Tag: Jeremy Hunt

Below is the text of the speech made by Jeremy Hunt, the Foreign Secretary, on 11 October 2018.

On behalf of the Foreign and Commonwealth Office – and our co-hosts, the Department for International Development and the Department for Environment, Food and Rural Affairs – I’m delighted to welcome you to this conference.

Our task simply is to address one of the greatest challenges facing humankind. How can we protect the magnificence of the natural world from the criminal gangs who threaten human beings just as surely as they plunder the planet?

The world’s population now stands at 7.5 billion human beings, that’s a fivefold increase on a century ago, reflecting humanity’s remarkable progress against poverty and disease. Since 1990, the global infant mortality rate has fallen by over 50 per cent. Almost everywhere, people are living longer and healthier lives – and we should give thanks for that cardinal achievement.

Yet as we have succeeded, other species have gone dramatically into decline. It was Yuval Noah Harari, from Hebrew University in Jerusalem, who described homo sapiens as the “deadliest species in the annals of Planet Earth”. By about 12,000 years ago – long before our ancestors invented the wheel or iron tools – we human beings had already exterminated about half of the world’s large mammals.

Today, the process has gone still further. If you placed all the people in the world on a giant set of scales, they would weigh about 300 million tonnes. But if you gathered all the surviving wild animals – of every size and species – and placed them on the other end of the scales, their combined mass would be less than 100 million tonnes, three times less than us.

The global population of vertebrate animals has fallen by almost 60 per cent since 1970. It’s even worse news for particular animals: forty years ago, Africa had about 1.3 million elephants. Today, the figure is down by two thirds to 415,000. In Asia, the population of wild tigers has dropped by 95 per cent since 1900.

The illegal wildlife trade is not the sole cause of the disappearance of wildlife, but we all suffer from its malign effect.

The same criminal networks that smuggle tusks and horns and hardwood also traffic in guns and drugs and people. They launder money, engage in modern slavery, fund conflict and thrive on corruption. By one estimate, the illegal wildlife trade is the fourth most profitable criminal enterprise in the world, generating as much as $23 billion.

Last year, the authorities in Hong Kong achieved the biggest ivory seizure in history, intercepting a shipment of tusks weighing 7.2 tonnes. For that one consignment, the smugglers or their accomplices will have killed at least 700 elephants.

In the process, these bandits were looting the natural wealth of Africa. From Mongolia to Laos, from Angola to the Amazon, the illegal wildlife trade robs sovereign nations of their resources and deprives some of the poorest countries in the world of the revenues of their biodiversity.

The World Bank estimates that governments lose as much as $15 billion every year from illegal logging. Money that could be spent on schools and roads and hospitals; instead much of it goes to criminal gangs who harm people even as they despoil nature.

If anyone asks why we devote effort and resources to combating the illegal wildlife trade when millions of human beings still endure war, hunger and disease, then here is the answer. This trade threatens some of the poorest people in the world, destroying livelihoods, empowering criminals, and depriving governments of the means to provide essential services.

The interests of humanity cannot be separated from the interests of the natural world. The one depends on the other.

So we are all here today because of our common resolve to combat this trade – and we are all looking for the most effective methods. Let me share some of the actions that Britain has taken, and where we think they could be more effective alongside a global coalition.

My predecessor, Lord Hague, called the first London Conference on this subject in 2014 and the framework we agreed then provides the best guidance for our response.

Firstly, we need to eradicate the market for illegal wildlife products. Secondly, we must ensure our laws are strong enough to deter the criminals. Thirdly, we must rigorously enforce those laws. Finally, we need to provide sustainable livelihoods for those who might otherwise be tempted by the short term gains of poaching.

Last year, the British Parliament passed the Criminal Finances Act, strengthening our powers to combat money laundering and freeze unexplained wealth. Since then, we have placed another law before Parliament that would ban domestic ivory sales.

We are now testing our legislation and enforcement capabilities using the methods developed by the International Consortium on Combating Wildlife Crime. Britain will be the first G20 country to go through this exercise and put our own house in order.

We will also contribute £250 million to the UN’s Global Environment Facility by 2022. Along with other donors, we secured agreement for a 30 per cent increase in the budget of the UN’s Global Wildlife Programme.

The Department for International Development is working alongside many of the governments represented here today in order to help provide alternative livelihoods for poor communities.

We are helping countries to improve their governance, strengthen the rule of law and achieve sustainable economic growth. I was pleased to announce another £3.5 million of technical support to help countries “follow the money” behind the grand corruption associated with the illegal wildlife trade.

The criminals don’t respect borders; if one nation toughens its laws, the smugglers will move into a neighbour. If we improve the protection of one endangered wildlife population, they will target another species – or the same species in a different country.

Our response has to rest on international cooperation and it’s so fantastic that 85 governments are represented here today. We welcome the trans-frontier approach to conservation – including “Green Corridors”- which we will do everything we can to support.

This conference will complement our joint work at the UN and CITES, which is the right forum to agree international rules and identify any species in need of extra protection.

But we know that governments and international organisations can’t address this problem alone. That’s why this conference includes businesspeople, NGOs, scientists, law enforcement experts and youth organisations.

We have brought the Interpol Wildlife Crime Working Group to London because we need to ensure that seizures result in prosecutions and convictions.

I offer a special welcome to the game rangers who are present. In the last year, over 100 brave rangers have been killed in the struggle to protect wildlife. We must do more to equip and safeguard the courageous people who risk their lives to guard the natural majesty of their homelands.

I welcome the representatives of communities who live alongside wildlife. I know how easy it is to romanticise that experience if you happen to reside in the safety of London so we all look forward to hearing more about how to reduce human-wildlife conflict from people who understand the issue best.

Yesterday, His Royal Highness the Duke of Cambridge launched a new private sector Financial Taskforce, designed to bolster the struggle against the illegal wildlife trade.

I hope that we all will use this conference to create new networks and learn from what has gone right as well as what has gone wrong. Nepal, for example, has doubled its tiger population since 2009; in fact not a single rhino or tiger has been poached in Nepal for the last four years.

Let me close by repeating my welcome to London. Let us all leave this conference with a renewed determination to thwart the criminal gangs who inflict grave injury on people with deadly consequences for animals. If we fail to act, quite simply we will never be forgiven.

Below is the text of the speech made by Jeremy Hunt, the Foreign Secretary, at the UN Security Council on 23 August 2018.

I shall now make a statement in my capacity as the Secretary of State for Foreign and Commonwealth Affairs of the United Kingdom, of Great Britain and Northern Ireland. I’d like to open the session by thanking Mr Voronkov and Ms Coninsx for their briefing on the Secretary-General’s report on the threat posed by the Daesh to international peace and security. I’d also like to welcome Dr Joana Cook. Thank you for sharing the key findings of your report on Daesh women and minors which shows the value of inviting civil society and researchers to inform our discussions.

In the summer of 2014 Daesh swept down the Tigris and Euphrates valleys capturing thousands of square miles of Iraq and Syria and imposing its pitiless rule on millions of people in an area that was once the cradle of civilization. Over the next 3 years, attacks that were directed, inspired or enabled by Daesh would claim more than 30,000 lives including 181 attacks outside Iraq and Syria.

The world responded by forming a Global Coalition to defeat this threat and military action by many countries including my own has driven Daesh from almost all of its domain and liberated millions from its oppression.

But the point I wish to emphasise today is that this has not been vanquished and the root causes of its emergence have yet to be resolved. Britain shares the assessment of the Secretary-General’s report that Daesh is responding to the loss of territory by evolving into a covert terrorist network that branches as far apart as Afghanistan, Libya and Yemen.

Daesh takes advantage of ungoverned space and weak states. Its terrorists do not necessarily require a central direction and they’ve demonstrated their ability to strike in Europe and Southeast Asia. The Secretary-General’s report estimates that as many as 20,000 Daesh fighters remain in Syria and Iraq, including the citizens of many countries. About 900 people with links to the United Kingdom have travelled to join the conflicts in Syria and Iraq. About 40% returned to the UK in the early days of Daesh’s so-called Caliphate and some 20% are believed dead. The rest are still in Iraq, Syria or elsewhere.

Our response to this enduring threat should fall into 2 parts. First we must press on with military operations against Daesh. British forces continue to play their part as members of the global coalition and UK leads in a vital area of strategic communications against Daesh. This year the British government has committed another £20 million to counter-terrorism projects in countries we assessed to be most at risk from returning foreign fighters.

Second, we should renew our focus on prevention. By addressing the root causes of the emergence of Daesh. This means doing more to support peace and reconciliation in Iraq and a lasting political settlement in Syria. It also means responding to specific humanitarian problems. For example, up to 20% of foreign fighters globally are women and girls. Almost 10% of the 40,000 individuals who travelled to join Daesh were minors. Many of whom have witnessed or experienced horrific violence and been exposed to radicalization. Some will be suffering from Post-Traumatic Stress Disorder. We need to act to prevent these minors from becoming the next generation of terrorists. The UN has a vital role in the struggle against Daesh consistent with the responsibility of this Council to address threats to international peace and security. This Council made air travel more secure by passing Resolution 2309 – the first ever Resolution on aviation security. And it addressed the threat from foreign fighters in Resolutions 2178 and 2396. Earlier in 2005, this Council passed Resolution 1624 condemning incitement and repudiating all attempts to justify or glorify acts of terrorism.

The Council should be willing to consider further action in order to counter the use of the internet by terrorists for propaganda and fundraising. Prevention is a key pillar of the UK’s approach to counter-terrorism. Our aim is to identify anyone at risk of radicalization and seek to reintegrate them into society. Agencies and local governments from health education social services and the police routinely meet to identify individuals at risk and refer them to programs run by specialists in de-radicalisation. This approach focused on prevention rather than prosecution after a crime has been committed has turned more than more 500 people away from terrorism in the UK.

Over the years we’ve learned lessons and refined our Prevent programme. We stand ready to share our experiences with countries that face similar problems. Societies that are confident about their beliefs and values and hold governments to account are societies that are resistant to the virus of terrorism. The key to success is partnership between many nations. We mustn’t lose sight of the importance of those partnerships even as Daesh loses its grip on Syria and Iraq. I look forward to our discussion today on how we can act together to prevent and counter the evolving threat from Daesh. Thank you.

Below is the text of the speech made by Jeremy Hunt, the Foreign Secretary, at the United States Institute for Peace on 21 August 2018.

In 1898 when Theodore Roosevelt had just completed his tenure as the relatively lowly Assistant Secretary of the Navy, he said: “There comes a time in the life of a nation, as in the life of an individual, when it must face great responsibilities. We have now reached that time… all that we can decide is whether we shall bear ourselves well or ill.”

History will surely judge that the United States lived up to Roosevelt’s challenge. Thanks to wise decisions made by him and his successors, strong American leadership has put in place a global order that has led to unparalleled peace and prosperity. No small part of that contribution has been made by the United States Institute for Peace and I am privileged to be making these comments here today.

This period in our history has seen not just the defeat of fascism and communism but the emergence of an international order based on the application of law rather than might. And the result? An exponential growth in trade, leading to extraordinary advances in economic and social prosperity across the globe.

This is borne out by virtually every indicator, even if they struggle to capture the headlines. For example, notwithstanding terrible recent bloodshed in Syria, the number of conflict-related deaths has fallen from 5 per 100,000 people across the globe in 1984 to just 1.2 per 100,000 in 2016. At the same time average life expectancy has risen from 31 in 1900 to 72 last year.

If you look at the poorest countries you see even more spectacular progress: when I was born in 1966 half of humanity lived in extreme poverty – now it is just 9%, with 137,000 people emerging from this condition every single day over the last 25 years.

It is probably not hyperbole to say this period has been the most productive and successful in the 300,000 years that homo sapiens has existed. But how confident can we be that this democratic political and economic order which has done us so proud will actually be sustained?

Four challenges to the post-war order

After the fall of the Berlin Wall many assumed we had reached ‘the end of history’ – that western liberal democracies were so obviously the best way of running a society that no one would ever question their uniquely successful combination of economic and political freedoms. Indeed what we used to call ‘Western’ values’ have in some ways become universal, adopted by citizens in Africa and Asia as much as Europe and America.

But we now know that such unalloyed optimism was misplaced. Not only is our democratic model declining in attractiveness for too many people but globalisation itself appears in retreat. Whilst in the 30 years after 1970 the number of democracies grew from 32 to 77, in the period since 2006 freedom has been in decline. According to Freedom House, 71 countries suffered net declines in political rights and civil liberties last year – and less than half of UN member states are designated ‘free’.

Four developments in particular should give us cause for concern:

Firstly the established rules of international conduct are repeatedly being flouted by major countries like Russia. The seizure of Crimea in 2014 was the first time that territory has been annexed in Europe by force of arms since 1945. But in fact it was not the Kremlin’s first territorial incursion in this century, which was the invasion of Georgia in 2008.

At the same time, we have also seen the open flouting of international norms on the use of chemical weapons by both Russia and Syria – in contravention of the Chemical Weapons Convention of 1997 to which both countries are parties.

As a result hundreds have died horrific deaths in Syria. And this March the Russian government even used a banned nerve agent on the streets of Salisbury in Britain in an attempt to assassinate Sergei and Yulia Skripal. One British citizen was tragically killed as a result.

Such aggressive and malign behaviour undermines the international order that keeps us safe. And of course we must engage with Moscow, but we must also be blunt: Russia’s foreign policy under President Putin has made the world a more dangerous place.

The second challenge is the changing East-West balance of power.

By 2030 China is forecast to overtake America as the world’s biggest economy. 800 million Chinese have lifted themselves out of grinding poverty, surely something everyone should welcome. By 2050 China and India are projected to account for a greater share of global GDP than the G7 – compared to less than half of that level today.

But with economic power comes political responsibility. And whilst China has been vocal in its support for some features of the existing system, particularly elements that enable it to trade freely with the world, it has been less supportive in other areas, refusing for example to oppose Russia’s annexation of Crimea or support measures to strengthen the international ban on chemical weapons. Our hope must be for consistent, strong backing from China for the international rules-based order – and the key will be to get the right balance of competition and cooperation so that we can secure shared objectives wherever possible.

Then there is the third challenge, namely the fraying domestic support for democratic systems in our own countries.

Since the financial crash of 2008, many voters have started to question globalisation and reject political leaders they associate as defending it. This has combined with a sense that attempts to export our own economic and political model to countries like Iraq have ended up as spectacular failures.

Disenchantment is so bad that according to one poll 1 in 10 people in Europe – and 1 in 6 in America – think it would be a good thing for ‘the army to rule’.

Added to which are basic challenges to the plumbing of our systems. The heart of any democracy is freedom of expression, which allows citizens to access independent information to help decide who to vote for. But the ubiquity of fake news, social media targeting and foreign attempts to manipulate elections have undermined confidence that this can actually happen.

The result is cynicism about both democratic systems and the elites who run them, a cynicism that would be fuelled further if companies with a global reach such as Google were to accept censorship as the price of entry into the Chinese market. The result is that those of us – myself included – who strongly support the basic tenets of the post-1945 international order find we are not just having to make the arguments for it abroad, but at home as well.

We should never be complacent about one further challenge, namely the continuing threat from Islamist-inspired terrorism. This continues to use distorted religious dogma to reject the entire basis of the international order – including the modern state system itself which they would like to replace with a so-called Caliphate.

Since the dark days of 9/11 in New York and 7/7 in London we have made great military progress towards defeating extremist organisations. But truthfully we have made far less progress in understanding why those movements arose in the first place so we can prevent their re-emergence. Nor have we successfully reassured our own peoples that such ideologies will never be allowed to threaten our own open culture.

So how should we respond to these challenges? I want to suggest 3 things in particular.

1. Firstly we need to rebuild the strongest possible alliances between countries that share the same values.

The visible advantage that won NATO the Cold War was military capability. The invisible weapon was a rock-solid alliance of like-minded nations that sat behind it. Those shared values meant no opponent was ever in doubt about our red lines.

Henry Kissinger, who I am privileged to be meeting in a couple of days in New York, said that “credibility for a state plays the role of character for a human being. It provides a guarantee that its assurances can be relied upon by friends and its threats taken seriously by adversaries.” But instead of building up our credibility, we have been weakening it.

A limp response to Russia’s intervention in Georgia in 2008 can only have made the 2014 annexation of Crimea more likely. Our failure to respond to Assad’s use of sarin gas in 2013 must be at least part of the reason why he chose to use chemical weapons again in 2014, 2015, 2017 and in April this year.

Not every hostile action constitutes the crossing of a ‘red line’ and we will always need a graduated menu of responses. But the strengthening of our credibility in support of a rules-based international order must become a central goal of foreign policy.

Those who do not share our values need to know that there will always be a serious price to pay if red lines are crossed – whether territorial incursions, the use of banned weapons or, increasingly, cyber attacks.

And part of that credibility comes from unity.

We showed that this year with a strong, united response from 28 allies to the use of chemical weapons in Salisbury. 153 Russian intelligence officials were expelled including 60 who were removed by the United States – more than any other country – and the US has since gone further by announcing sanctions. Combined with the decisive US military response to Assad’s use of chemical weapons in Douma in April – joined by Britain and France – we can see that the red lines on chemical weapon use have started to regain credibility.

And today the United Kingdom asks its allies to go further by calling on the European Union to ensure its sanctions against Russia are comprehensive, and that we truly stand shoulder to shoulder with the US. That means calling out and responding to transgressions with one voice wherever and whenever they occur, from the streets of Salisbury to the heart of Crimea.

We need to remember the importance of unity as we face, not just on this issue – whether it is halting the malign influence of Iran, ending the conflicts in Syria and Yemen, denuclearising the Korean Peninsula or fair burden-sharing within NATO, where President Trump is surely right to urge higher defence spending by European allies as Britain is doing.

Making compromises for the sake of unity will always be necessary. We should never forget Margaret Thatcher’s words: “It is in a country’s interests to keep faith with its allies. States in this sense are like people. If you have a reputation for exacting favours and not returning them, the favours dry up.”

And one of the biggest threats to European unity would be a chaotic no-deal Brexit. Britain would, of course, find a way to prosper and we have faced many greater challenges in our history. We will always be a dependable ally for the US and all countries that share our values. But the risk of a messy divorce, as opposed to the friendship we seek, would be a fissure in relations between European allies that would take a generation to heal – a geostrategic error for Europe at an extremely vulnerable time in our history. So, as I have been saying to European governments, now is the time for the European Commission to engage with an open mind with the fair and constructive proposals made by the Prime Minister.

For all of us – the United States, the EU and the UK – the strategic choices we make on these issues will have a profound impact on the solidity of our democratic and economic systems. In the face of these new challenges now is surely the time to rebuild the unity of purpose we know is essential.

2. The second response to the challenges we face will take longer – but is even more important. We need to regain the economic momentum that ultimately lies at the root of political power. Power follows money. If we want to project our values, we need competitive economies.

Professor Paul Kennedy of Yale University defined the “process of rise and fall among the Great Powers” as being the result of “differentials in growth rates and technological change, leading to shifts in the global economic balances, which in turn gradually impinge upon political and military balances.”

Britain of course knows this well. In the 19th century, thanks to the Industrial Revolution and the invention of steam-powered mass production, we eclipsed all of our rivals and became the first truly global power in history.

Of course as poorer countries develop, their share of global wealth will increase – and we should welcome that. But we also need to stay in the game. Recent improvements in US growth are encouraging, but all of us need to play to our strengths.

Free and open societies are not just the best hedge against the corruption that disfigures and constrains economic growth in so many countries. They are also the natural incubators of innovative technological advances that power modern economies. As John Stuart Mill put it: “Genius can only breathe in an atmosphere of freedom.” Of the top 10 countries in this year’s Global Innovation Index, nearly all are liberal democracies. Britain is fourth, the US comes sixth – and those 2 countries account for 19 of the world’s top 20 universities.

China’s astonishing march into AI and robotics show that our leadership in creativity and innovation is not unchallenged. We in Britain are responding with a modern industrial strategy, focused on the fourth industrial revolution and including major education reforms along with the biggest investment in rail since Victorian times. But there is much more to do and we must all prove in this new era that free, open, capitalist values are still the key to economic renewal and prosperity. Free trade is a critical too and that the United Kingdom warmly welcomes the support from the US administration for a UK/US free trade deal.

3. The final response to the challenges we face must be to get our own house in order.

Dissatisfaction with the way society works is nothing new – although social media can make it spread like wildfire. But we are putting our heads in the sand if we think we can blame social media by pretending that some of the causes of that resentment are not real – whether caused by the decline in real incomes for many Americans and Europeans, dislocation caused by changes in technology or the identity concerns of many voters caused by immigration.

To reject those concerns as being held by a minority of voters with illiberal views is to make a dangerous mistake. In Britain the 52% of our country who voted to leave the EU cannot be dismissed as far-right extremists. Nor the many who seek change in the US.

Our 2 histories share a common thread of the benefits of freedom and prosperity progressively being shared with more and more of our peoples. But if our electorates believe that such benefits are no longer being shared fairly between political elites and the people they represent, then resentment boils over. Expressing such resentment is an affirmation and not a rejection of the core democratic instinct that a society must work for all its citizens – so the sooner we address those concerns the stronger our democracies will be.

Part of that must be to address concerns about the basic functioning of our democracies. Given the importance of the online world for political communication, the rules governing online activity in the run up to elections should surely be as strict as those elsewhere – and modern electorates should be given confidence that the results cannot be influenced by the cyber activities of other countries.

At the same time, we need to restore confidence in the multilateral institutions whose job is to protect the stability of the international order and the values it depends on. No-one understood the importance of this task better than Kofi Annan, a humane and principled leader who embodied the best of the UN during his 10 years as Secretary General and whose death last Saturday we all mourn. But he would have been the first to acknowledge that all too often these institutions are seen as talking shops with little capacity to engineer real change. Given they sit at the heart of the international rules-based order the UK and US must continue to make common cause to progress bold and necessary reforms.

These are just 3 of the many possible responses to the challenges we face. But if the issues seem daunting, history also tells us that nothing is inevitable.

The progress we have made did not happen by accident – but rather as the result of extraordinary endeavour and difficult choices made at critical moments. I started with Teddy Roosevelt so let me finish with his formidable niece Eleanor who said that in working for the dignity and freedom of the human race “to stand still is to retreat”. Just as others before us, now is the time to move forward, with clarity and purpose.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, on 20 March 2018.

“Grow old along with me! The best is yet to be.”

The famously optimistic line by Robert Browning might seem out of place to many worried about how we will cope with an ageing population

In modern-day Britain, one of the most developed countries on the planet, our aspiration should be to prove those worries wrong. Because how we care for our most vulnerable citizens is the true litmus test of whether we are a civilised society – not only the care for older people but for younger disabled people who are living much longer.

Progress has been made: the Better Care Fund is transforming the way councils and the NHS work together to treat the whole person: nearly 7 in 10 service users were extremely or very satisfied with their care and support over the last 3 years, and 81% of adult social care providers are rated as good or outstanding. Spending will rise by 9% this year, the number of care home agencies is up 55% since 2010, and we recently set out a new package of measures to protect care home residents from unfair practices.

But today I want to be honest about how well we are meeting that litmus test. In truth, not well enough.

Many families find it incredibly hard to access the care they want with or without means-tested support from the state.

Many people employed in the system find themselves working too hard as they struggle with fragmented services coming under unprecedented pressure.

The CQC has itself expressed serious concerns about the state of the adult social care market and the risks of provider exit.

And that pressure is feeding through to the NHS with A&Es becoming overcrowded because hospitals find themselves unable to discharge patients who cannot access social care support packages.

Behind these systemic issues sit many ordinary human beings in a great deal of distress. Families coming to terms with a relative with dementia. Older people living on their own who won’t admit they are lonely. Care home residents with clinical depression, as we know happens in 4 in 10 cases.

So let’s be brutally honest. In a country that prides itself on kindness, neighbourliness and respect this does not sit easily, and we need to do better.

Now no-one could accuse this or any government of not talking about the issue. In the past 20 years there have been 5 Green or White Papers, numerous policy papers, and 4 independent reviews into social care. So it would not be unreasonable to expect scepticism about yet another one this year – and as the new Health and Social Care Secretary I do rather feel the weight of stalled reform programmes on my shoulders.

So in order to get things right this time I want to outline the 7 key principles that will guide our thinking ahead of the Green Paper. And in doing so I wish to pay tribute to the work done by Damian Green, my predecessor, on whose thoughtful foundations much of our thinking has developed.

1. Quality

The first key principle relates to the quality of care. 81% of adult social care providers are good or outstanding according to the CQC – testament to many hardworking and committed professionals working in care to whom we owe a huge debt of gratitude.

But still too many people experience care that is not of the quality we would all want for our own mum or dad. They describe a daily visit from a rotating cast of care workers, perhaps as brief as 15 minutes, with barely time to get help washing or getting dressed and no time to build the friendly relationships that are only possible with proper continuity of care.

And then, despite some improvements, we also still get cases of demonstrable neglect, such as a few weeks ago when a worker at a care home in Norwich was jailed for bullying vulnerable patients, including humiliating a resident with incontinence problems in front of others.

So my first of the 7 principles will be that we need a relentless and unswerving focus on providing the highest standards of care – whatever a person’s age or condition. This means a commitment to tackle poor care with minimum standards enforced throughout the system so that those using social care services are always kept safe and treated with the highest standards of dignity and compassion – or as our Chief Inspector for Social Care puts it, that all provision passes the “good enough for my mum” test.

Part of this will be tackling the unacceptable variations in quality and outcomes between different services and different parts of the country.

How can it be, for example, that, according to the NHS atlas of variation, there is around a 90-fold difference in the over 75s’ rates of admission to hospital from care homes or nursing homes between the highest and lowest performing local authority areas?

Over the last 5 years enhanced CQC inspections have been central to the journey of improvement that the NHS has been on. And thanks to the superb leadership of Andrea Sutcliffe and her team, those principles have been extended to the social care provider sector. No longer do we worry in the same way as before that abuses in a small minority of cases will go undetected for long periods and we see demonstrable improvements in the majority of cases when people are inspected a second time round.

But the recent local systems reviews conducted by the CQC have demonstrated that an independent approach to reviewing commissioning as well as provision can also be a powerful force for good. These reviews have highlighted variation in performance between local authorities across a range of measures, including how the local authority commissions care from local providers.

So we now need to ask whether the time is right to expand that approach, and one of the questions the Green Paper will pose is whether we can build on the learning from the introduction of independent Ofsted-style ratings for providers to spread best practice to commissioners as well.

2. Whole-person integrated care

Secondly we know that right now, despite many warm words, if you have complex needs our current health and social care system can be confusing and fragmented.

An 85 year old living alone with multiple conditions such as diabetes and early stage dementia often faces a bewildering range of services and organisations.

And the risk is that too often an individual and their family are passed from pillar to post, giving the same information repeatedly without receiving joined up, personalised care that makes them feel like a valued human being and not just another task on someone else’s to do list.

So my second key principle is the full integration of health and social care centred around the person. We know when this happens people stay longer at home, healthier, more independent and needing fewer hospital services.

There are many good examples of progress from around the country:

In Waltham Forest they have introduced a managed network of care and support to meet the needs of local residents through individually selected services – and seen emergency admissions reduced by a fifth during 2015/16.

In Leeds an integrated care record is now used by over 5,000 health and social care professionals so hospitals arrange faster discharges with care packages put in place more quickly.

The Better Care Fund, too, has incentivised local areas to work more closely together, and many now have mature systems in place to bring together health and care services around the needs of their older populations.

But the key to this progress is that users of the social care system should have just one plan covering all their health and social care needs based on a joint assessment by both systems. So today I can announce new pilots in Gloucestershire, Lincolnshire and Nottinghamshire which will mean that over the next 2 years every single person accessing adult social care will be given a joint health and social care assessment and – critically – a joint health and care and support plan, where needed.

Why does this matter? Because integration must never be a bureaucratic exercise that makes life easier for professionals but makes no difference to people using the services. We will fail if we only join up the structures – we have to focus relentlessly on joining up the actual care experienced by vulnerable adults and service users on the ground – and these 3 pilots are intended to be trail-blazers for how to get this right.

3. Control

My third critical principle is control. What matters to individuals and families is the ability to direct the care they receive and autonomy to lead the lives they want.

Personalisation isn’t new, and there is a strong consensus that it is the right path to follow, but progress has often been slower for older people than for working age adults with disabilities. Whilst over 90% of older people receive some type of self-directed support, only around 1 in 6 take it as a direct payment with take-up stubbornly low for older people.

Yet we know that the greater control people have over their care, the better their outcomes and the lower the cost. I heard the story of Malcolm Royle, who had dementia, from his son Colin. His personal budget meant that Malcolm no longer had to go to the day centre 8 to 5, but could have regular carers when he needed them. He got back control of his life – and we need to help everyone do this if they have the mental and physical capacity to do so.

So I want to turbo-charge progress on integrated health and care budgets, making them the norm and not the exception when people need ongoing support.

And today I can announce that we will be consulting on Personal Health Budgets, in order to achieve better integration for those with the greatest ongoing social care needs as well as health needs.

And as part of that I commit that over the next 2 years in Gloucestershire, Lincolnshire and Nottinghamshire – our 3 pilot areas – every single person with a joint care plan will also be offered an integrated health and care personal budget.

Control also means transparency and access to reliable information. Where individuals and families have the necessary information to make informed choices, it usually drives quality up. Yet the truth, as set out in a comprehensive report by the Competition and Markets Authority last year, is that the current social care market is anything but transparent. We also need to make sure that anyone who needs to can get the right information to make a meaningful comparison between services so that they end up with a fair and straight deal on their choice of care provider. This isn’t just fairer, it will also spur quality and innovation in the sector.

4. Workforce

My fourth principle is to respect and nurture the social care workforce.

People who work in care homes, who do home visits, who look after people with care needs with kindness and love in every street in every town – these are our society’s modern-day heroes. Often highly skilled, they are typically also the lowest paid.

I am deeply proud that the introduction of the National Living Wage means that the average salary for a care worker in the independent sector has gone up by 4%, with those on the minimum wage seeing a pay rise of up to £2,000 since 2015.

But to attract more people into this sector, financial support must be matched with recognition of the value of this vital work and action on the wider set of challenges facing the workforce.

Today is World Social Work Day. So it is right to acknowledge that as a society we have ascribed too little value to these vital caring roles: yet the quality of care our parents get in their final years is as important as the quality of education our children get at the start of their lives.

So it is time to do more to promote social care as a career of choice and to ensure there are better opportunities for progression into areas like nursing which span both the health and social care sectors. And we need coherent workforce planning that is better aligned with that now being undertaken by the NHS. Alongside social workers, occupational therapists and nurses in social care we have many care workers who could benefit or be inspired by new progression ladders similar to those that are being developed in the NHS including roles such as associate nurses and nurse degree apprenticeships. These must be as available to those working in social care as in the NHS.

We have many registered professionals including social workers, occupational therapists and nurses in social care; and many more care workers and other unregistered professions. We need to ensure we have enough people within all of these skilled roles to support people to live the best possible lives. That means making sure that the new routes in to professions that we have developed for those working in the NHS, and the new roles such as nurse associates, also work for those wanting to build their careers in social care.

We need to recognise that people move between the NHS and social care systems – and will do more so as the 2 systems join up. So part of our thinking must be to think about health and care workforce issues in a joined up way. I can therefore confirm today that later this year we will not now be publishing an ‘NHS 10 year workforce strategy’ – it will be an ‘NHS and social care 10 year workforce strategy’ with the needs of both sectors considered together and fully aligned.

5. Supporting families and carers

Ronald Reagan famously quipped that “the nearest thing to eternal life we’ll ever see is a government programme.” A big danger in this debate is to see it purely as a government solution.

So my fifth principle is to make the needs of carers central to our new social care strategy.

Of course we need to foster the deep, innate and human responsibility we all feel to look after our loved ones, families and friends. But we should never take it for granted.

If we can make it simpler to look after a loved one, if we can make it easier to juggle working and caring responsibilities, if we can encourage volunteering – whether by more flexible working, better employer support or harnessing new technologies, then that is what we should do.

Over the past months we have been listening to the views of carers so ahead of the Green Paper we will publish an action plan to support them.

And alongside support for carers, as a society we also must tackle the epidemic of loneliness. It is truly a scandal that over 30% of people in Britain over the age of 65 say that television is their main form of company. So the appointment of Tracey Crouch as Minister for Loneliness is a welcome sign of the Prime Minister’s personal determination to address this issue, and we will work with her as we develop the Green Paper to address the underlying causes of loneliness by building an active and creative partnership between the state, individuals and wider civil society.

6. A sustainable funding model for social care supported by a diverse, vibrant and stable market.

Person-centred care means nothing if the individual’s choice and control is undermined by a lack of high-quality services to provide the support they need. Too often we hear of people unable to find the care they want, or of services which are only available in some places but just don’t exist in others.

We have to make sure that we have a vibrant and diverse base of care services for people to draw on. So the sixth principle running through our Green Paper will be the question of how we ensure a sustainable financial system for care, delivering a stable and vibrant market which delivers cost-effective, quality services for all including the debate we need to have with the public on the challenges of sourcing additional social care funding.

We should not assume that the best long term answer will be necessarily the same for different age cohorts. There may be changes that are equitable and achievable for younger people that would not be either of those for the generation approaching retirement. And part of the outcome of this process must be much greater public understanding of where the costs – often inappropriately – currently lie both for the state and individuals in every age cohort.

We also know the economics of the publicly funded social care market are highly fragile so we need to transform and evolve our models of care.

We will therefore look at how the government can prime innovation in the market, develop the evidence for new models and services, and encourage new models of care provision to expand at scale.

This will specifically include looking at the role of housing, including how we can replicate the very best models that combine a home environment with quality care and how we can better support people through well-designed aids and adaptations.

We must also recognise the potentially transformative role of new technology. We British are good at innovation, although sometimes less good at its application: so let’s see the brightest and best new ideas put into action to help us tackle the challenges we face and that will help us stay at home independently for longer.

Which is why the Ageing Grand Challenge announced as part of the Industrial Strategy needs to play a definitive role. Only last week the Government announced a new £98 million innovation fund to support healthy ageing. This funding will aim to catalyse public-private investment in technologies and innovations so that we don’t just invent great ideas here, we see them taken up throughout our system.

Going forwards, I will be working closely with other government departments, industry, civil society, academia and local government to ensure we make the most of the opportunities that the Industrial Strategy presents.

A more vibrant and diverse market offer will give people greater choice and more effective support. But it is also vital because if we do nothing to support people’s needs more creatively or efficiently, the cost of simply delivering these services today will double in a decade.

And of course we must make sure there is a long term financially sustainable approach to funding the whole system.

Resolving this will take time. But that must not be an excuse to put off necessary reforms. Nor must it delay the debate we need to have with the public about where the funding for social care in the future should come from – so the Green Paper will jump-start that debate.

7. Security for all

The final principle, which lies at the heart of this debate, is the question of security.

We are proud that 70 years ago this country made a big statement of our values when we established the National Health Service. It is, to this day, the most powerful expression of what we believe in as a society, the central idea that no-one – rich or poor, young or old – should have to worry about affording good healthcare.

But this year is also social care’s 70th birthday. The National Assistance Act that abolished the Poor Law and created many of the core elements of the modern social care system came into effect on the same day as the NHS Act.

The National Assistance Act established a related but different principle: that of shared responsibility for care. Whilst the State has always accepted – and continues to accept – its duty to provide decent care for those unable to afford it – notably for those born with a disability or developing a care and support need early in life – our system has also reflected the principle of personal responsibility for care by individuals and families.

And the principle of shared responsibility continues to be right and people should continue to expect to contribute to their care in the future as they prepare for later life – but we are clear that there has to be a partnership between the state and individuals.

But the way our current charging system operates is far from fair. This is particularly true for families faced with the randomness and unpredictability of care, and the punitive consequences that can come from developing certain conditions over others.

If you develop dementia and require long-term residential care, you are likely to have to use a significant chunk of your savings and the equity in your home to pay for that care. But if you require long-term treatment for cancer you won’t find anything like the same cost.

So people’s financial wellbeing in old age ends up defined less by their industry and service during their working lives, and more by the lottery of which illness they get. We therefore need a system that includes an element of risk-pooling and, as the Prime Minister promised in the election campaign, we will bring forward ideas as to how to do this alongside their potential costs in the Green Paper.

Conclusion

The Green Paper will be published before the summer and will be framed by thinking on the 7 principles that I have set out today:

quality and safety embedded in service provision

whole-person, integrated care with the NHS and social care systems operating as one

the highest possible control given to those receiving support
a valued workforce

better practical support for families and carers

a sustainable funding model for social care supported by a diverse, vibrant and stable market

greater security for all – for those born or developing a care need early in life and for those entering old age who do not know what their future care needs may be.

Innovation is going to be central to all of these principles: we will not succeed unless the changes we establish embrace the changes in technology and medicine that are profoundly reshaping our world.

By reforming the system in line with these principles everyone – whatever their age – can be confident in our care and support system. Confident that they will have control, confident that they will have quality care and confident that they will get the support they need from wider society.

Let me finish by quoting the words of Fauja Singh, who at a mere 100 years of age became the oldest person ever to complete a marathon: “Anything worth doing”, he said, “is going to be difficult.”

The path to a long-term settlement for social care, built around a strong social contract, has been equally long and arduous, and there will no doubt be further twists and turns.

But Britain has a proud pedigree in establishing one of the first comprehensive healthcare systems in the world. Our innate sense of decency, kindness and common humanity will also drive us to the right solution for social care as it has for health.

Below is the text of the statement made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 21 July 2016.

Today, I am laying before Parliament my annual assessment of the NHS commissioning board (known as NHS England) for 2015-16. I am also laying NHS England’s annual report and accounts for 2015-16 (HC311). Copies of both documents will be available from the Vote Office and the Printed Paper Office.

NHS England’s annual report and accounts includes a self-assessment of performance which describes an organisation that has experienced a year of both progress and challenge. NHS England continues to deliver high-quality care as it progresses with implementing the vision set out in the five year forward view delivering constancy of direction, consistency of leadership and effectiveness of delivery.

In response, my annual assessment welcomes the good progress that NHS England has made against many of its objectives including managing the commissioning system. Additionally it has continued to deliver the specialised services and primary care commissioning systems and improved the operation and management of the NHS. There does, however, remain much to do in order to achieve our agreed goals by 2020. In particular, I have drawn attention to the need to address year-round performance against the standards reflected within the NHS constitution, many of which have been routinely missed this year, as well as the need to make further progress on achieving parity of esteem between physical and mental health.

Although NHS England met its objective to deliver financial balance in the commissioning system this year, the provider sector remains financially challenged. To achieve its financial objective in 2016-17, NHS England must work with its system partners and the Department of Health to jointly deliver a balanced budget across the NHS as well as delivering its share of the productivity and efficiency savings identified in the NHS five year forward view.

Overall NHS England has made progress during 2015-16 but there remains much more to do. The extra real-terms investment of £8.4 billion agreed as part of the 2015 spending review is evidence of this Government’s continuing commitment to the NHS. My Department and I will continue to work with NHS England and its partners to ensure that this investment is used to build on the good work seen so far and to deliver an NHS that provides safe, compassionate and reliable care for those who need it while living within its means.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 19 May 2016.

Mr Speaker, for the last 3 years there have been repeated attempts to reform the junior doctors contract to support better patient care 7 days a week, culminating in a damaging industrial relations dispute that has lasted over 10 months.

I am pleased to inform the House that after 10 days of intensive discussion under the auspices of ACAS, the dispute was resolved yesterday with a historic agreement between the government, NHS Employers (acting on behalf of the employers of junior doctors) and the BMA that will modernise the contract making it better for both doctors and patients. The new contract meets all the government’s red lines for delivering a 7 day NHS and remains within the existing pay envelope. We will be publishing an equalities analysis of the new terms alongside publishing a revised contract at the end of the month. It will now be put to a ballot of the BMA membership next month with the support of its leader, the Chair of the Junior Doctors’ Committee of the BMA, Johann Malawana.

Mr Speaker, I would like to first of all express my thanks to the BMA for the leadership they have shown in returning to talks, negotiating in good faith and making an agreement possible. I would also like to put on record my thanks to Sir Brendan Barber, the Chairman of ACAS, for his excellent stewardship of the process, and to Sir David Dalton for his wisdom and insight in conducting the discussions on behalf of employers and the government both this time and earlier in the year.

Reforming an outdated contract

This agreement will facilitate the biggest changes to the junior doctors’ contract since 1999. It will allow the government to deliver a 7 day NHS, improve patient safety, support much-needed productivity improvements, as well as strengthening the morale and quality of life of junior doctors with a modern contract fit for a modern health service.

The contract inherited by this government had a number of features badly in need of reform, including:

– low levels of basic pay as a proportion of total income, making doctors rely too heavily on unpredictable unsocial hours supplements to boost their income

– automatic annual pay rises even when people take prolonged periods of leave away from the NHS

– an unfair banding system which triggers payment of premium rates to every team member even if only one person has worked the extra hours

– high premium rates payable for weekend work which make it difficult to roster staff in line with patient need

– risks to patient safety with doctors sometimes being required to work 7 full days or 7 full nights in a row without proper rest periods

Seven day NHS

This government has always been determined that our NHS should offer the safest, highest quality of care possible – which means a consistent standard of care for patients admitted across all 7 days of the week. So the new contract agreed yesterday makes the biggest set of changes to the junior doctors’ contract for 17 years including:

– establishing the principle that any doctor who works less than an average of one weekend day a month (Saturday or Sunday) should receive no additional premium pay compensated by an increase in basic pay of between 10 and 11%

– reducing the marginal cost of employing additional doctors at the weekend by about a third

– supporting all hospitals to meet the 4 clinical standards most important for reducing mortality rates for weekend admissions by establishing a new role for experienced junior doctors as ‘senior-clinical decision makers’ able to make expert assessments of vulnerable patients who may be admitted or staying in hospitals over weekends

– removing the disincentive to roster sufficient numbers of doctors at weekends by replacing an inflexible banding system with a fairer system that values weekend work by paying actual unsocial hours worked with more pay to those who work the most.

A better motivated workforce

The government also recognises that safer care for patients is more likely to be provided by well-motivated doctors who have sufficient rest between shifts and work in a family-friendly system. So the new contract and ACAS agreement will improve the wellbeing of our critical junior doctor workforce by:

– reducing the maximum hours a doctor can be asked to work in any one week from 91 to 72

– reducing the number of nights a doctor can be asked to work consecutively to 4 and reducing the number of long days a doctor can be asked to work to 5

– introducing a new post, a Guardian of Safe Working, in every trust to guard against doctors being asked to work excessive hours

– introducing a new catch up programme for doctors who take maternity leave or time off for other caring responsibilities

– establishing a review by Health Education England to consider how best to allow couples to apply to train in the same area and to

– offer training placements for those with caring responsibilities close to their home by giving pay protection to doctors who switch specialties because of caring responsibilities

– establishing a review to inform a new requirement on trusts to consider caring and other family responsibilities when designing rotas.

Taken together, these changes show both the government’s commitment to safe care for patients and the value we attach to the role of junior doctors. Whilst they do not remove every bugbear or frustration they will significantly improve flexibility and work life balance for doctors, leading we hope to improved retention rates, higher morale and better care for patients.

Reflections on industrial action

But whatever the progress made with today’s landmark changes, it will always be a matter of great regret that it was necessary to go through such disruptive industrial action to get there. We may welcome the destination but no one could have wanted the journey: so today I say to all junior doctors whatever our disagreements about the contract may have been, the government has heard and understood the wider frustrations that you feel about the way you are valued and treated in the NHS.

Our priority will always be the safety of patients but we also recognise that to deliver high quality care we need a well-motivated and happy junior doctor workforce. Putting a new, modern contract in place is not the end of the story in this respect. We will continue to engage constructively with you to try to resolve outstanding issues as we proceed on our journey to tackle head on the challenges the NHS faces and make it the safest, highest quality healthcare system anywhere in the world. Today’s agreement shows we can make common cause on that journey with a contract that is better for patients, better for doctors and better for the NHS and I commend it to the House.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 18 April 2016.

This House has been updated regularly on all developments relating to the junior doctors contract, and there has been no change whatsoever in the Government’s position since my statement to the House in February. I refer Members to my statement in Hansard on 11 February, and to answers to parliamentary questions from my ministerial colleagues on 3 March, which set out the position clearly. Nevertheless, I am happy to reiterate those statements to the hon. Lady.

The Government have been concerned for some time about higher mortality rates at weekends in our hospitals, which is one reason why we pledged a seven-day NHS in our manifesto. We have been discussing how to achieve that through contract reform with the British Medical Association for more than three years without success. In January, I asked Sir David Dalton, the highly respected chief executive of Salford Royal, to lead the negotiating team for the Government as a final attempt to resolve outstanding issues. He had some success, with agreement reached in 90% of areas.

However, despite having agreed in writing in November to negotiate on Saturday pay, and despite many concessions from the Government on this issue, the BMA went back on that agreement to negotiate, leading Sir David to conclude that

“there was no realistic prospect of a negotiated outcome.”

He therefore asked me to end the uncertainty for the service by proceeding with the introduction of a new contract without further delay. That is what I agreed to, and what we will be doing. It will start with those in foundation year 1 from this August, and proceed with a phased implementation for other trainees as their current contracts expire through rotation to other NHS organisations.

Let me be very clear: it has never been the Government’s plan to insist on changes to existing contracts. The plan was only to offer new contracts as people changed employer and progressed through training. This is something that the Secretary of State, with NHS organisations as employers, is entitled to do according even to the BMA’s own legal advice. NHS foundation trusts are technically able to determine pay and conditions for the staff they employ, but the reality within the NHS is that we have a strong tradition of collective bargaining, so in practice trusts opt to use national contracts. Health Education England has made it clear that a single national approach is essential to safeguard the delivery of medical training and that implementation of the national contract will be a key criterion in deciding its financial investment in training posts. As the Secretary of State is entitled to do, I have approved the terms of the national contract.

The Government have a mandate from the electorate to introduce a seven-day NHS, and there will be no retreat from reforms that save lives and improve patient care. Modern contracts for trainee doctors are an essential part of that programme, and it is a matter of great regret that obstructive behaviour from the BMA has made it impossible to achieve that through a negotiated outcome.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at Lancaster House in London on 3 March 2016.

Every year an estimated million patients die in hospitals across the world because of avoidable clinical mistakes.

It is difficult to confirm the exact number because of variability in reporting standards, but if it is of this scale it sits alongside hypertensive heart disease and road deaths as one of the top causes of death in the world today.

In the US they estimate it at up to 100,000 preventable deaths annually and in England the Hogan, Darzi and Black analysis says that 3.6% of hospital deaths have a 50% or more chance of being avoidable – that’s potentially 150 avoidable deaths every week. Holland and New Zealand make similar estimates.

So today is historic.

Distinguished guests, health ministers from across the world, Director General Chan from the World Health Organisation thank you for attending this first ever ministerial-level Global Patient Safety Summit. A special welcome to my friend and colleague the German Health Minister Hermann Grohe with whom I am jointly hosting the summit and who will organise a follow up summit in Berlin in a year’s time. And a warm thank you to the many people who have travelled long distances to be here as we aim to make a decisive step towards improving standards of safety in healthcare.

In 1990 a bright 24-year old medical school graduate started his first job in medicine. He was a pre-registration house officer looking forward to a glowing career in surgery.

In his first month he was attending to a 16-year old boy undergoing palliative chemotherapy. The boy needed two different injections, one intravenously and a second by lumber puncture into the spine.

The intravenous drug was highly toxic – indeed fatal – if administered to the spine. But it arrived on the ward in a nearly identical syringe to the other injection. Both syringes were handed to the young doctor for the lumber puncture procedure and both injected into the patient’s spine.

As soon as the doctor realised what had happened, frantic efforts were made to flush out the toxic drug from the boy’s spine. But it was to no avail and tragically he died a week later.

So what happened next?

You might think the most important priority would be to learn from what went wrong and make sure the mistake was never repeated. But instead the doctor was prosecuted and convicted for manslaughter. He and a colleague were given suspended jail terms.

In this case the convictions were eventually overturned at the Court of Appeal. But the real crime was missed: as the legal process rumbled on, exactly the same error was made in another NHS hospital and another patient died because our system was more interested in blaming than learning.

The blame culture doesn’t just create fear for doctors. It causes heartbreak for patients and their families as I discovered when I met the parents of 3-year old Jonnie Meek.

Jonnie tragically died unexpectedly in hospital in 2014. His parents found their grief at losing Jonnie compounded several times over by the immense difficulty in establishing what actually happened. An independent report found: ‘Two different [hospital] trusts… Both responded in the same closed, unhelpful manner…[Jonnie’s parents] on the outside, unable to find a way in to ask simple questions. [NHS employees] blocked by fear…expectation of blame lead[ing] to defensive behaviours.’

We are now working with Jonnie’s family to seek an order for a second inquest.

But it shouldn’t need an inquest to find out the truth. Instead we need to ask what is blocking the development of the supportive, learning culture we need to make our hospitals as safe as they should be.

Too much avoidable harm and death

In England we have made much progress in improving our safety culture following the Francis Report into the tragedy of what happened at Mid Staffs.

According to the Heath Foundation the proportion of patients being harmed in the NHS dropped by over a third (34%) in the last 3 years. MRSA bloodstream infections have fallen by over half in the last 5 years. We have introduced a new and much tougher peer-led inspection regime which has led to 27 hospitals being put into special measures, 11 of whom have now come out. The law has changed placing on all hospital trusts a statutory duty of candour to patients and their families when things go wrong. The government was elected on a firm commitment to make NHS care safer across all 7 days of the week and we are making good progress.

But today I want to talk about the profound culture change necessary if we are to complete this journey: the change from a blame culture to a learning culture.

A learning culture not a blame culture

In his book Black Box Thinking, Matthew Syed talks about how that same blame culture used to exist in the airline industry.

He tells the tragic story of United Airlines flight 173, where 10 people died in a crash that happened in December 1978. The pilot, Captain Malburn McBroom, was trying to rectify a potentially dangerous problem with the landing gear but failed to notice that the plane was dangerously low on fuel. When he was forced to crash land the plane, he did so with extraordinary skill saving the lives of over 150 passengers. But because of his mistake, he got tied up in a 7-year long court case, came close to suicide, lost his pilot’s licence, and ultimately died a broken man.

But that tragedy had a surprisingly positive ending.

Because it became the moment the airline industry realised that if it was going to reduce airline fatalities, it needed to change its culture. They realised that ‘human factors’, rather than technical or equipment failure had been at the heart of the problem. Anyone could have failed to notice low fuel levels when they were trying to fix the landing gear. Why didn’t other crew members spot the problem and speak out? The issue was not that particular person, but what could have happened to any person in the same situation.

As a result the airlines transformed their training programmes. They mandated reforms that required pilots to attend group sessions with engineers and attendants to discuss communication, teamwork and workload management. Captains were required to encourage feedback, and crew members were required to speak up boldly.

And the result? There were dramatic – and immediate – reductions in the number of airline fatalities. The number of deaths overall halved over 30 years – at the same time as air travel increased nine fold. 10 people died in the United 173 crash, but experts are unanimous that the learning that resulted has saved thousands more.

Healthcare is of course very different to aviation.

When someone dies in an airline accident you know there has been a mistake – whereas with over 1,000 deaths every year in the average hospital it is not always so clear. And while modern airplanes are undoubtedly highly complex, they are nowhere near as complex as the human body.

But the airline industry did change its culture. And so can we.

How? In my speech to the Kings Fund last June I talked of the 3 stages necessary.

Intelligent transparency

The first step is intelligent transparency.

Intelligent transparency leads to action – and that means we need to understand the scale of the problem not just nationally but where we actually work.

So following a request to NHS hospitals by Dr Mike Durkin, NHS National Director of Patient Safety, the NHS in England will this month become the first country in the world to publish estimates by every hospital trust of their own annual number of avoidable deaths. Methodologies vary, so the numbers cannot be compared, but it is a major step forward for every hospital trust to make their own estimate of avoidable mortality and be open about what they find.

What you can compare, however, is the quality of reporting culture. Just how easy is it to speak about things that have gone wrong? Do hospitals listen to doctors raising genuine concerns or do they punish them as we saw happened to Dr Raj Mattu and other whistleblowers? So we yesterday published a table that grades the openness and honesty of reporting cultures in our hospitals. Chief Inspector of Hospitals Sir Mike Richards and NHS Safety Director Mike Durkin have looked at a range of indicators including staff survey measures of how supported frontline staff feel if they raise safety concerns, whether staff feel able to contribute towards improvements at work, and how effectively a trust uses the national reporting and learning system. On the basis of these indicators every trust has been graded as having an outstanding or good reporting culture – or as requiring improvement.

Once we have validated both sets of data, the CQC will include them in a new annual report on the state of hospital quality which will be published from this year.

The world’s largest learning organisation

The second stage in changing culture is to use intelligent transparency to turn the NHS into what I have long wanted it to be: the world’s largest learning organisation.

There is of course a huge amount of learning that goes on every day in our NHS. One study found doctors take 158 clinical decisions every day and we should never diminish their efforts to extract every possible piece of learning from daily work.

The government too, has played its part by introducing the new CQC inspection regime; legislating for a statutory duty of candour; making progress – not always smoothly – towards a 7-day NHS; asking every trust to appoint independent freedom to speak up guardians so clinicians can relay concerns to someone other than their line manager; launching the Sign up to Safety campaign and recently the campaign to halve the number of stillbirths and neonatal deaths.

But if we really are to tackle potentially avoidable deaths, we need culture change from the inside as well as exhortation from the outside. A true learning culture must come from the heart.

And this means a fundamental rethink of our concept of accountability.

Time and time again when I responded on behalf of the government to tragedies at Mid Staffs, Morecambe Bay, Winterbourne View, Southern Health and other places I heard relatives who had suffered cry out in frustration that no one had been ‘held accountable.’

But to blame failures in care on doctors and nurses trying to do their best is to miss the point that bad mistakes can be made by good people. What is often overlooked is proper study of the environment and systems in which mistakes happen and to understand what went wrong and encouragement to spread any lessons learned. Accountability to future patients as well as to the person sitting in front of you.

The rush to blame may look decisive. It may seem like professionals are being held accountable. In fact, the opposite can happen. By pinning the blame on individuals, we sometimes duck the bigger challenge of identifying the problems that often lurk in complex systems and which are often the true cause of avoidable harm.

Organisational leadership is vital if we are to change this – and we can see world class organisations inside and outside healthcare have a very different approach. They have the boldness to probe more deeply, thus learning precious lessons. They see a medication error as an opportunity to make labelling clearer, a mistake in an operating theatre as a chance to improve teamwork and communication, just as airlines did after the crash of United 173.

Which is why we need a new mindset to permeate the entire ethos of the NHS, where blame is never the default option. Justice must never be denied if a professional is malevolent or grossly negligent. But the driving force must be the desire to improve care and reduce harm – fired by an insatiable curiosity to pursue improvement in every sphere of activity. This is what I mean by the world’s largest learning organisation.

And when we give patients an honest account of what happened alongside an apology, what is the impact? Countless academic studies have shown there is less litigation, less money spent on lawyers and more rapid closure, even when there have been the most terrible tragedies.

Resources

Some say that is all very well, but with hospitals in deficit what happens if you can’t afford to implement the lessons you learn about how to improve the standards of care?

Even after the significant rise in the NHS budget announced at the autumn statement, the resources to tackle these deep-rooted issues are finite. But as Sir Mike Richards and many others have pointed out, it is quite wrong to make out there is a choice between safe care or balanced budgets because the evidence shows that hospitals with better care usually have better balance sheets as well.

Of course there are times when safer care requires more resources, but unsafe care is even more expensive – in fact we know from the 2014 Frontier Economics report it costs the NHS up to £2.5 billion a year due to longer hospital stays, repeat visits and expensive litigation.

A compensation culture costs money – £1.4 billion of the NHS budget – but it also costs lives by creating a culture of defensive medicine which means avoidable harm remains stubbornly higher than it should be because we make it so hard for frontline clinicians to speak openly and honestly about how to learn from mistakes.

Next steps

That means a profound change in culture.

The recommendations from Sir Robert Francis’s Freedom to Speak Up review have not yet taken effect and there are still too many stories of whistleblowers being bullied or hounded out of their jobs.

We must go further.

Just as the Carter process announced last month will harness the power of transparency to improve our use of resources, so today I want to harness that same power to bring down the rate of avoidable deaths by turning the NHS into a true learning organisation.

Following the commitment I made to Parliament at the time of the Morecambe Bay investigation, we will from 1 April set up our first ever independent Healthcare Safety Investigation Branch. Modelled on the Air Accident Investigation Branch that has been so successful in the airline industry, it will undertake timely, no-blame investigations.

Harvard Professor Dr. Lucian Leape has said that ‘the single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes’. So just as the Air Accident Investigation Branch gives a legal ‘safe space’ which protects those cooperating with its inquiries, we will bring forward measures to give similar legal protection to those who speak honestly to HSIB investigators so that the principle of a ‘safe space’ is at the heart of what the Healthcare Safety Investigation Branch does.

Affected patients or their families will need to be involved as part of the safe space protection. And while the findings of investigations will be made public, the details will not be disclosable without a court order or an overriding public interest, with courts being required to take note of the impact on safety of any disclosures they order. This legal change will help start a new era of openness in the NHS’s response to tragic mistakes: families will get the full truth faster; doctors will get support and protection to speak out; and the NHS as a whole will become much better at learning when things go wrong. What patients and families who suffer want more than anything is a guarantee that no-one else will have to re-live their agony. This new legal protection will help us promise them ‘never again’.

I have asked the new organisation to consider focusing initially on maternity and neonatal mortality investigations to give us time to examine and understand its effect before rolling it out to other areas of clinical activity. It is intended to make a major contribution to our new ambition to halve still births, neonatal injury and death and maternal death rates where we still rank unfavourably to many other high income countries.

But it will not be limited to maternity. And as we create the legally safe space for learning that has long benefited the airline industry, we will in the words of NHS National Director of Patient Safety Dr Mike Durkin be taking ’the biggest single step in a generation to foster a positive learning culture that will support NHS hospitals to become safer for patients.’

I can also announce some other important steps to help foster a true learning culture.

The GMC and NMC guidance is now clear – where doctors, nurses or midwives admit what has gone wrong and apologise, the professional tribunal should give them credit for that, just as failing to do so is likely to incur a serious sanction. As in the airlines, doctors, nurses and other health professionals need to know that they will get credit for being open and honest and the government is committed to legal reform that would allow professional regulators more flexibility to resolve cases without stressful tribunals, where professionals have admitted their mistake.

NHS Improvement will ask for this to be reflected in all trust disciplinary procedures and ask all trusts to publish a Charter for Openness and Transparency so staff can have clear expectations of how they will be treated if they witness clinical errors.

From April 2018, we will be introducing the system of medical examiners recommended in the Francis Report. This will bring a profound change in our ability to learn from unexpected or avoidable deaths, with every death either investigated by a coroner or scrutinised by a second independent doctor. Grieving relatives will be at the heart of the process and will have the chance to flag any concerns about the quality of care and cause of death with the independent clinician.

NHS England is working with the Royal College of Physicians to develop and roll-out across the NHS a standardised method for reviewing the records of patients who have died in hospital.

The objective of these changes is to make it unnecessary for anyone ever to feel they have to ‘blow the whistle’ on poor care. But as we make this transition, it is vital that we offer whistleblowers protection wherever they are in the NHS so if we discover that there are any gaps in the law protecting whistleblowers, we will act to close them.

Conclusion

Karl Popper said true ignorance is not the absence of knowledge but the refusal to acquire it. So now is the time to use the power of intelligent transparency to make sure that we really do turn our healthcare systems into learning organisations – and offer our patients the the safe high quality they deserve.

Below is the text of the statement made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 9 March 2016.

With permission, Mr Speaker, I would like to update the House on the steps the government is taking to build a safer 7-day NHS. We are proud of the NHS and what it stands for and proud of the record numbers of doctors and nurses working for the NHS under this government. But with that pride in the NHS comes a simple ambition: that our NHS should offer the safest, highest quality care anywhere in the world. Today we are taking some important steps to make that possible.

In December, following problems at Southern Health, I updated the House about the improvements we need to make in reporting and learning from mistakes. NHS professionals deliver excellent care to around 650,000 patients every day, but we are determined to support them to improve still further the quality of the care we offer. So this government has introduced a tough and transparent new inspection regime for hospitals, a new legal duty of candour to patients and families who suffer harm and a major initiative to save lives lost from sepsis. As a result of these measures, according to the Health Foundation, the proportion of people suffering from the major causes of preventable harm has dropped by a third in the last 3 years.

But still we make too many mistakes. Twice a week in the NHS we operate on the wrong part of someone’s body and twice a week we wrongly leave a foreign object in someone’s body. The pioneering work of Helen Hogan, Nick Black and Ara Darzi has estimated that 3.6% of hospital deaths have a 50% or more chance of being avoidable, which equates to over 150 deaths every week.

We should remember that, despite this, our standards of safety still compare well to many other countries. But I want England to lead the world in offering the highest possible standards of safety in healthcare so today I am welcoming to London health ministers and healthcare safety experts from around the world for the first ever ministerial-level summit on patient safety.

I am co-hosting the summit with the German Health Minister, Hermann Grohe, who will host a follow-up summit in Berlin next year. Other guests will include Dr Margaret Chan, Director General of the World Health Organisation, Dr Gary Kaplan, Chief Executive of the renowned Virginia Mason Hospital in Seattle, Professor Don Berwick and Sir Robert Francis QC.

In the end, Mr Speaker, no change is permanent without real and lasting culture change. And that culture change needs to be about 2 things: openness and transparency about where problems exist, and a true learning culture to put them right.

With the new inspection regime for hospitals, GP surgeries and care homes, as well as a raft of new information now published on My NHS, we have made much progress on transparency. But as Sir Robert Francis’s Freedom to Speak Up report told us, it is still too hard for doctors, nurses and other frontline staff to raise concerns in a supportive environment.

Other industries – in particular the airline and nuclear industries – have learned the importance of developing a learning culture and not a blame culture if safety is to be improved. But too often the fear of litigation or professional consequences inhibits the openness and transparency we need if we are to learn from mistakes.

So following the commitment I made to Parliament at the time of the Morecambe Bay investigation, we will from 1 April 2016 set up our first ever independent Healthcare Safety Investigation Branch. Modelled on the Air Accident Investigation Branch that has been so successful in reducing fatalities in the airline industry, it will undertake timely, no-blame investigations.

As with the Air Accident Investigation Branch, I can today announce that we will bring forward measures to give legal protection to those who speak honestly to Healthcare Safety Investigation Branch investigators.

The results of such investigations will be shared with patients and families, who will therefore get to the truth of what happened much more quickly. However, unlike at present they will not normally be able to be used in litigation or disciplinary proceedings, for which the normal processes and rules will apply. The ‘safe space’ they create will therefore reduce the defensive culture patients and families too often find meaning mean the NHS can learn and disseminate any lessons much more quickly so that we avoid repeating any mistakes.

My intention is to use this reform to encourage much more openness in the way the NHS responds to tragic mistakes: families will get the full truth faster; doctors will get support and protection to speak out; and the NHS as a whole will become much better at learning when things go wrong. What patients and families who suffer want more than anything is a guarantee that no-one else will have to re-live their agony. This new legal protection will help us promise them ‘never again’.

Fundamental to this is getting a strong reporting culture in hospitals where mistakes are acknowledged and not swept under the carpet. So today NHS Improvement has also published a Learning from Mistakes ranking of NHS Trusts. This draws on data from the staff survey and safety incident reporting data to show which trusts have the best reporting culture and which ones need to be better at supporting staff who wish to raise concerns. This will be updated every year in a new Care Quality Commission (CQC) State of Hospital Quality report that will also contain trusts’ own annual estimates of their avoidable mortality rates and have a strong focus on learning and improvement.

Furthermore, the General Medical Council and the Nursing and Midwifery Council guidance is now clear – that where doctors, nurses or midwives admit what has gone wrong and apologise, the professional tribunal should give them credit for that, just as failing to do so is likely to incur a serious sanction. The government remains committed to further reform that would allow professional regulators more flexibility to resolve cases without stressful tribunals.

This change in culture must also extend to trust disciplinary procedures. So NHS Improvement will ask for a commitment to openness and learning to be reflected in all trust disciplinary procedures and ask all trusts to publish a Charter for Openness and Transparency so staff can have clear expectations of how they will be treated if they report clinical errors.

Finally, from April 2018, the government will introduce the system of medical examiners recommended in the Francis Report. This will bring a profound change in our ability to learn from unexpected or avoidable deaths, with every death either investigated by a coroner or scrutinised by a second independent doctor. Grieving relatives will be at the heart of the process and will have the chance to flag any concerns about the quality of care and cause of death with an independent clinician, meaning we get to the bottom of any systemic failures in care much more quickly.

Taken together, I want these measures to help the NHS to become the world’s largest learning organisation as part of our determination to offer the safest, highest quality standards of care.

An NHS that learns from mistakes. One of the largest organisations in the world becoming the world’s largest learning organisation – that is how we will offer the safest, highest quality standards of care in the NHS and I commend this statement to the House.