most straightforward to buy in the first place.

In that respect I would especially like to recognise the leadership of Professor John Britton, the Chair of the RCP’s Tobacco Advisory Group and co-chair of the UK Centre for Tobacco Control Studies, for his leadership in this and other fields.

International reputation

It’s helping cement our reputation as a world leader on stopping tobacco use.

In 2010, theUKwas ranked as having the most effective tobacco control policies across the 30 European counties that were surveyed.

And we are recognised as leading the world in helping people to quit smoking as well.

According to this month’s issue of Tobacco Control, we are at the top of the international league table when it comes to the WHO’s MPOWER approach to tobacco control – one of only four countries in the world to get score of four out of five.

I’m also very proud that we’re active members of the Framework Convention on Tobacco Control.

We have made a big contribution, including supporting the development of guidelines on secondhand smoke, tobacco ingredients, packaging and labelling, and we led the development of guidelines on smoking cessation.

Those guidelines will help governments across the world improve their own tobacco control strategies.

And both at home and internationally, we will continue to act against the vested and commercial interests of the tobacco industry.

As Secretary of State for Health, I haven’t met with those companies. Not now or when I was in Opposition as the Conservative’s health spokesman.  Their interests are not my interests.  My objective is to achieve smoke-free communities; theirs is to make a profit from selling intrinsically harmful products.  We don’t have common ground.  This is not like alcohol, where there is a level of responsible drinking and potential shared campaigns between Government and retailers.  That’s why there is no place in the Responsibility Deal for tobacco companies.  There is no responsible level of tobacco consumption.


So let me conclude, the foundations for our current ambition for reducing smoking were laid 50 years ago with the RCP’s report.

After that, with cause and effect laid out so clearly, the tide of public and political opinion shifted dramatically.

So while celebrating the 50th anniversary of that report, we should also celebrate what’s happened since then, both inside and outside the RCP and look to the future.

Government, healthcare professionals, health charities, academics, employers and individuals themselves have all contributed to 50 years of progress.

Sometimes it’s been frustrating and slow, sometimes we’ve made real progress quickly. But if I compare the number of smokers I see when I’m walking down the street today, compared to when I first started off onWhitehallas a Civil Servant in the 1970s, the shift has been dramatic.   We do not have the lowest levels of smoking in the world, but we have come a long way and I am ambitious that we can go further and faster.

Promoting good health; preventing ill-health, reducing health inequalities.  All of these will be the result of the implementation of our Tobacco Control Plan and with your leadership here at the RCP and the opportunities given by the new Public Health service, to improve health, to reduce health inequalities, to support Healthy Lives and Healthy People.  That will be our objective.

Andrew Lansley – 2012 Speech to the World Health Association


Below is the text of a speech made by the then Secretary of State for Health, Andrew Lansley, to the World Health Association on 21st May 2012.

I am delighted to be here today to talk on the vital topic of universal health care.

Universal healthcare has been at the heart of the National Health Service in the United Kingdom for over 60 years. And it will remain so. Universal access to a comprehensive health service – free, based on need, is part of our social solidarity and an essential basis for improving the population’s health.

When we came into government two years ago we made two very clear commitments. Firstly that we would increase the budget of our National Health Service in real terms, and secondly that we would increase our spending on development to meet our historic 0.7% commitment. I am proud of our performance on both of those commitments.

Across the Globe, each year, tens of millions of poor people fall ill and die due to diseases and conditions that are preventable and treatable. Out-of-pocket costs stop many of these people getting the help they need. The solution is efficient and effective healthcare that does not exclude or impoverish the poor. Governments have a duty to manage this.

In July, the UK government and the Bill and Melinda Gates Foundation, with the United Nations Population Fund, and others, will host an international family planning summit in London. The aim is to launch a global movement to give 120 million extra women in the world’s poorest countries access to contraceptive information, services and supplies by 2020. I am sure many of your governments will wish to participate. And I am extremely pleased that our Director General will be playing a key role in the event.

Back home our investment in the National Health Service is strengthening our universal primary care infrastructure. We are focused on developing preventative services, on early interventions and minimising unnecessary hospitalisation. We are reforming the National Health Service to empower clinical leaders to deliver outcomes for patients which are amongst the best in the world.  We are giving more autonomy to healthcare providers; but we are making them increasingly accountable for the results they achieve.

We are reforming our public health system, to ensure we are able to tackle the social determinants of health. Nationally and locally, improving the health of the population is a government-wide responsibility. We are recognising and acting on the effects which employment, education, housing and the environment have on health outcomes.

Our approach to tackling public health issues, is to maximise our impact at key moments in people’s lives, for example through support in maternity and the early years of children. We are also focused on the major risk factors such as obesity, tobacco, drugs, alcohol and sexual health. We will be strong and effective in tobacco control. With food, drink and retail industries we are forming a partnership, based on a shared understanding that public health is everyone’s business and that by co-operation we can achieve more progress, more quickly, towards an environment which enables consumers to lead a healthier lifestyle.

We have a busy week ahead of us. Our agenda here underlines the importance of the WHO being the best it can be. We need the WHO to facilitate the sharing of ideas and strategies for member states to build strong universal healthcare systems. We need continued action to tackle emerging and continuing public health threats. When these things happen, we must be ready to act collectively.

The reform of WHO, supporting these objectives, will enable us to make more progress in improving the health of all our peoples.  A strong WHO, ready to face these challenges in the 21st Century is vital.  It is in all our interests to ensure the reforms of WHO are advanced this week.

Andrew Lansley – 2011 Speech to King's Fund Leadership Conference


Below is the text of the speech made by the Secretary of State for Health, Andrew Lansley, to the King’s Fund Leadership Conference on 18th May 2011.

Thank you Kate [Lobley, Director of Leadership, The King’s Fund].

As the Prime Minister set out so clearly this week, the NHS faces some significant long-term challenges. An ageing and increasing population, increasing burden of chronic disease, rising costs of drugs and treatments, and growing, almost insatiable public expectations.

If we choose to ignore these pressures, if we stick with the status quo, then in the years ahead the NHS will face a genuine crisis. One that would threaten the core values of a comprehensive health service, available to all, free at the point of use and based on need.

This government will not allow that to happen.

But given the financial context, how to ensure the NHS is not only sustainable in the long term, but that it gets better? That it gives the people of this country healthcare that is consistently among the very best in the world?

I think the answer is straight-forward.

You put the right people in charge.

You make it crystal clear what it is they are trying to achieve and how they will be held to account.

And you then do everything in your power to support them in what they are doing.

Where they need extra powers or resources, as far as you can, you supply them. Where there are obstacles, you remove them.

That is what happens every day in successful organisations around the world. And it is what I want to happen in the Health Service too.


Today is about leadership in the NHS. About what good leadership can do for patients and about how we can support and nurture current and future leaders within the Health Service.

Note that I say ‘leaders’ – not leader. For leadership in the Health Service cannot be about one person at the very top. The leadership style of Henry V on St Crispin’s day – the man on horseback- as dramatic and inspiring as it is, just isn’t appropriate for something as vast, as complex or as subtle as the NHS.

The Health Service needs far more than that. It needs leaders at every level, in every institution and in every profession.

And the people that I believe, first and foremost, should be leading the NHS are clinicians. GPs, hospital doctors, nurses, pharmacists, allied health professionals, scientists.

We need people in every area to step up to the plate and lead.

No profession can be left out if we are to deliver truly integrated, high quality healthcare for everyone in the country.


And when I say that, I include managers. But leadership and management are not the same. Some managers are leaders in the service now, like David Nicholson. Others will be leaders in the future – but not just because they rise up the managerial ladder. Management is one of the professional disciplines inside the NHS, but it is a support to clinical leadership, not a substitute for it.

Just so there is no confusion, I know that high quality managers are essential to the effective and efficient running of the NHS.

No fundamental change in any NHS organisation ever came about without the support of managers – people who are every bit as committed to the health service and to improving patient care as clinicians.

The problem is not the people, it’s the system. Managers are placed in an impossible position.

Too often in the Health Service, change is seen as a process whereby managers tell clinicians what to do. But why is this the case? It’s because people like me in government are constantly ordering them to do it.

So you end up with a top-down, command-and-control system with the Health Secretary driven more by that day’s headlines than the best interests of patients.

He then gets his officials to come up with some ploy that he can sell to the press, tells all NHS managers to carry it out and then claim to be saving the day.

Managers are then left to force it through on the ground – whatever the clinicians might think and whatever the consequences down the line for patients.

So you get new initiatives with exciting names. Policies that sound great, but amount to little more than hot air.

The result? Emasculated and frustrated clinicians, overstretched managers caught in the middle and patient care that is at the political whim of whoever happens to have won the previous election.

And over the years, the accumulated weight of countless…

– initiatives to implement,

– targets to meet,

– reports to produce

– and boxes to tick…

…means that the NHS isn’t managed. It’s bureaucratised.

Managers are no more free to run their organisations than clinicians are. Over these last seven years, it was as often managers who told me to get rid of the top-down culture as it was nurses or doctors.

And while those who work in the Health Service add “frustration” to their job descriptions from day one, it’s patients who lose out on the potential benefits of a truly clinically-led Health Service.

It’s been like this for decades. It cannot continue for another. It’s time that politicians and managers handed the controls over to the people who really understand the needs of patients and how to serve them best – to clinicians.

King’s Fund report

Today, the King’s Fund’s Commission on Leadership and Management in the NHS has published its report.

I very much welcome the report. It speaks to the same ambition that I have for the NHS. For a Service led from the front. An integrated NHS that is focussed on improving clinical outcomes and nothing else. A Service that is well managed, not overly administered.

I understand the caution around the size of reduction to the management and administration budgets. But most of these will come from the abolition of Primary Care Trusts and Strategic Health Authorities.

Across the public services, similar reductions in administrative costs are required. In the NHS, we can see how we can achieve this by changing the shape and burden of administration, not just the numbers of administrators – not keeping the system the same and asking fewer people to run it, but reducing the scale of administration alongside the cost.

By handing power to clinicians and by ending the constant micro-management and over-burdensome performance management of the NHS, much of this work will no longer be needed.

Where I fully agree with the report is in the vital importance of high quality leaders and managers. The gains made in recent years must be maintained and built upon. Every NHS organisation and provider must take their staff development role incredibly seriously, especially new entrants from the charity and independent sectors.

I’m keen to continue the excellent work of the National Leadership Council. Just last week, I announced that we would fund a further 60 Fellows as part of the Council’s Fellowship programme, developing tomorrow’s leaders from all parts of the Health Service,.

Every one of whom will make their own individual mark on their local NHS, and collectively make a real and lasting difference to the level of leadership within Health Service as a whole.

The King’s Fund report says that the NHS needs a national focus on leadership and would welcome a national leadership development centre.

I am now considering the idea of a national centre. I know there are some interesting and novel schemes already running. For example, the innovative programme at UCLH, which has drawn on models of leadership from the armed services. We’ll respond to this and the other recommendations once the listening exercise has closed.


I said at the beginning that if you want to achieve success in an organisation you first have to put the right people in charge. But that’s not all. You then need to be clear about what they are trying to achieve and show them how you will hold them to account for that.

So let me ask you a simple question. What’s the NHS for? We all know when we see it: supporting childbirth; promoting good health; treating illness and injury and promoting recovery; care for those with chronic illness; care when dying.

But if this is what the NHS is for, why have we never measured in a systematic way how well it’s achieving these aims? Of course, these things are not always easy. But they are worth the effort.

What is the gain if you treat people in a shorter period of time if the quality of the care and the quality of the outcomes were to be poor? Too often we measure the success of the Health Service by the number of units it processes, not by how well it improves people’s lives.

So from now on, I want all parts of the NHS to be judged on the clinical outcomes they achieve. We published the Outcomes Framework in December to help all clinicians to pull in the same direction.

– Reducing avoidable mortality;

– enhancing recovery after treatment;

– improving the quality of life for people with chronic conditions;

– maximising safety and cutting the number of infections;

– and continually improving patients’ experience of their own healthcare.

To flesh out the detail, NICE is developing a library of condition specific Quality Standards. These will mean that, over time, every clinician – and every patient – will be able to see just what excellent care really means and judge whether they are receiving it. These aren’t targets by another name. They state what should be achieved, not how clinicians should achieve them.

As General Patton once said, “Don’t tell people how to do things, tell them what to do and let them surprise you with their results.”

And because all providers of NHS care will be aiming for the same high quality outcomes, I, the NHS Commissioning Board, General Practice Consortia, local authorities and, most importantly, patients themselves will be able to hold providers to account for delivering that excellent care.


And more often than not, delivering excellent care will mean delivering integrated care.

But unfortunately, the NHS is not particularly good at integration. What it is good at is episodic care.

If you’re young and relatively healthy but fall ill with a specific disease, or have a particular injury, the Health Service is excellent at taking you in, making you better and sending you on your way.

The problem with this is that the vast majority of the people the NHS looks after don’t fit that description. Most of today’s patients are older and with one, or often more than one, long-term condition.

So you have the typical example of an older person with terminal cancer, having to rely on her daughter to coordinate care between her GP, community nurses, hospitals and social care because they can’t quite seem to join up the dots by themselves.

And what about the many who don’t have someone to fight their corner? What happens to them?

The needs of patients are too often not catered for by the strengths of the Service. The result is that, far too often, care today in the NHS is fragmented.

A patient with COPD might be treated by her GP, by a pulmonary specialist, and by a community nursing team.

– Three separate groups of people to contact,

– three separate sets of forms to fill in,

– and three separate notes to keep track of.

All this with the patient in the middle, often the one who has to try and coordinate their own care between them.

Or look at end of life care. At the end of their life, most people want to die in their own home. But the fact is that most people actually die in hospital.

This isn’t because of the high level of intensive, hospital based care they need.

It’s not because the people who work in the NHS don’t want to provide the very best care to their patients.

It’s simply because the system isn’t set up to provide the quality of out-of-hospital care needed to help patients die at home.

– The system of tariffs doesn’t encourage hospitals to do it.

– The people with the money, the PCTs, often aren’t aligned properly with clinicians.

– It’s hard for the voluntary sector – organisations that can add so much at the end of a person’s life – to offer their services.

– Patient experience and outcomes aren’t measured.

And all too often, health and social care organisations just don’t join up.

But there are examples where people have joined together to beat the system. Since 2004, the Marie Curie Cancer Care’s ‘Delivering Choice Programme’ has taken a whole system approach to end-of-life care. Working across all those involved – the NHS, the voluntary sector, social services and carers – to provide 24-hour, patient centred care for those at the end of their lives.

The evaluation of the first scheme in Lincolnshire, carried out by the King’s Fund, found that deaths at home rose from 19% to 42%, while deaths in hospital fell from over 60% to just 45%. All the while being cost neutral.

Another important opportunity for joined-up services is in urgent care. Services are too often fragmented, varying in quality across the country and often confuse patients into using inappropriate services – like going to A&E rather than seeing their GP.

But by adopting new technologies to encourage greater self-care, by introducing the ‘111’ telephone number as a single point of contact for non-emergency care and by giving local commissioners the freedoms they need, we can change this.

We can deliver a properly integrated urgent care system that turns the NHS into a 24/7 service, and makes phrases like “out of hours” feel redundant.

Care needs to be organised not around the needs of a particular provider, but around the needs of the individual patient.

To have good care, care needs to be integrated.

Choice and competition

Another thing that is essential for achieving excellence is involving the patient in their own care. This means more than just explaining things to people. It’s bringing them into the decision making process. It’s giving patients a choice.

Now patients already have a degree of choice. They can choose the hospital that will carry out an elective procedure. Or at least they could if they were able to distinguish to any meaningful degree the quality of care offered by one hospital from another. But whether you’re going in to have an in-growing toe nail removed or for radical cancer treatment, if you don’t know how good a particular provider is, how can you – or your GP – decide which to choose?

And even if you look at the current overall hospital ratings, they won’t tell you how good their clinical outcomes are at the one thing that you’re most interested in – at the procedure you’re about to have.

So while patients today theoretically have a choice. In reality, it’s hardly a choice at all.

So is it any wonder that although almost all GPs maintain that they always offer their patients a choice, according to research by the by Anna Dixon here at the King’s Fund, less than half [49%] of them recall being offered one?

We need to offer choice where appropriate; but even more so we can make the framework for choice more robust. If you could see not only how good a hospital was, but how good a specific department or even a specific consultant-led team was, wouldn’t that change things dramatically?

That is when GPs and other clinicians can really draw a patient in to the decision making process. For with the right sort of information, choice becomes meaningful.

And patients will choose the care that offers the best results for them.

Last month the National Cancer Intelligence Network published, for the first time, mortality rates 30 days following surgery for bowel cancer. Across the country, the figure was 5.8%. Not bad, perhaps. But that national figure masked huge variation. From just 1.7% to 15.6%.

Now this doesn’t automatically mean that care at one place is necessarily better or worse than elsewhere. As you know, there will be all sorts of factors at play. But it does give clinical teams pause for thought. To ask the question, is there more that we can do? To look at those with the best performance and see if there are things that they are doing that we are not.

Making this information available to the public will also have an impact. Patients, with their doctor, will be able to make a more informed choice as to by whom they wish to be treated. And given the choice between one hospital with a very high survival rate and another with a lower one, which would you choose?

Integration through competition

Now choice, real choice, means that providers will be sometimes, in effect, competing for patients. They do now. Strengthening information and accountability will encourage all providers, however good they may be, to raise their game and to offer patients the best possible care.

No provider, whether from the NHS, charity or independent sector will be competing on price. As we extend tariffs prices will either be fixed for all providers nationally or locally by commissioners. The only way to distinguish yourself as a healthcare provider is to provide a higher quality service than everyone else.

But at this point, some people start to question whether competition isn’t utterly at odds with that other essential ingredient I’ve mentioned – proper integration of healthcare.

I would like to explain not only why this is not the case, but why competition can actually lead to a far greater degree of integration than would ever be the case without it. And to do that I hope you will forgive me if we leave the realm of healthcare for a moment.

We live in a complex world where we take for granted the minor miracles of integration that we see and experience every day. Integration that is so seamless that we don’t even notice it.

Let me take just one example. I bet virtually everyone here today has a phone in their pocket or handbag. Some of you will have more than one. It might be a basic model where you can make calls and send texts and that’s about it. Or it might be one of the latest smart phones that can do just about everything bar the washing up.

Either way, you are enjoying the fruits of countless individual companies operating in a wide range of individual, highly competitive markets, all working together to deliver that one complex, ubiquitous product.

Mining companies, designers, chip manufacturers, haulage companies, marketing agencies, precision engineers, logistics companies, data management, network providers, warehouses and, finally, the place that sold you the finished product.

Each one competing fiercely for business at every step of the way. Each one successful in large part because of the high degree of integration they can offer with the other parts of that supply chain.

When organisations compete but don’t offer to integrate their services, the result is clear… they don’t get the business.

It is in the interests of every provider to offer the greatest possible degree of integration. Even with those they are competing directly against. Vodafone and T-Mobile both rely on common standards. Whether you have a Nokia, an iPhone or a Samsung, the same SIM card will work in all three.

The same can be true of healthcare. Only here we don’t call it a supply chain, we call it a care pathway.

Of course, the NHS isn’t a mobile phone. It’s infinitely more important than that. If things go wrong on your phone, you can’t make a call. If things go wrong in the Health Service, people’s lives are at stake.

Modernisation isn’t about competition. It’s about improving results for patients. It’s about building quality services for patients. It’s about extending information and choice. It’s about competition as a means to an end, not an end in itself. And it means ensuring that the service is patient-centred, not provider-centred.

I know the clinicians in charge of commissioning will demand nothing less.

Because it will be an essential element of every contract within the NHS.

Because they will be rewarded by the outcomes they deliver and they will be better if they are deeply integrated within the wider pathway of care.

So a hospital that doesn’t go out of its way to integrate its general surgery with community nursing teams and with local GPs will quickly run into problems.

The community dialysis provider that does not link up with specialist community nursing, with hospital renal specialists or with social care organisations will find it very difficult to convince commissioners to pay for their services.

And if nothing else, if they don’t prioritise integration, their competitors certainly will.

And in those circumstances where the best care is be provided by commissioning a single provider across the whole pathway, that’s allowed too. The Bill doesn’t prevent that. It will support that. This is about doing whatever it takes to produce the best outcomes for patients.


If we agree that the whole point of the NHS is to provide the very best outcomes for patients, then I believe we must have a fully integrated NHS that is clinically led and that gives patients a real choice.

I am very clear that this is what we must achieve, but I am also very open to views and ideas as to how we achieve it. To my mind, nothing is more important than getting this right. The law of unforseen consequences can play no part in NHS modernisation.

That’s why we have paused after the Health and Social Care Bill has left committee to listen and reflect on what people are saying and to see if there are things we can do – substantive things – that will mean that our ambition is matched by the reality on the ground.

The Bill is necessary not to give more power to the centre, but to give it away to clinicians. You cannot have a clinically led system without the legislation necessary to give them that lead. And if you want the NHS to be truly run from the bottom-up then you do at some point need the people at the top to let go the direct reins of power. That is what the Health and Social Care Bill is about.


I don’t want the future of the NHS to be determined by me or any other politician. I want it to be determined by the millions of choices made by millions of individual patients and by the healthcare professionals responsible for their care.

By local NHS and social care organisations working with local authorities and patient groups to bring cohesion and integration to local patient services.

And by the many thousands of clinical leaders in GP surgeries, hospitals, cooperatives and independent sector providers all across the country.

The government will put the right people – clinicians – in charge. We will make it clear what they need to do and how they will be held to account. And we can do everything possible to support them in this difficult role.

This is our vision for the NHS. A vision of an NHS led from the bottom-up. A vision that puts patient care above news headlines.

A vision that I believe in and that I fully expect to deliver outcomes that are consistently among the very best in the world.

Andrew Lansley – 2011 Speech on Hospices


Below is the text of the speech by Andrew Lansley, the then Health Secretary, given on 26th September 2011 at Help the Hospices.

Thank you Michael [Howard].

There are few people better qualified than you are to talk about the relentless cut and thrust of British politics.

We all know what we’re getting into, of course, but there are still times when all the press, the interviews, the meetings and policy documents can feel like a bit much.

But there was a reason why I first asked you if I could be health spokesman for our party eight years ago.  It’s because nothing is more important than the care we give to people when they are at their most vulnerable; and nothing more inspiring than the people who give that care.

As the Secretary of State in charge, it’s important never to lose sight of that.  That’s why I visit the NHS and other health and care providers every week.  I recently visited three hospices in one day up in the North West.

Each of them had received funding from the Department of Health’s £40m capital grant scheme.  So I went up to see how it was being put to use.  A proper thing to do from an accountability point of view …but it was also very moving personally as well.

I saw places where the hospice workers give excellent levels of care and support.  Where patients, their families and their carers get the best experience that their circumstances allow.

For me, the quality of the interaction and relationships between patients and the professionals who work with them defines good healthcare.

I know how important hospices are to local communities and what excellent work they do.

In 2007/8, hospices in England, Wales and Northern Ireland cared for around:

– 41,000 new adult in-patients,

– 18,000 new day care patients

– 102,000 patients at home

– as well as supporting 110,000 patients in hospital.

In every single case, they play an essential role:

– providing specialist care to those who need it,

– educating health and social care professionals,

– innovating in service provision,

– and supporting services for people who want to get their care in the community.

Hospices play a valuable role in giving people choices.

They’re well placed to provide, or be a part of, many of the community-based end of life care services set out in the End of Life Care Strategy.

They’re essential in ensuring that the needs of patients and their families are met, whatever their circumstances.

That’s why I – and the coalition government as a whole – want to see hospices flourish and develop.  We have already taken action to support that, and we’re going to do more as well.

End of life care

It’s said that you can judge the civility of a society based on how well it treats its most vulnerable citizens.  On the basis of some cases that have recently come to light, we need to do a lot better.

There’s more work to do to develop better end of life and palliative care services, to make sure that all of the people that need that care always get it.

Care that is compassionate, appropriate and a high quality. And care that always takes account of patients’ choices and their personal preferences.


The health reforms currently being put in to place will put improving the quality of care truly at the heart of the NHS.

We are developing a new indicator for end of life care, to help assess its quality and to inform the improvement of services.  It will be based on a national survey of the bereaved, who will report on the deceased’s, and their own, experience of care, so that developments will be based on the evidence of those who know.

And NICE is developing a quality standard for end of life care.  Due in November, it will set out – based on the evidence – the characteristics of what a high quality services.  It will help commissioners and providers see what the best care looks like.

Already today, end of life care comes from a range of providers, including hospices.  As we move into the future, with an NHS based around patients rather than process, I want to encourage new partnerships and more organisations to get involved.

Because I believe that, where it’s appropriate, patients should be able to choose from a range of groups, all offering services that are high quality, consistent, and delivered in a way that the patient likes.

We are asking the NHS to listen to patients, and if they hear a strong call for more choice about who provides care at the end of life, then commissioners should make that happen locally.

If providers meet strict qualifying criteria, and if they’re ready, it’s right that they should be allowed to offer care to people who want that choice.  It will mean more innovation in the sector, which will benefit patients, because their care will keep getting better, and it will benefit the best providers who will then attract more patients.

To secure continuing improvements in quality, we must empower people with information, shared decision-making, and choice.  “No decision about me, without me” is, I know, already integral to hospice care.

I really can’t overstate how important choice is, particularly when it comes to end of life care.

We want to make sure the wishes of the patient and the family come first.  Moving towards a system where everybody is supported in how they want to die.

The recent report from Cicely Saunders International on local preferences and place of death told us yet again that most people would prefer to be cared for and to die at home.

But sadly, it also found that for many people, it just doesn’t work out that way.

For some, Hospital will continue to be the appropriate place to die.

But many more people could be cared for and die at home or in a ‘home from home’ such as a hospice…

– if the system allowed it.

– if money was available,

– if services could be provided where and when they were needed,

– and if some of the red tape could be cut back.

I want this to happen.

People need more choice and control about the care they get when they are dying. In particular, services should be set up to help people who want to die where they live, including in a care home if that has become their usual home.

We want to introduce a right that will make this happen.

And if it is going to happen, we need to fully implement the End of Life Care Strategy, particularly around delivering improved services in the community.


Hospices have a particularly important role to play for children

When it comes to palliative care, their can differ greatly from those of older patients.  It’s not just a matter of end of life care, but also helping children with life-threatening or terminal conditions to live as full a life as possible.

We are working with children’s hospices to improve palliative care for children and to develop a more sustainable and patient-centred funding system.

This year, the Department of Health gave £10m to forty children’s hospices in England through the children’s hospice and hospice-at-home scheme.  The grant, introduced 5 years ago, has now provided £57 million to children’s hospices.

Last year, we also give up to £30 million to support local projects to develop children’s palliative care services, bringing together local commissioners and providers, including voluntary sector organisations.


Altering the system to allow more choice can’t be done overnight.  Everything must be re-aligned and that takes time.  For example, commissioners need to be sure that the right services are available to support people to be looked after at home.  Effective co-ordination of care will also be essential.

To support this, we have piloted End of Life Care Locality Registers, also known as Electronic Palliative Care Co-ordination Systems, as a way to ensure that all professionals involved in a person’s care at the end of their life have access to key information about a person’s care and their care preferences. And we are now working with partners to help this practice become more widespread.

There’s a lot of work to be done.  In 2013, we’ll review our progress and see how we’re doing.  See how close we are to giving everyone greater choice.

Palliative Care Funding Review

A huge part of all of this is getting the system of funding right.

The coalition’s Programme for Government says we will introduce a new per-patient funding system for all hospices and providers of palliative care, for both adults and children.

It’s right there, in black and white, on page 26.

I’m sure you all have a well-thumbed copy on your bedside tables, so have a look when you get home.

To help drive forward our commitment to innovative, integrated services, I set up the independent Palliative Care Funding Review.

In a nutshell, the Review’s job was to develop funding options that would be fair.  Fair to patients, ensuring that they have access to the care they want, where and when they want it. And fair to all providers of dedicated palliative care, including hospices, giving them the means to make it happen.

Per-patient funding should be sustainable; it should provide stability; and it should actively encourage palliative care to be given in the community, so people can stay at home or in a care home if they want.

But for it to be a viable option, it also has to be affordable.  Fair to the taxpayer, if you will.  Particularly when you look at the financial situation at the moment.

I have welcomed the Review’s final report, which has made a really positive start at looking at what is an incredibly complex issue.


It came up with a range of significant proposals.  They now need detailed consideration, and, crucially, they need to be backed up with new information and data.  One key conclusion of the review is that “There is a stunning lack of good data surrounding costs for palliative care in England.”

For example, at present there is no data on individual patients receiving specialist palliative care.  Work is underway to change that, but it may well need to be extended to include the points recommended by the Palliative Care Funding Review.

The pilots, the next stage in taking this forward, will collect a range of data covering different age groups, different diagnoses, and different settings.

And they will be designed to consider questions that are central to the development of per-patient funding.

Questions like:

– Can clinicians classify patients easily and reliably?

– What care did patients receive during each phase of their illness?

– And what will their treatment cost?

I’m under no illusions about the scale of that task.  But at the same time, I know it’s a hugely positive step.  We’re going to work out how it might best be carried out, and then there will be extensive engagement through piloting.

A key outcome of the pilots will be to develop the building blocks – the currencies, as the jargon has it – that we’ll need to construct a tariff – a set of NHS prices for services delivered.

A national tariff will provide a clear and transparent method of reimbursing service providers.  The introduction of a tariff for most acute services has helped to shift discussions between providers and commissioners onto quality and away from price.

Linking payment to better patient outcomes drives improved quality, encourages efficiency and supports patient choice.

I’ve been hugely encouraged by the numbers of organisations already offering to help with the pilots.  Already, over 25 had said they want to be involved, and we’re always on the lookout for more.

Getting per-patient funding off the page and into practice is not going to be easy.

But without losing sight of the practicalities, we should all recognise the potential benefits.

We have an opportunity to give people the best care at the end of their lives.  We need to push forward with reform and I want a new system in place by 2015.  Moving forward faster than the review proposed.

We also want to get people’s opinions about what our priorities should be when we reform the care and support system.

On 15 September, the Government launched Caring For Our Future: Shared Ambitions For Care And Support, an engagement with those who use care and support services, carers, local councils, care providers, and the voluntary sector about the priorities for improving care and support.

Both the National Council for Palliative Care and the National End of Life Care Programme will organise events where you can give your views on how to improve end of life care through social care reform.

As part of this, we would also value views on the Palliative Care Funding Review.  In particular, we’d like to be able to explore in more detail its recommendations on free health and social care at the end of life.


As progress is made, we need to move forward together.

Today we published the Third Annual Report on the End of Life Care Strategy, which provides more information on work and developments over the past year.

It’s available on the Department’s website and it’s a good and encouraging read.

Of course, there is much more to be done.  But if patients are to receive the care they deserve at the end of their lives, then hospices are going to be central in delivering improved care, providing an expanding range of vital, high quality, compassionate services in the community.

I look forward to continuing our partnership with all of you in the hospice movement.

Thank you.

Andrew Lansley – 2011 NHS Modernisation Speech


Below is the text of the speech made by the Secretary of State for Health, Andrew Lansley, on NHS modernisation to NHS staff at Frimley Park Hospital in Surrey on the 5th April 2011. The Prime Minister, David Cameron, and the Deputy Prime Minister, Nick Clegg, were both also in attendance.

There is no more important institution in this country than the NHS. This is true for everyone, not least for me. I am passionate about improving our NHS; for today and for generations to come.

As David and Nick have said, there is widespread support for the principles of our proposals:

– For a patient-centred service with ‘No decision about me, without me’;

– For clinical leadership,

– And a relentless focus on what matters most, clinical outcomes and results for patients;

But while there is agreement on the principles, people also have genuine concerns as to the detail. So in the coming weeks we will pause, listen, reflect and improve with the professions and the public to make the Bill better in four areas.

First, we need to make sure that we have the right sort of competition in the Health Service. Not competition for its own sake, not cherry picking the lowest hanging fruit, not giving preference to the private sector over and above NHS or charities.

Fair competition that delivers better outcomes for patients.

Second, we need patients and the public to play an active role in the NHS. Local decisions should not be made behind closed doors, but open to the genuine influence of the people they serve.

Care should be integrated and designed around an individual’s needs. The needs of the patient, not the convenience of the system, should come first.

Third, commissioning should mean GPs coming together with their colleagues across the NHS – nurses, allied health professionals, hospital consultants – to design the best possible services for patients. That is the idea. The Bill must make this a reality.

And finally, education and training. The new NHS must build upon what works for the benefit of patients.

Today heralds the first of a series of listening exercises and events with the Prime Minister, the Deputy Prime Minister and me. This as a genuine opportunity to shape the future of the NHS.

The NHS Future Panel, a team of top health professionals, will help lead the process and be chaired by Professor Steve Field, former head of the RCGP.

And anyone can go to the Department of Health website to put forward their ideas on the four areas.

By taking advantage of this natural pause in the legislative process, taking us up to late May or early June, we can be sure that we achieve what is our ultimate goal:

– a health service that is free;

– that is based on need and never a person’s ability to pay;

– and an NHS that, on what matters most – on outcomes for patients – is consistently among the very best in the world.

I want to thank the more than 6,000 GP practices already taking the lead in improving local services and to thank the 90% of local authorities who are starting to bring a greater degree of local democratic accountability and coordination to the Health Service.

I encourage everyone to take part in this and to help make the NHS as good as we know it can be.