John Hutton – 2005 Speech at NHSFT Forum

johnhutton

Below is the text of the speech made by John Hutton, the then Minister of State for Health on 11 January 2005.

Good afternoon.

I’m delighted to take advantage this opportunity to say a few words to you today because it is very important we have an open and effective dialogue over the future of NHS Foundation Trusts. But first I’d like to say 1 or 2 words about what it is we’re trying to do – because NHS Foundation Trusts are very much a means to an end.

Establishing NHS Foundation Trusts was all about re-invigorating the delivery of NHS services by introducing new freedoms and new rewards for good performance. As far as the Department and Government are concerned we remain absolutely committed to these objectives and they will continue to guide our thinking about the next steps in the process of establishing new waves of NHS Foundation Trusts.

For the vast majority of the people who live in our country, the NHS remains central to our national identity and national sense of purpose. It stands for a set of values and principles our society continues to hold dear. Our task in Government is, and remains, to ensure the NHS delivers its services in a way that will allow support for these core values to be maintained and strengthened. That is what NHS Foundation Trusts are all about. They are designed to sustain not to supplant these essential principles of equity and universality.

If we are going to succeed in doing this we cannot afford to stand still, because the challenges the NHS faces today are different from those of fifty, twenty or even ten years ago. Our national expectations, both as consumers and taxpayers are higher today then they’ve ever been before. Rightly so. We know how important good health is to the quality of our lives and those of our families. We expect a more personal service. We want our healthcare to be provided at a time and place that suits us best. And we want more choice over what sort of service we can use.

That sort of healthcare service has of course always been available to those who could afford it. For most of our fellow citizens however, it has sadly always been out of reach because this wasn’t the service that the NHS provided. This is what has to change. Making this change is I think the biggest challenge facing the NHS today. People want the NHS to succeed in rising to this challenge, because we know it is the fairest and most efficient way to organise and deliver the highest quality healthcare to the largest number of people.

NHS principles stand head and shoulders above private insurance or voucher based alternatives in terms of equity of access. Every piece of research, both national and international, confirms this. The task facing all of us today is how to convert the principle of equity of access that rightly underpin the NHS into a modern delivery mechanism that guarantees patients the kind of service they have come to associate exclusively with the private sector. To succeed in this historic challenge we need two things. Investment and reform.

We need significant and sustained investment so that we can make good decades of under funding which has left the NHS short of the necessary capacity and the infrastructure to meet the needs of the people we seek to serve.

The extra investment is already making a very big difference to the NHS. Waiting times are falling quickly in every part of the country. The quality of the care we provide is improving too. Fewer people with cancer and heart disease are dying from their illnesses. New treatments and drugs are being made available more quickly. More doctors and nurses than ever before are helping us to realise these improvements in the standards of care that we provide. We cannot claim that every single problem facing the NHS has been solved in the last seven years. That’s palpably not the case. But we are now heading firmly in the right direction.

But one thing is clear. Although essential, this investment on its own would never have been enough to complete this process of transition from the old NHS to the new. That’s why the way we deliver our services needs to change as well.

We have set out the changes we believe are necessary in order to help the NHS become the service we all want it to be. Led by greater choice for NHS patients, resourced through payment by results and supported through the largest investment in new information technology underway in any healthcare system anywhere in the world, the NHS stands on the threshold of the most radical reforms since it was created over fifty years ago.

NHS Foundation Trusts and the work of MONITOR are at the forefront of this programme of change. That is why the Government remains absolutely committed to the principles that underpin NHS Foundation Trust status and to making these reforms a success.

To make these reforms work in the acute sector, we need greater operational and financial freedom for providers, less bureaucracy and red tape, stronger local accountability, and greater rewards and incentives to raise the standards of patient care. In all of these key areas, NHS Foundation Trusts are quite literally leading the way. All of you can point to real improvements and benefits to your patients that Foundation status has helped deliver. All of you have helped the NHS rise to the challenges it faces today. Less than a year into these reforms, I believe the progress you have made has been truly impressive.

It is clearly right however that we should look carefully at how we take forward this policy over the next few years. Firstly, we have to learn from the experience of the first wave. In particular, we need to reflect carefully on the support the Department provides applicants for NHS Foundation Trust status to see what more we can do to help Trusts prepare for the new financial regime under which they will operate.

Secondly, we all need to consider very carefully the experience of the first wave of NHS Foundation Trusts in operating the new Payment by Results system in order to make sure the wider NHS can benefit from the new incentive and reward systems. I think this is particularly true in the area of emergency care and outpatient activity.

Thirdly, we need to be mindful of the need to keep bureaucracy and red-tape to an absolute minimum so that hospitals can focus on the job at hand – treating patients and raising standards of care. This must be a shared priority for all of us. I was particularly glad last week that we were able to announce that NHS Foundation Trusts no longer need to inform the Department of Health every time there is a false fire alarm. I’m sure there is more that we can do on this front.

Fourthly, we need to maintain a strong focus on making the new governance arrangements work as they were intended by strengthening the new links that exist between hospitals and their local communities. I think we’ve got to ensure that this new form of public ownership adds real value to the NHS – strengthening the concepts of local accountability and public engagement.

And finally we will need to consider the report of the Healthcare Commission into how the new freedoms for NHS Foundation Trusts are working in practice.

So there is a full agenda in front of us. For our part, we are fully committed to working with individual NHS Foundation Trusts, with the FT Network, with MONITOR and the wider NHS to make a success of these reforms and a success of NHS Foundation Trust status. That is why we remain open to new ideas and suggestions from all of you about how foundation status can lead to a more dynamic, flexible, entrepreneurial and higher quality NHS.

I want to finish with this observation. At the beginning of this reform process two years ago, what mattered most was what Ministers said about NHS Foundation Trusts. Now what matters most is what you do with the new freedoms that you have – how you use them to improve the quality and convenience of the care you provide to your patients.

Thank you.Good afternoon.

John Hutton -2004 Speech on Practice Based Commissioning

johnhutton

Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 7 December 2004.

Can I first of all thank the HSJ for giving me the opportunity of saying a few words at this very important gathering.

This is a decisive moment for the future of primary care in the NHS. Last year we saw agreement on the new contracts for GPs and the first tranche of new investment to go in alongside it. Next year we will see the introduction of the new practice based commissioning arrangements. Both of these changes have the potential to fundamentally change the quality, capability and capacity of primary care services. We need to take full advantage of these opportunities if we are to maximise the benefits of both. We need to do this for one very obvious reason.

The NHS was built on the foundations of primary care and primary care remains central to its future. Nearly all of our patients begin and end their treatment in a GPs surgery. Primary care continues to enjoy the highest satisfaction rates of any part of the National Health Service. It has a proud record in public health and health promotion. And despite all of its detractors, NHS primary care is still the envy of every other developed health care system and a model admired right across the world. If primary care is the cornerstone of the NHS then it is clear that the ambitions we have for the NHS can never be fully realised unless primary care has the tools to do its job properly.

But I believe we have every reason to be positive and optimistic about what lies ahead for both primary care and the NHS.

There are more GPs and nurses working in primary care than at any time in the history of the NHS. More doctors than ever before want to work in general practice. As a result, people can see their GPs more quickly and there are more services available to patients. Many GP surgeries have been improved and modernised – creating a better environment in which both to work and to treat patients. And there is a steady increase in resources going in to primary care. Helping to build up capacity and capability even further.

So we’ve come a long way. But clearly not everything is perfect. Not every part of primary care in our country has seen all of these improvements. The pressures are still there and they are experienced every day by hundreds of dedicated staff and thousands of increasingly frustrated patients. So it is not my argument today that every problem in primary care has been solved. We all know that isn’t true. Nor am I saying that primary care cannot improve further still, because we all know that it can. My argument today is that primary care has an extraordinary opportunity to build for the future. To play a leading role in shaping our definition of healthcare. To make Britain a healthier place to live for me the most important thing is the health of the poorest of all.

If we are going to take advantage of these opportunities there needs to be further significant investment and change in primary care. Not change for changes sake. But reform with a very clear purpose. To strengthen primary care and to improve the service it provides helping, in the process, the NHS to become the service we all want it to be.

Advances in technology and in our understanding of illness and disease together with an expanded workforce and greater resources will allow us to provide more services to a higher quality. So in the future more surgery, testing and diagnostics will be performed in primary care settings.

GPs with a special interest will take on new roles that have, until now, always been the exclusive preserve of hospital consultants – particularly in the area of chronic long term illness. Nurses and other health care professionals working in primary care will similarly see their responsibilities expand as they enter into new partnerships with GPs to deliver GMS and PMS.

New contractual frameworks will, for the first time, allow both for improvements in the quality of services to be properly rewarded for the first time as well as encourage new providers to enter primary care and help deliver a wider range of NHS services. Expanding choice as well as accessibility for patients.

The introduction of new information technology applications in primary care through the National Programme I hope too will herald further improvements to the quality, safety and convenience of the service we provide to the public.

All of these changes are designed to improve the service available to patients in primary care and are going to be backed up higher investment in primary care – up by a third over the next few years. And who better to lead this process of change than our family doctors and our primary care staff who have always been at the forefront of innovation in the NHS.

That is why I believe the engagement and involvement of front line professionals themselves is going to be essential to the success of these reforms.

Thousands of doctors and nurses are currently engaged in designing new ways of working and are hoping therefore to reshape the boundaries between primary and secondary care.

I want this to be the norm everywhere in England. I want GPs and their practice staff to be properly enabled and encouraged to fashion services around the needs of patients. Where we do look critically at all of the care pathways patients follow to ensure we offer the best possible configuration of expertise and resource.

To make this happen, I don’t think we need another re-organisation. But we will require a new balance of responsibilities in primary care, with new powers for general practices to work creatively with their local NHS partners in taking the key decisions that affect the delivery of frontline services.

We set out in July our plans for practice led commissioning. Next week we will publish the final guidance. There won’t be any major changes. From next April, every practice will have the right to hold a practice level commissioning budget. From elective care to prescribing, from chronic care to diagnostic screening, practices will be better able I think to help determine the future shape of the NHS.

There will be no new targets. No one will be forced to do anything they don’t want or choose to do. Instead, we will set out what practices are entitled to receive as a budget and how any disputes about the budget can be easily resolved. We will set out the ground rules about how any savings can be re-deployed into developing better services. And we will highlight many of the local success stories from around the country where practice led commissioning is already making a major contribution to the work of our NHS.

Within this framework, people will be free to determine their own pace of travel. They will be free to develop their own local preferences. They will be free to do it their own way. Because here there is no one size fits all model and therefore we will not be imposing one.

So this will be a bottom-up process. Led by GPs and their practice staff and working alongside PCTs and NHS Trusts to deliver the best possible services that we can provide. We want to see local innovation resulting in flexible high quality services for patients. And, if innovation leads to money being freed up, which I believe it will, then it will be ploughed back into patient care to further improve the services that patients receive.

We have always been clear about the need to fully involve GPs and practice staff in local decision making in the NHS. In our very first White Paper on the NHS in 1998, we made clear that we wanted to:

“Extend to all patients the benefits, but not the disadvantages of GP fundholding”

That is what practice based commissioning is all about. It is not a return to the fundholding arrangements of the past.

Unlike fundholding, there will be no extra resources going to those practices who take up PBC. There will be a level playing field for all practices whether they want to take advantage of PBC or not. No patient will be unfairly disadvantaged if their practice decides not to take up these new opportunities to have more say over how local services are designed. That wasn’t true under the policy of fundholding.

Secondly, PBC, unlike fundholding, will not usher in a huge expansion in bureaucracy as PCTs will still retain legal responsible for the contracting process.

And finally, there will be no return to the situation under fundholding where it frequently came down to which hospital could provide a service at the lowest possible price. The single national tariff will prevent this from arising. PBC will instead focus on quality and efficiency. This will put the interests of patients first. As it should be.

So we remain clear that it was right to end fundholding because it unfairly discriminated against the patients in those practices who chose not to take it up and because it spawned a giant bureaucracy. So we won’t be repeating these mistakes with PBC.

But clearly in return for the significant new freedoms that PBC will bring I do believe that it is fair and reasonable for PCTs to expect that primary care services will operate to the appropriate level of customer service and convenience. For example, patients should be able to take advantage of electronic booking systems that connect GP surgeries to hospital admission systems. And patients should also be guaranteed prompt and fast access to GPs and their practice staff.

There will also be effective safeguards to ensure value for money and the proper use of public funds. Practices will have the responsibility of balancing their budget over three years and PCTs will have the right to intervene if public money is being used inappropriately. In balancing rights and responsibilities, we want to encourage PCTs and practices to work in a mature partnership to ensure the best outcomes for their patients.

We are not promoting Practice Based Commissioning at the expense of commissioning at a locality level by groups of practices. For the correct size for commissioning care varies for different services.

And we should aim high. I hope that all practices will be involved in Practice Based Commissioning by 2008. Within that context, people can decide their own pace of change. We will actively support those practices and PCTs who want to take advantage of the possibilities that practice led commissioning provides. Next year, we will be offering support to the NHS in the form of further technical guidance and IT support, which I think will be essential. This will give practices the tools they need in order to take the fullest advantage of these new opportunities. The rest will be down to you. You will write the next chapter in the history of NHS primary care. That is how it should be, because there is no one better placed to do that than Britain’s family doctors.

The ultimate test of any new policy must be what benefits it brings for patients. I believe Practice Based Commissioning will be particularly advantageous for people with long-term conditions, allowing their doctors to commission integrated care that ensures holistic treatment of a condition. Diversity of provision and more use of primary care should also reduce waiting times. In North Bradford PCT, which has been using Practice Based Commissioning for 4 years, waiting times are well below six months. And Practice Based Commissioning will give GPs and their patients greater choice in how services are provided and should lead to more varied and more local services. For instance, East Devon PCT has used Practice Based Commissioning to reduce reliance on secondary care. Patients that would have gone to the Royal Devon & Exeter Hospital for Ear Nose and Throat complaints are now being treated in a primary care setting by practitioners with special interests.

These are a just a few examples of the benefits that Practice Based Commissioning offers. It will be for those who work in the NHS to explore the full potential.

Practice Based Commissioning is part of a journey to improve the NHS and make it the service we all want it to be. Focused absolutely on the needs of patients. On managing referrals into secondary care efficiently and effectively. On providing services in the most appropriate setting possible and as close to the patient as we can. That journey is not over yet. We still have a great deal to do. But even our most sternest critics would, I think, be prepared to acknowledge that there are now real and tangible signs of progress right across the country. Shorter waiting times. Reduced mortality from cancer and coronary heart disease. Newer hospitals and better GP premises. Faster access to the latest drugs, treatments and equipment that can help us improve our ability to diagnose and cure our patients. This is down to the hard work of people like you in the NHS.

So I want to conclude my remarks by expressing my own appreciation for your commitment to the NHS and for the values it stands for. Those values have never been more relevant to our society than they are today.

Our challenge is simple. It is to make these values meet the aspirations of the British people for the best possible healthcare that money can buy. Work with us to meet those aspirations. Help us to make the NHS the service we know it can be.

John Hutton – 2004 Speech on Alternative Provider Medical Services

johnhutton

Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 23 November 2004.

Can I first of all thank the NHS Confederation for asking me to say a few words this morning at this very timely event. It’s important we have the opportunity to talk about the future of primary care, to shape and mould it. It’s been the cornerstone of the NHS for fifty years. And will continue to remain so for the next fifty years. The boundaries between primary and secondary care going to shift. We are going to see new and different services being provided in primary care settings and this is all to the good.

Primary care must never be seen simply as a set of organisational structures. Like the NHS itself, it is instead a set of values that reflect a particular concept of care. It can be delivered by different types of providers – some in the public sector, some in the private sector. What matters is the quality of care being provided rather than who is commissioned to provide it. It is the sense of care being designed around the needs of the individual in settings that are convenient and accessible that really matters most to patients. Those characteristics should be the hallmarks of modern Primary Care services. I think it is in this sense that APMS can play an important and distinctive role in this in the future.

So we are on a journey. Services are going to change. The boundary between primary and secondary care is going to shift. And not before time.

If we are going to take advantage of these opportunities there needs to be further significant investment and change in primary care. Not change for changes sake because we don’t want to do that. But reform with a very clear purpose. To strengthen primary care and to improve the service it provides helping, in the process, the NHS to become the service we all want it to be.

Advances in technology and in our understanding of illness and disease together with an expanded workforce and greater resources will allow us to provide more services to a higher quality. So in the future more surgery, testing and diagnostics will be performed in primary care settings. GPs will have more direct access to diagnostics. Health professionals like physiotherapists will be taking more direct referrals from GPs and more self referrals from patients. We should be looking to use LIFT schemes to help build up a new infrastructure in primary care capable of accommodating this shift from hospital to community based models. Bringing our services closer to where people live and work.

GPs with a special interest will take on new roles that have, until now, always been the exclusive preserve of hospital consultants – particularly in the area of chronic long term illness. Nurses and other health care professionals working in primary care will similarly see their responsibilities expand as they enter into new partnerships with GPs to deliver GMS and PMS.

If this process of change is going to be managed properly we need to get the basics right.

Firstly, we need to get additional resources into primary care and they need to get to the right part of the system. It is for these reasons that investment in primary care is set to rise by a third over the next two years with more to come in future years. It is for PCTs to use these resources effectively. The best way to do this is to fully involve primary care professionals in the decision making process.

Secondly, we will need a range of flexible contracting mechanisms so that we can tailor local services to meet the needs of local people. The new primary care contracts – GMS and PMS – will help us to focus on quality and convenience. But I do think it is absolutely right that PCTs should have other routes available to them in order to ensure that local needs are being properly met. That is why APMS is so important.

APMS allows PCTs to contract with commercial, voluntary and mutual providers, with GMS and PMS practices, and with NHS Trusts, including Foundation Trusts for primary medical services. APMS can be used for essential, additional, enhanced and Out of Hours services. Overall, because APMS embodies minimal – although important – statutory requirements, it gives PCTs considerable discretion to develop different ways of improving primary care capacity and shaping service delivery. Possible examples include:

– Improving access in areas with GP recruitment and retention difficulties

– Providing services where GMS and PMS practices opt-out

– Commissioning services for particular populations

– Developing greenfield or brownfield sites

– Provision of out-of-hours services

For our part in the Department, we have deliberately kept the requirements for APMS contracts to a minimum so that it will remain a flexible instrument that can be adapted to meet local circumstances. It will stay that way. It is not to be strangled by red-tape at birth.

APMS will, I hope, be seen as a powerful tool to level change and improvements in primary care services. Our job at the centre is to support PCTs, who are working to secure these ends: helping the NHS become the service we all want it to be.

John Hutton – 2004 Speech at the Nurse of the Year Awards

johnhutton

Below is the text of the speech made by John Hutton, the Minister of State for Health, on 2 November 2004.

It’s a tremendous honour to have been asked to present this year’s Nursing Standard Awards. I’m absolutely delighted to be here this evening.

For over 150 years, nursing has been a profession with high standards, a clear ethos and a strong sense of public service. It’s not surprising therefore that nurses are amongst the most respected of all of our caring professions. Respected just as much for the care you provide to the sick and to the injured as for your compassion and humanity, often in the face of personal tragedy and distress. There will be very few people in this room tonight, in our country, whose lives haven’t been touched by the comfort and reassurance that nurses provide, every hour of the day, every day of the year.

It is an extraordinary job that you do.

And the role of nursing is central to the delivery of high quality care to patients. So our national health service must always look to strengthen this role and help make nursing an attractive and rewarding career. As part of this process we need to highlight the achievement and contribution that nurses make to the work of the NHS and to work with the profession in planning for the future – for what lies ahead of the profession. Because it’s the future of nursing as a profession, not what might have happened to it in the past, that is probably at the forefront of all of our minds this evening.

And I do believe that the future for the profession is a hugely bright one. Of course we haven’t solved every problem. There are still too few nurses working in the NHS and the pressure this generates is experienced every day by nurses and patients up and down the country – we all know this. And we do need to do more to break through the artificial demarcations that still limit the contributions that nurses can make. In our hospitals and in primary care too. I accept that.

But neither is it true that no progress has been made in any of these areas. There are more nurses than ever before working in the NHS – both full time and part time and we are able to do more in ensuring access to decent childcare support.

We are succeeding in attracting more of those who have left the profession to come back to nursing.

There are more nurses in training than ever before.

We have hundreds of nurse consultants running their own clinics and treating their own patients. Not enough, but a good start.

Thousands of nurses are now able to prescribe drugs – a task which in the past, had always been the exclusive preserve of doctors.

And nurses are delivering care in over 50 NHS walk in Centres and in NHS Direct.

And in primary care, nurses are now employing doctors. We have come a very long way indeed. But there is more still to do.

But I believe, and I hope people in this room do too, that if we are going to lay the foundations for a successful future for the profession we have to get the basics right.

Agenda for Change, negotiated by all of the NHS trade unions and supported by the RCN is a huge step forward for nursing. No more artificial barriers to how far a nurse can progress. Nurse consultants earning the equivalent of senior doctors. Parity between nurses and teachers in terms of career salaries. And a proper acceptance that if a nurse takes on new roles and responsibilities then he or she will be properly rewarded for doing so. We will continue to work closely with the RCN on making Agenda for Change the beginning of a new deal for nurses. For Agenda for Change to succeed partnership at every level is going to be essential. The RCN had asked for more resources to help meet the backfill costs of staff representatives who are helping to implement Agenda for Change. Last month, I was pleased to do just that – an extra £30 million to help Trusts meet these additional costs. So I am grateful to the RCN for the leadership it is showing.

But it’s not just nurses who will benefit from these reforms. Patients will benefit too. Agenda for Change will help us recruit more nurses into the profession. It will help us to retain them for longer as well, and so improving the continuity of care to patients. Helping the NHS to become the service we all want it to be.

We need to do more I accept to reduce the drop out rate from nurse training courses and also to improve the career prospects for nurse educators in college. Attrition rates of 15% are simply not good enough. We need to reward those colleges that do more to keep attrition rates as low as possible. And we need to look carefully at whether we are providing the right financial support to student nurses because ensuring that nursing remains a popular career choice for young people is absolutely essential for the future success of the profession as a whole.

In all of these areas we want to work constructively with the profession. We want to make more progress in all of those areas where we know there is still more work to be done. And we would like to do this, as I said, in a partnership with nurses themselves so that the advances we are able to make are sustainable and that we focus on the right priorities. And we will always listen with respect to the profession because no one understands better than nurses themselves what isn’t right and what isn’t working.

So you can help us to get it right.

But tonight we are also focusing on what we know is already right about nursing.

We are here to celebrate the achievements of some truly outstanding nurses. Nurses from all over the country whose professionalism and service to others has been rightly identified as being of the highest possible professional standard.

You have done an absolutely brilliant job. I want to congratulate each of you for winning these very special awards tonight. The decision to make these awards has been made by other nurses. I don’t think there can be any higher praise than that.

We can now move on to the award ceremony itself. Thank you for listening. And thank you once again for everything you do for the NHS and its patients.

John Hutton – 2004 Speech to NHS Alliance Conference

johnhutton

Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 20 October 2004.

I’d like to start by thanking the NHS Alliance for giving me this opportunity to say a few words at your annual conference this morning. The NHS Alliance continues to play a very important role in the national debate over the future of the NHS. We share common ground over the values the NHS should continue to espouse. And we agree that the NHS can never afford to stand still – to rest on its laurels. We all know there is more we need to do if the NHS is to become the service we all want it to be. So the dialogue between us should continue because the process of change has not come to an end. For our part, we want the debate on the long-term direction of travel for the NHS to be informed by the views and opinions of those working on the frontline. That is why we value your contribution and your opinions.

And the future of primary care remains central to the future of the NHS.

Nearly all of our patients begin and end their treatment in a GPs surgery. The relationships we all forge with our GPs and other healthcare professionals working in the community form a re-assuring presence in the lives of each and everyone of us. Primary care has a proud record in public health and health promotion. And despite what people say, NHS primary care is still the envy of every other developed health care system and a model respected right across the world.

All of this adds up to an outstanding record of achievement for primary care in the NHS over the last fifty years. But we all know that primary care can do more provided the resources are in the right place and that we encourage primary care professionals to have more say over the shape and design of local services. Because primary care must never be seen simply as a set of organisational structures. Like the NHS itself, it is instead a set of values that reflect a particular concept of care. It can be delivered by different types of providers – some in the public sector, some in the private sector. What matters is the quality of care being provided rather than who is providing it. It is the sense of care being designed around the needs of the individual in settings that are convenient and accessible that really matters most to patients. These can and should be the hallmarks of modern Primary Care services

So we are on a journey. Services are going to change. The boundary between primary and secondary care is going to shift. And not before time.

These changes will represent a significant challenge to the NHS as a whole and to Primary Care Trusts in particular. Every member of staff needs to be fully engaged in this process of change because they will all be affected by them. So the nature and purpose of these changes will need to be spelt out clearly in every part of the service. Patients and the public will need to be involved too. And our resources will need to be put to the best possible use. So I am not going to minimise the scale or the importance of the work that lies ahead of us. But I believe we have every reason to be positive and optimistic about the future of primary care in our country because we have a solid platform on which to build.

There are more GPs and nurses working in primary care than at any time in the history of the NHS. More doctors than ever before want to work in general practice. As a result, people can see their GPs more quickly and there are more services available to patients. Many GP surgeries have been improved and modernised – creating a better environment in which both to work and to treat patients. And there is a steady increase in resources going in to primary care. Helping to build up capacity and capability even further.

So we’ve come a long way. But clearly not everything is perfect. Not every part of primary care in our country has seen all of the benefits of these improvements. The pressures are still there and they are experienced every day by hundreds of dedicated staff and thousands of frustrated patients. Not everyone working in primary care feels that their views are heard and listened to.

So it is not my argument today that every problem in primary care has been solved. We all know that isn’t true. Nor am I saying that primary care cannot improve further still, because we all know that it can. My argument today is that primary care has an extraordinary opportunity to build for the future. To play a leading role in shaping our definition of healthcare. To make Britain a healthier place to live for all of our people and for those in the poorest health most of all.

If we are going to take advantage of these opportunities there needs to be further significant investment and change in primary care. Not change for changes sake because we don’t want to do that. But reform with a very clear purpose. To strengthen primary care and to improve the service it provides helping, in the process, the NHS to become the service we all want it to be.

Advances in technology and in our understanding of illness and disease together with an expanded workforce and greater resources will allow us to provide more services to a higher quality. So in the future more surgery, testing and diagnostics will be performed in primary care settings. GPs will have more direct access to diagnostics. Health professionals like physiotherapists will be taking more direct referrals from GPs and more self referrals from patients. We will be able to use LIFT schemes to help build up a new infrastructure in primary care capable of accommodating this shift from hospital to community based care. Bringing our services closer to where people live and work.

GPs with a special interest will take on new roles that have, until now, always been the exclusive preserve of hospital consultants – particularly in the area of chronic long term illness. Nurses and other health care professionals working in primary care will similarly see their responsibilities expand as they enter into new partnerships with GPs to deliver GMS and PMS.

New contractual frameworks will, for the first time, allow both for improvements in the quality of services to be properly rewarded as well as encourage new providers to enter primary care and help deliver a wider range of NHS services. Expanding choice as well as accessibility for patients.

Developments in out of hours arrangements following the introduction of the new primary care contracts give PCTs the opportunity to design improved unscheduled care services that are more integrated with other parts of the NHS. Helping to manage demand more efficiently and raise both the quality of the care as well as the choices available to patients.

The introduction of new information technology applications in primary care through the National Programme I hope too will herald further improvements to the quality, safety and convenience of the service we provide to the public. And here too, PCTs have a critical role to play in introducing the new electronic booking systems and building up the national care records service. Because without the successful introduction of the National Programme, the NHS will never become the service we all want it to be.

All of these changes are designed to improve the service available to patients in primary care and are going to be backed up higher investment in primary care – up by a third over the next few years with more to come. And who better to lead this process of change than our family doctors and our primary care staff who have always been at the forefront of innovation in the NHS.

That is why I believe the engagement and involvement of front line professionals themselves is going to be essential to the success of these reforms.

Thousands of doctors and nurses are currently engaged in designing new ways of working and are helping therefore to reshape the boundaries between primary and secondary care. We see the fruits of this hard work all over the country where many practices have been working with local PCTs and acute sector providers to make sure our services are as efficient and effective as they possibly can be.

I want this to be the norm everywhere in England. I want GPs and their practice staff to be properly enabled and encouraged to fashion services around the needs of patients. Where we do look critically at all of the care pathways patients follow to ensure we offer the best possible configuration of expertise and resource.

To make this happen, I don’t think we need another re-organisation, and I want to make this clear. Because this is not about organisational change. But it will require a new balance of responsibilities in primary care, with new powers for general practices to work creatively with their local NHS partners in sharing in the key decisions that affect the delivery of frontline services.

Now as I’m sure all of you know, earlier this month we published guidance to the NHS on practice based commissioning. From next April, every practice will have the right to hold a practice level commissioning budget. From elective care to prescribing, from chronic care to diagnostic screening, practices will be better able I think to help determine the future shape of the NHS.

This will be a bottom-up process. Led by GPs and their practice staff and working alongside PCTs and NHS Trusts to deliver the best possible services that we can provide. We want to see local innovation resulting in flexible high quality services for patients. And, if innovation leads to money being freed up, which I believe it will, then it will be ploughed back into patient care to further improve the services that patients receive.

There will be no new national targets. People can decide their own pace of change. They can chose to share their commissioning budgets with other practices. But it will be a level financial playing field for everyone. And the national tariff will guarantee that practice level commissioning does not become a bargain basement competition between those who can provide the lowest price for treating patients, because it is quality that must always come first.

I said a few moments ago that I believed the future of primary care was a very positive one. A rising share of the NHS budget coupled with a greater influence over the future shape of the NHS will allow primary care to play a leading role in improving the quality of the care we provide to our patients.

The journey is not over yet. We still have a great deal to do. But there are real and tangible signs of progress right across the country. Shorter waiting times. Reduced mortality from cancer and coronary heart disease. Newer hospitals and better GP premises. Faster access to the latest drugs, treatments and equipment that can help us improve our ability to diagnose and cure our patients. A great deal of this is down to the work you are doing. So I want to conclude my remarks by expressing my own appreciation for your commitment to the NHS and for the values it stands for. Those values have never been more relevant to our society than they are today. Our challenge is simple. It is to make these values meet the aspirations of the British people for the best possible healthcare that money can buy. Work with us to meet those aspirations. Help us to make the NHS the service we all want it to be.

Thank you.

John Hutton- 2004 Speech on Promoting Opportunities

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Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 11 October 2004.

I am very very pleased to be here this morning.

I want to start first of all by thanking all of you for the work you do in helping the NHS and social care improve the service we provide to the public. I also want to thank you too for your commitment to helping the NHS become a better employer by ensuring our staff are treated fairly and also reflect the communities we are here to serve.

As you all know, Positively Diverse began here in Bradford. Over 200 NHS Organisations across England are part of this important new network. It was designed first and foremost to help the NHS become that better employer by recognising the talents and skills of all of its staff. To help us break down barriers that had so often held people back in the past. And to help us meet our legal as well as moral obligations as the largest public sector organisation in Britain to give more people than ever before the opportunity to be part of the greatest army for good in our country and that is the NHS.

The Government is committed to supporting NHS Employers to become better employers. We have this responsibility because, I think, of the position the NHS occupies in the life of our country. Because for me and everyone else here the NHS represents a set of values. Fairness. Equality. Compassion. Respect for the individual. Decent values that reflect the powerful instinct of the our people for fairness and tolerance. If we are to properly discharge our responsibilities as the main provider of healthcare services in Britain today, we have to embed these values in the way we behave as an employer. Because we recognise that to improve the care we provide our patients we do need to improve the way we look after our staff. This means we will need to confront discrimination and prejudice within our own organisation. Because it is there. It does exist. And we have to tackle it.

I think now we are making significant progress. Over 600 NHS organisations have already been awarded the Improving Working Lives Standard.

All of these 600 organisations are committed to offering flexible, modern employment practices that recognise the need to balance responsibilities at home with our responsibilities at the workplace. Our job is to help staff balance both of these responsibilities. Not to find reasons why things can never be done differently. But to find ways to make change happen.

We all recognise that to get the best from all our staff we need working patterns that fit the way people live their lives today and they are changing. We have to support staff to better manage their work life balance. Take child care for example. There are over 230 childcare co-ordinators in post and 150 on-site nurseries that have received funding, of which 140 have been opened offering 6,000 new subsidised places. That’s a start.

Modern working practices are reaping rewards for NHS Employers. Not only are staff able to work more flexibly. We need to do more to make sure they are supported in the workplace with good training and development programmes and continual professional development. And I think have to – perceptions of us as an empolyer are changing.

The NHS, the world’s third largest employer is now the 5th in the Times top 100 graduate list, a jump of 22 places over the past 2 years. I think we’ve made that leap because the NHS is now offering better career prospects, together with improved salaries and conditions of work.

It is not my argument today however that every problem has been solved. It hasn’t. And neither is it my claim today that we can’t do more. Because we all know that we can. But it is my argument today that we are making progress in the right direction. That’s not just my view. I think that I can say it’s the view of NHS staff themselves.

The first ever national survey of NHS staff was conducted during October and November of last year. The overall results have been very encouraging. For example, the survey showed that 73% of respondents were satisfied with their jobs, enjoyed their jobs, with 91% having received training and development opportunities in the previous 12 months. This figure is much higher than a survey by the Department of Trade and Industry (DTI) of employees in the private sector. There were also good results in team working and a general satisfaction with the help that we are now able to provide in achieving a work-life balance.

These results highlight what many of us already know: that NHS staff are committed, caring and well trained; The survey also indicated that the NHS is getting better at reporting and recording accidents and violence and has considerably improved its compliance with statutory obligations to provide staff with a safe and healthy working environment for staff over the last six years

NHS Employers are also committed to enabling staff to work differently, making the best use of their skills.

The Skills Escalator will provide new opportunities for staff to develop new roles and responsibilities and then to be paid fairly for the work they do. A persons job title will be less important than their own individual contribution to the success of their enterpise. Treating people fairly. Breaking through some of the glass ceilings that have held people back for so long in our NHS.

As I said earlier, the fundamental value of the NHS is equity of access to its services. Everybody, irrespective of their gender, age, disability, race, colour, nationality, ethnicity, religion or sexuality should have equal access to services that are, as far as possible, sensitive and responsive to their own individual needs. The Health Service is committed to ensuring that its workforce is able to respond fully to the needs of all its patients. I know local authorities share this aspiration as well in relation to SC. For this reason, it is important that staff working across the NHS and social care reflect the diverse communities they serve.

As well as Positively Diverse we have a number of national equality & diversity projects that are helping to develop a more reflective workforce.

The Positive Action project is aiming to identify and map positive action intiatives and schemes that exist within the NHS and then share the good practice that emerges.

We have started the first ever national leadership development programme for managers form black and minoroty ethnic communities. Better career development and succession planning by the Leadership Centre I think will help us track the talent of BME staff and help them reach the most senior positions in our organisation.

The Equality & Diversity in the Medical Workforce Project aims to gain a better understanding of what the current barriers are for equalities target groups within the medical profession and to assess the effectiveness of different approaches to tackling this. Some of you might have seen a consultation document ‘Sharing the challenge, sharing the benefits’ we issued recently. The consulation period closed on the 17 September and a joint action plan will be produced to respond to the conclusions. Similar work is underway in relation to nursing.

So the pursuit of equality and diversity must always be central to the work of both the Department of Health, social care and the NHS itself. Because we are in the equality business. Nigel Crisp has issued a personal challenge to NHS leaders – both managers as well as clinicians – to give greater prominence to race equality as part of our culture to improve health. He has set up an independent panel to review progress and provide the opportunity to bring external scrutiny to our work, offering support to every part of the organisation in promoting equality across all of our activities.

A commitment to equality runs through this vision of a reformed health and social care system too. Because only by building equality into every aspect of our work can we hope to create a truly patient centred and responsive service that provides fair access to services for every section of our community.

For our part in Government, we are fully committed to working with you to improve the working lives of NHS staff and those working in social care. To confront prejudice and intolerance wherever it exists. To protecting our staff from harassment and violence. And to extending new opportunities to develop worthwhile and rewarding careers in the public sector, where what matters is what you can contribute, not where you come from or where you were born. Work with us to realise these ambitions. And in the process, help us make the NHS and social care the service we all want it to be.

John Hutton – 2004 Speech to the National Association of Primary Care conference

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Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 6 October 2004.

First of all, I’d like to thank the NAPC for hosting this very important event today and for giving me the opportunity to say a few words. I am also very grateful for the way in which the NAPC has engaged positively with Government in keeping primary care at the centre of the debate about the future of the NHS. I think you’ve succeeded in doing that.

The NHS was built on the foundations of primary care and primary care remains central to its future. Nearly all of our patients begin and end their treatment in a GPs surgery. Primary care continues to enjoy the highest satisfaction rates of any part of the National Health Service. It has a proud record in public health and health promotion. And despite all of its detractors, NHS primary care is still the envy of every other developed health care system and a model admired right across the world.

All of this adds up to an outstanding record of achievement for primary care in the NHS over the last fifty years. But the question to answer today is what about the future?

I believe we have every reason to be positive and optimistic about what lies ahead.

There are more GPs and nurses working in primary care than at any time in the history of the NHS. More doctors than ever before want to work in general practice. As a result, people can see their GPs more quickly and there are more services available to patients. Many GP surgeries have been improved and modernised – creating a better environment in which both to work and to treat patients. And there is a steady increase in resources going in to primary care. Helping to build up capacity and capability even further.

So we’ve come a long way. But clearly not everything is perfect. Not every part of primary care in our country has seen all of these improvements. The pressures are still there and they are experienced every day by hundreds of dedicated staff and thousands of frustrated patients. So it is not my argument today that every problem in primary care has been solved. We all know that isn’t true. Nor am I saying that primary care cannot improve further still, because we all know that it can. My argument today is that primary care has an extraordinary opportunity to build for the future. To play a leading role in shaping our definition of healthcare. To make Britain a healthier place to live for all of our people and for those in the poorest health most of all.

If we are going to take advantage of these opportunities there needs to be further significant investment and change in primary care. Not change for changes sake. But reform with a very clear purpose. To strengthen primary care and to improve the service it provides helping, in the process, the NHS to become the service we all want it to be.

Advances in technology and in our understanding of illness and disease together with an expanded workforce and greater resources will allow us to provide more services to a higher quality. So in the future more surgery, testing and diagnostics will be performed in primary care settings.

GPs with a special interest will take on new roles that have, until now, always been the exclusive preserve of hospital consultants – particularly in the area of chronic long term illness. Nurses and other health care professionals working in primary care will similarly see their responsibilities expand as they enter into new partnerships with GPs to deliver GMS and PMS.

New contractual frameworks will, for the first time, allow both for improvements in the quality of services to be properly rewarded for the first time as well as encourage new providers to enter primary care and help deliver a wider range of NHS services. Expanding choice as well as accessibility for patients.

The introduction of new information technology applications in primary care through the National Programme I hope too will herald further improvements to the quality, safety and convenience of the service we provide to the public.

All of these changes are designed to improve the service available to patients in primary care and are going to be backed up higher investment in primary care – up by a third over the next few years. And who better to lead this process of change than our family doctors and our primary care staff who have always been at the forefront of innovation in the NHS.

That is why I believe the engagement and involvement of front line professionals themselves is going to be essential to the success of these reforms.

Thousands of doctors and nurses are currently engaged in designing new ways of working and are hoping therefore to reshape the boundaries between primary and secondary care. We see the fruits of this hard work here in West Yorkshire where practices have been working with local PCTs and acute sector providers to make sure our services are as efficient and effective as they possibly can be.

I want this to be the norm everywhere in England. I want GPs and their practice staff to be properly enabled and encouraged to fashion services around the needs of patients. Where we do look critically at all of the care pathways patients follow to ensure we offer the best possible configuration of expertise and resource.

To make this happen, I don’t think we need another re-organisation. But we will require a new balance of responsibilities in primary care, with new powers for general practices to work creatively with their local NHS partners in taking the key decisions that affect the delivery of frontline services.

We set out in July our plans for practice led commissioning. From next April, every practice will have the right to hold a practice level commissioning budget. From elective care to prescribing, from chronic care to diagnostic screening, practices will be better able I think to help determine the future shape of the NHS.

Today we are publishing our guidance on practice led commissioning to the NHS. There will be no new targets. No one will be forced to do anything they don’t want or choose to do. Instead, we are setting out what practices are entitled to receive as a budget and how any disputes about the budget can be easily resolved. We are setting out the ground rules about how any savings can be re-deployed into developing better services. And we are highlighting many of the local success stories from around the country where practice led commissioning is already making a major contribution to the work of our NHS.

Within this framework, people will be free to determine their own pace of travel. They will be free to develop their own local preferences. They will be free to do it their own way. Because here there is no one size fits all model and therefore we will not be imposing one.

So this will be a bottom-up process. Led by GPs and their practice staff and working alongside PCTs and NHS Trusts to deliver the best possible services that we can provide. We want to see local innovation resulting in flexible high quality services for patients. And, if innovation leads to money being freed up, which I believe it will, then it will be ploughed back into patient care to further improve the services that patients receive.

So in launching this guidance today I want to emphasise that this is the beginning not the end of this process. We will actively support those practices and PCTs who want to take advantage of the possibilities that practice led commissioning provides. Early in the New Year we will be offering support to the NHS in the form of further technical guidance and IT support, which I think will be essential. This will give practices the tools they need in order to take the fullest advantage of these new opportunities. The rest will be down to you. You will write the next chapter in the history of NHS primary care. That is how it should be, because there is no one better placed to do that than Britain’s family doctors.

I know that the NAPC will continue to champion this cause. The Department of Health for its part will put its weight behind these reforms. I hope together we can make sure they succeed and in the process help the NHS become the service we all want it to be.

John Hutton : 2008 Climate Change Speech

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Below is the text of the speech made by John Hutton in Brazil on September 2nd 2008.

Good morning.

I’d like to start by thanking the British Embassy for organising this event with the CBI and the CNI. For me, it seems only natural that Brazil and the UK work together on the issue of climate change. Brazil continues to play a leading role in pushing forward the climate change agenda internationally. And we in the UK are keen to build on this and to work with others to make the transition to a low carbon economy a reality across the globe.

Tackling climate change and ensuring energy security are, I believe to be, two of the greatest challenges that every country today now faces. Both are interrelated and both requiring global solutions. The work of CBI and others here today in Sao Paulo, convinces me even further that we need to work together to tackle these enormous challenges.

Because we cannot afford to wait.

The science is clear and beyond doubt. Human activity is causing changes to our climate. Do nothing and we threaten lives, economic growth and the standard of living of all of our citizens.

Nicholas Stern argued this point persuasively in his report for the UK government. Inaction will cost the equivalent of between 5-20% of global GDP. Taking early action to stabilise global emissions at an acceptable level will cost the equivalent of maybe 1-2% of global GDP. That’s the equivalent of being as rich in 2051 as otherwise would have been in 2050. Is that an unreasonable price to pay?

We can already see some of the economic and human costs associated with more extreme weather events. The occurrence of climate-related disasters in this region increased by 2.4 times during the periods 1970-1999 and 2000-2005, continuing the trend observed during the 1990s. Only 19% of these events have been economically quantified between 2000 and 2005, representing losses of almost $20 billion. In Brazil in 2001, I understand that a combination of increased energy demand and droughts affected hydroelectric supply, which amounted to a GDP reduction of 1.5%.

Brazil, as a leading economy, is right to take into account the potential costs to its economy and people. For this reason, I understand that a consortium of leading Brazilian institutions has embarked on Stern type study, looking at the economic costs as well as the opportunities of climate change here in Brazil. The UK government, as a friend and partner with Brazil, is happy to be supporting this initiative because we know how informative it was to our own thinking. Because we must all understand the economics as well as the science of climate change if we are to make the most cost effective interventions that can help achieve what I think should be our twin goals – firstly reducing green house gases to reduce the threat of climate change and secondly securing economic growth and prosperity in the future.

But climate change is not just a threat – there are countless opportunities as well. Opportunities for those countries in particular, those businesses and entrepreneurs who see that a high growth and low carbon economy are not incompatible. And there are opportunities too for those who move first, to deliver new technologies, create new jobs and drive economic growth.

Now of course some companies are looking to exploit new markets and technologies. Others are looking to become more energy efficient. Others are acting to enhance their corporate image and reputation, something which is increasingly central to the value of any brand or product.

But whatever drives these companies, the benefits of this work are huge.

Globally it is estimated that environmental industries will be worth $700bn by 2010 – equal to the size of the global aerospace industry.

While by 2050, the overall added value of the low carbon energy sector alone could be as high as $3 trillion per year worldwide.

Globally, a record $73 billion has been invested in green technologies this year. And of course green jobs also mean more jobs. This could employ more than 25 million people, creating a new generation of green collar jobs, spreading wealth and opportunity in countries across the world. A country with an energy mix containing 20% renewables can create twice as many jobs as a purely fossil fuel based economy. And we in this room all know the advantage that Brazil has in the renewables market.

Given the scale and urgency of our climate change challenge, the leadership of the global business community in this area can only increase in importance.

So how do we enable more businesses to seize these opportunities and help build our low carbon economies in the most cost-effective way possible?

Firstly, I believe Governments can help by creating the right incentives and frameworks to stimulate the deployment of new technologies. And at the heart of this work, there must be a commitment to competitive energy markets.

It is often very tempting in the face of high energy prices and the speed with which we need to decarbonise our economies, for governments to steer towards over-regulation, protectionism and away from market-based solutions.

But the transformation of global energy systems will require an enormous amount of investment in the decades ahead that in the end, in my view, only open, robust markets can deliver.

And as more and more countries compete for the people, finance and technology to make their own, low-carbon revolution a reality, we also know that the actions of government can make the critical difference between investors choosing to invest in one country over another.

So it is essential governments create the most stable, predictable and attractive regulatory environment to encourage companies to invest. And give investors the confidence and certainty to choose our markets as the right place to do green business. We can use the power of markets to provide the impetus for change and innovation – both of which will be needed to deal with the challenges that confront us all.

So this market-based approach applies not just to energy supplies but also to tackling climate change by cutting carbon emissions.

The UK is part of the EU Emissions Trading Scheme, which caps emissions from the electricity generating industry among others. We are making our 60% emissions reduction target for 2050 legally binding, and as the EU-ETS establishes a meaningful price for carbon, it will ensure the reductions are made in a cost-effective way. I believe the EU ETS is already starting to emerge as a model for carbon trading worldwide. UK/Brazil low carbon links

Secondly, we must build strong bilateral and multilateral relationships to share our expertise and help diversify energy sources, suppliers and transit routes.

Trade between our two countries began two centuries ago, when the UK Royal Navy helped to open up Brazilian ports.

In recent years, it has increased by more than 20% – totalling over £3 billion in 2007 – and matched by significant growth in bilateral investment.

The future development of low-carbon industries and solutions offers us even greater chances to build on this success.

An excellent recent example of business co-operation between our two countries has been the development of Clean Development Mechanism projects under the Kyoto Protocol.

Brazil has been a leading host country with over 290 CDM projects – a significant number involving UK companies.

Brazil is also a world leader in the generation of renewable energies such as hydro power and biofuels. And the UK is keen to learn from your knowledge and experience.

We have recently set measures aimed at delivering a ten-fold increase in our use of renewable energy by 2020.

And although we’re making substantial progress to grow our renewable energy sector, especially in the area of offshore wind generation, I think in the UK we need to go much further, much faster, and develop a range of renewable sources in the future.

By 2020 we’re aiming to source up to 10% of our road transport energy consumption from renewables – in line with the EU target.

We expect biofuels to play a big part in this. I believe there are huge opportunities in UK and EU markets for Brazilian biofuel.

Studies already show that Brazilian bioethanol can save up to 89% in greenhouse gas emissions when compared to fossil fuels. And your long-standing expertise in biofuel technology and as an ethanol exporter is invaluable.

There is also huge potential for co-operation between UK and Brazilian automotive companies in the design and delivery of flexfuel cars.

But first we need to gain agreement on sustainability issues to give business, government and individuals the certainty and confidence they need to act. Events such as the forthcoming international biofuels conference here in Sao Paulo will be critical to encourage international discussion and agreement in this area.

Facing up to the scale of the challenge presents the international community with immense opportunities. We are negotiating a new climate change agreement that will govern global emissions in the future to ensure we avoid the worst case scenarios of climate change. This is not an easy process – and alongside the DDA is an area of foreign policy today where a truly global effort is required to succeed.

This framework will not only have long-term environmental implications but, perhaps more importantly for those here today, it will form the basis of a long-term economic framework setting the planet on a low carbon path.

If we can achieve an ambitious global climate change deal next year in Copenhagen, we can move swiftly to a low carbon economy. An economy in which businesses like yours and ours can manage the risks and maximise the opportunities presented by a low carbon future.

We cannot be complacent. And we must recognise that there is no easy, cheap or risk free option before us. It will take a global mobilisation of leadership and resources. If we fail, the economic and social cots will be great.

As governments, businesses and individuals, we must act now to tackle climate change by reducing our carbon emissions, enhancing energy efficiency and adapting to some of the inevitable consequences of climate change. Consequences which will change our businesses, our livelihoods and lives.

But I would like to leave you with this final thought. We must see this as an opportunity – an opportunity for closer working, sharing of knowledge, expertise and technology. Making the investment now that will help secure our future prosperity, with economic security and, perhaps most importantly of all, continued progress in the fight against poverty and disadvantage across the globe.

Thank you very much indeed.

John Hutton – 2007 Speech on Public Sector Reform

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Below is the text of the speech made by John Hutton, the then Secretary of State for Work and Pensions, to the CBI Public Services Forum on 16th May 2007.

Can I first of all thank the CBI for inviting me to come and talk with you this morning.

I very much welcome the commitment of the CBI to engage in the debate about public service reform.  For many years business organisations in the UK were not always fully involved in the debate about how we improve the quality of our public services.  That has now changed.  Businesses use and fund public services.  Education, transport and health systems make a critical difference to the competitiveness of the UK economy. And increasingly you are part of the solution – partnering with the public sector in the delivery of those services.  The creation of the CBI’s Public Services Strategy Board and this Public Services Forum reflects the tremendous growth of this new industry and a commitment on behalf of business in engaging fully in that debate. We welcome this involvement and participation.

This is probably the right time for us to reflect on what we have learnt from a decade in office – what has worked and what hasn’t worked – and for us to debate where the focus of public service reform needs to shift to meet the challenges of the coming decade.

There is no doubt in my mind that a continuing commitment to reforming our public services will be central to the Government’s agenda.  The reason for this is obvious.  Globalisation and demographic change necessitate an appropriate response from our public services so that we can help individuals and families realise the opportunities of the new world economy.  Without such a response, our society and our economy would be impoverished – the life chances of millions diminished.

I know there are some on the political margins who hope the coming political transition inside the Labour Party will open a window of opportunity to reverse our approach.  They will be disappointed.  The core of our reform programme – significant and sustained investment, choice, personalisation and empowerment for users, devolution to the front line, an open minded approach to who provides – is being built into the DNA of our public service infrastructure.

There is little doubt that this Government’s progress on public service reform can be described as a journey.  It is tempting for all of us when we look back to try and retrofit a neat story about our public service reforms.  In reality, whether in the public or private sector, you have to learn on the job. And themes do emerge over time.

There are four that stand out.

First, that investment in our public services – in people, technology, infrastructure – has been a necessary pre-condition for reform.  But on its own it is insufficient.  Many in my party wanted to believe that we would deliver service improvement simply by building more schools and hospitals and recruiting more staff.  Ten years on we recognise the incredible benefits that that investment has brought – I see it all the time in my own constituency and across the country – but we also recognise its limits. Money can not solve all of the problems we face.

Second, timelines are frustratingly long.  If ministers decide that something fundamental needs to change in the system today, in reality it often takes several years before the effects of that change start to flow through.  Then more time before it has widespread impact.  And for that reason alone, we should perhaps have started more of our reforms from Day 1.

Third, that part of the political and intellectual journey we have been on, is to realise that the development of social markets hold the key to reform.  This has been perhaps the most controversial and difficult of our reforms.  Opening up monopoly state provision to private and voluntary sector providers.  In the early days we believed that structural change was a distraction from raising educational standards or healthcare.  Eventually we came to understand that structural change and incentives also have an important role to play in raising standards; that you simply could not have one without the other.

And finally, it is clear that there are limits to central intervention, planning, targets, audit and inspection.  Self-sustaining reform – a built-in mechanism to drive continuous quality improvement – can only be achieved if individual users of public services become the drivers of performance in the system and local staff and institutions are empowered to respond to and help deliver those preferences.

And it is on this last point – about how we create a wider ownership for reform that I want to focus my remarks today.

It has become a familiar critique that despite substantial investment, recruitment of hundreds of thousands more staff and above average wage increases, that those who have to deliver public services feel insufficient ownership or responsibility for the reforms being implemented.

So, one of our most difficult tasks in this next phase of reform is how to share power, responsibility and accountability with staff and institutions to create a new momentum behind these reforms, one that is less reliant on central direction but balanced by new accountabilities to customers and an intolerance of failure.

You know only too well from the way you manage your own businesses, that there is ultimately a limit to how much you can achieve through imposing targets and practice on staff.  If those that work within your organisations do not believe in what you are saying and feel disconnected from the process of change, then change – real and sustained – simply won’t happen.

Forging a new relationship with staff will be important.  5.5 million people are now employed in the public sector.  They are a conduit for informing and shaping the national public debate about our public services.

There are those that think the root of this problem lies with too much top down central control and the imposition of targets that distort customer priorities.

There are those that think we have placed too much emphasis on structural change and reorganisation for its own sake.

There are those that think the so-called marketisation of our public services has eroded a public service ethos.

There are those that think the cause lies with our tone, our communication strategy or ‘narrative’.  If only we explained more clearly what we were trying to do, then ‘they would get it’.

And there are those that think it will always be like this and that we just need to accept that they will never be ‘on our side’.  Change disrupts comfortable patterns and established ways of doing things.

As ever, there’s no simple answer.  No straightforward solution.  I’m sure that there is more we need to do to engage effectively with staff.  Communicate where we are going and why.

But for me, what this challenge really reflects is a more fundamental question. ‘Who owns the responsibility for reform in our public services today?’

I don’t just mean the day to day implementation of today’s priorities but tomorrow’s innovation in patient care, welfare or teaching standards?

Because we believed strongly in the case for change, we drove it hard from the centre.  We ‘owned’ the challenge of change.  Both the problem and the answer.  We came to believe that policy makers and politicians in Westminster and Whitehall were meant to be the brain for every creative impulse across the system.  It delivered improvements and continues to do so.  But it comes with a price.  A stream of initiatives, targets and legislation in which staff often feel passive recipients; in which they have little influence or control.

But analyse any of the UK’s best performing companies and you will find few that are able to maintain high customer service standards, innovation and efficiency without creating that shared sense of ownership deep within the organisation that can ensure continued success.

So, if our challenge is to create a shared sense of ownership amongst both staff and customers for the future of public service reform, how we create it is equally critical.

And I am clear that it won’t be achieved by slowing down the pace of reform.  It won’t be achieved just through engaging more effectively with staff or communicating our message.

It will only be achieved through sharing the responsibility and accountability for change.  For as long as reform is seen simply as a dialogue between the national media and politicians, we will continue to detach local institutions and the people who work within them from owning the change that should be made.

That shared sense of ownership can only come if we at the centre are clearer about our national priorities and frame them increasingly in ways that reflect the outcomes that we want to achieve.

If we want to move to a system based on a shared sense of ownership then we will need to empower not only the customer but also the staff to bring about the changes they feel are necessary to respond to customer needs.

The mistake we must avoid is sharing power and responsibility without accountability.  That will never work.  Government can only step back if there’s a strong, responsive framework of accountability for individuals and organisations that fall short.

When we nationalised public services in the post-war era, it was based on a deal with public service professionals that said, ‘we will nationalise this service but we will give you the freedom to get on and manage’.  But there was a flaw. No one took responsibility for service failure. We had come to expect that public services would never be as good as those that could be paid for by people who could afford to opt out.

In 1997 many people within the public sector believed that we would go back to that post-war settlement – except this time with increased investment.

We did of course significantly increase investment.  But we also broke with the post-war past by creating new forms of accountability.  We set national targets and oversaw their delivery through one of the most expansive audit and inspection regimes in the world.  However necessary this shift, it prioritised accountability to the centre.  It underplayed the role of the consumer in shaping public services.  Or the importance of public preferences and choices in driving performance.  As such it meant the ‘ownership’ for change was ‘grabbed’ by the centre and left there.  And as the pace of reform intensified and more fundamental change advanced, the dynamic between employees and the political leadership of the country felt critical at best and passive at worst.

So if we share ownership for change, we must base a new settlement of accountability through two routes; firstly to match devolution of power with the use of payment by results funding systems; but secondly and crucially through enhancing, wherever possible and appropriate, the use of competition that allows the customer to influence public services through the choices they make.

If we can get this right, then public service reform will become more self-sustaining; driven not by central Government, but increasingly designed and championed by those operating within the public sector. Performance should no longer need to be managed through an overly engineered web of targets, audit and inspection.  Instead, accountability driven first hand by customers.

At the DWP our City Strategy seeks to capture these principles – offering local consortia of providers new funding and flexibilities in return for outcome-based payments. And David Freud’s report on our welfare system earlier this year, argued for a more effective market in welfare provision, rewarding providers proportionate to the value to the taxpayer of getting an individual into work and helping them to stay there.

With such an approach must come a re-balancing of welfare expenditure towards those who are most in need. A payment by results system – as we have tested out in the Employment Zones – could create incentives to develop programmes across the full spectrum of clients and avoid cherry-picking of the easiest clients to help by paying more to help those furthest from the labour market and facing the greatest barriers to work.   And critically, the centre will be able to step back as the system imbeds itself.

The same is increasingly true for education and health. At the heart of the public service reform programme in the NHS is the development of a more transparent payment by results system that incentivises output based performance. While in education we are developing and piloting models of “Contextual Value Added” – measuring the results of pupils against what might be expected based on previous attainment and factors relating to their background.

The potential power of such information is not just that it strengthens accountability and performance management – but when combined with greater contestability and choice, it can give the user of public services a strong mechanism to shape these services through the choices they make.

We need to put an end to the essentially passive relationship that has all too often characterised the nature of the interaction between the user of public services and the State that provides them.

A relationship that can be particularly damaging for those who need good quality public services the most – where poor outcomes can all too readily become accepted as all that can reasonably be expected.

Exercising choice over a provider or programme can be a powerful way of restoring a real sense of personal responsibility in the individual – enabling them to shape the service outcomes that they themselves want. Of course there are limits to choice – and we must always understand this. But that must not become an excuse for failing to extend the opportunity of choice to those most in need of our public services.

At its most simple, the ability to make an informed choice is still about getting the very basics of a service culture right within the public sector; choice about which channels to use to access services or booking a next-day appointment with a GP online. At its most complex, choice is about a deliberative process of engagement with a school about a child’s education.

Afterall, public services are there to give people a choice. The choice of a good education, good health and the chance to succeed in life – especially for people who could never afford to buy these services themselves.

Critically, over the past decade we have also learnt about the intrinsic benefits of managed competition as a way of strengthening accountability and shifting the ownership of change.  It is that process of competition and how we structure it that creates the dynamic for change – not necessarily whether competing services are delivered by the public, private or voluntary sectors.

I have always believed that strong public services are the best provider of opportunity that any society can have.

But ultimately our values can only be maintained in the decades ahead if we are prepared to continue radical reform. If we are serious about transforming people’s lives by making our public services accountable to the people they serve.

And if, in doing so, we hope to make the best possible use of the energy, expertise and commitment of public service professionals, then we must be prepared to see through the fundamental change we have begun.

John Hutton – 2007 Speech to NAPF Conference

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Below is the text of the speech made by John Hutton, the then Secretary of State for Work and Pensions, to the NAPF conference on 24th May 2007.

I’m grateful to Joanne and the NAPF for the opportunity to join you again at your annual conference – what is without doubt, the leading forum for occupational pension provision in Britain.

A year ago today, we published our White Paper on Pension Reform. It set out a new structure for the long-term future of the UK Pensions system based on the proposals of the Turner Commission.

At its heart a simpler, fairer and more generous state pension paid for by a higher State Pension Age; and a new system of personal accounts that will help more people to build these savings by extending the benefits of an occupational pension to those without good company schemes.

These proposals have laid the foundation for a consensus around a lasting pensions settlement that would meet the challenges set out so vividly by the Pensions Commission – rapid demographic change; chronic under-saving and the historical legacy of an overly complex system that delivers unfair outcomes with excessive means-testing. We need to sustain this consensus because this will be in the long term interests of our society and our economy.

Thanks to the leadership of the NAPF – along with many others – I believe the broad consensus around the main elements of our reforms is stronger than ever.

The Pensions Bill currently before Parliament is fixing the main elements of these reforms in legislation. The restoration of the earnings link will mean that by 2050 the Basic State Pension will be worth twice as much in real terms as it is today. And there are signs of political consensus too – with no votes against the Bill at its Third Reading in the Commons last month.

Thanks to the work of the new Pensions Regulator, most companies facing pension fund deficits now have, or are putting in place, comprehensive and affordable programmes to make good these shortfalls. Just last weekend, research from Aon consulting found that the UK’s largest pensions schemes are back in the black for the first time in more than five years.

And a range of surveys highlighted in this year’s NAPF Conference Magazine even suggest some signs of optimism and confidence returning. In March, the ACA found that while half of firms had reviewed their schemes in the last year, less than a fifth planned a review in the coming year; and Towers Perrin found that around half of employers surveyed saw their occupational pension schemes as having significant recruitment and retention benefits.

But my argument today is not that we have solved every problem connected with our pensions system. This is far from true. Real challenges remain.

Public confidence will not be restored overnight. Many employers are still finding that there is too much red tape in running good schemes. Overall participation in occupational schemes has been falling since the late 1960s.

My argument today is that if we get the next stage of reforms right – in particular around auto-enrolment and personal accounts – then we can embed a new savings culture in Britain – not one that competes with existing occupational pension provision – but actually builds on it, expanding its coverage and making occupational pensions the centrepiece of retirement saving in Britain for all.

Achieving this will depend on three things.

Firstly, the effectiveness of the new system of personal accounts in targeting this key group of moderate to low earners who do not have access to a good quality occupational pension.

Secondly, ensuring that personal accounts complement rather than compete with existing occupational schemes – and that we take steps to strengthen this existing provision; not weaken it.

And thirdly, the quality of information and guidance on which people can make savings decisions with greater confidence about how much they need to save to achieve the income in retirement they want.

I’d like to say a few words about each.

Firstly, personal accounts.

Last December we published our White Paper on Personal Accounts. It began a consultation on a number of important issues – and we will be responding formally to this consultation next month – along with our response to the report from the Work and Pensions Select Committee.

But what I can say today is we are determined to ensure that the accounts are designed as a no-frills occupational pension. Research shows that simplicity is a crucial design feature in reaching our target group of under-savers. Aside from keeping costs down, we know that too many options can be confusing – and the majority do not want to be taking decisions over the investment or administration of their savings.

We’re also clear that accounts must be independent of Government. That is why we are creating the Personal Accounts Delivery Authority to commission the infrastructure to deliver the scheme from the private sector. The delivery of the scheme will be a huge undertaking – one of the biggest challenges our pensions system has faced for many years.

Personal accounts will be the biggest step forward for workers seeking to build up a pension since National Insurance was introduced in the 1940s. But if we are to make them a success for the millions of people who currently aren’t saving for a pension, we must put in place measures to ensure they have the interests of future members at their heart.

It is protecting the interests of members that underpins our decision to establish the scheme as a trust-based occupational pension. As such they will face the very same level of regulation as all other trust-based occupational schemes.

A Board of Trustees will take ultimate responsibility for setting the strategic direction for the scheme from the collection of contributions to the investment of assets and payment of benefits. This will include deciding on the choice of funds and the strategy for the investment of the default fund; the appointment and management of external fund managers and ensuring that contributions are invested in the best interest of members.

This will be important in ensuring that personal accounts deliver for our target group. As we emphasised in our Personal Accounts White Paper, it is essential to the success of the scheme that members’ needs remain at the core of operational decision-making. Trustees are legally obliged to handle the scheme’s assets in the best interests of the beneficiaries. They must have a good level of knowledge and understanding of the law relating to pensions and trusts – the principles of funding and the investment of assets of occupational schemes.

We want the trustees to be highly-qualified experts in their field in order to make the best decisions possible for the millions of members and to retain the confidence of the public.

We know from the National Pensions Debate and from the examples of the consultation procedures of the National Institute for Clinical Excellence and the BBC Trust, just how important it is to involve members in the key decisions that will affect them. That’s why I’m keen for the Personal Accounts Delivery Authority to draw up an ambitious approach to deliberative consultation around the implementation of personal accounts and automatic enrolment.

We are making the system of Personal Accounts an occupational pension; because occupational pensions are the gold standard in pension provision. That’s why, in building personal accounts, we’re modelling the new scheme on what you do – as leaders in the field.

We want to follow the best practice of other occupational schemes in ensuring an appropriate degree of member representation whilst being mindful of the costs and practicalities of a scheme on the scale of personal accounts, with multiple employers and millions of members.

In taking this forward, our plan is to create a members’ panel along similar lines to the Thrift Savings Plan in the USA.

The Panel could nominate a proportion of the trustees and would be consulted by trustees on key decisions, providing them with access to the views of members, and a stronger sense of collective ownership.

Given the scale of personal accounts, I believe such an approach could be absolutely critical to the success of the scheme and to increasing confidence across the whole pensions industry.

Secondly, we need to go further in supporting existing occupational schemes.

We have always been clear that personal accounts are designed to complement, not compete with, existing occupational schemes. And the NAPF has played a pivotal role in helping us to ensure that this will be the case.

As a simple defined contribution scheme, with a limited amount of choice and a basic structure, personal accounts will not compete with existing high-quality occupational provision. And neither should they.

We’ve been clear that there will be no transfers into or out of personal accounts. There will be a simple self-certified scheme exemption test based around clear principles not heavy-handed regulation. And I can confirm today, that a similar approach will also apply to hybrid schemes. Rather than a complex series of specific tests, employers will be able to use their discretion to apply just one of the three simple high-level tests or an appropriate combination.

And, of course, there’s the annual contribution limit. I think it’s important to be clear that while the NAPF and others in the financial services and pensions industry have always felt that a cap of £5000 was simply too high, many others, especially those that are consumer-based, would prefer not to set a limit at all – concerned about placing a cap on people’s aspirations for their retirement and the need for flexibility for the consumer, so individuals can deposit inheritance sums or other windfalls.

This is a very difficult balance to strike and we are still looking carefully at how we can best meet these varying objectives. But I do not under-estimate the importance of getting this right and it will be an important part of our response to the consultation next month.

Strengthening existing provision is not just about ensuring that personal accounts remain focused on their target group. We must also revitalise the whole occupational pensions sector with reforms that will help all schemes.

From 2012, employers will automatically enrol their employees into personal accounts or into their own existing occupational pension scheme, as long at it meets the specified minimum standards. This simple but radical step will affect around 10 million employees in Britain, and will be vital in overcoming the barriers that prevent many people from making the decision to save. Around 1 million employees will be auto-enrolled into existing schemes as a result of our reforms.

Again we will look to support those good employers who offer higher contributions or benefits in meeting the costs of extending their scheme by permitting a short waiting period. And by allowing employers the flexibility to re-auto-enrol employees at set points in a way that suits their business, rather than on an individual basis.

I believe the NAPF’s own Quality Mark is also an important development in supporting existing schemes and valuable too in helping employers to communicate the benefits of good quality schemes. I know there are a number of issues that are still being worked through, in particular around the clarity of exactly what the mark would indicate but I’m keen to re-emphasise my support for the principle of the industry developing such a scheme.

Government does, however, need to be careful not to become part of the Governance chain and confer legal or technical status on it. Not least because the mark must never become a benchmark for future regulation such as raising the personal accounts minimums.

For our own part as Government, the Deregulatory Review represents a real opportunity to simplify the regulatory framework for all occupational schemes – to make running schemes easier; to lighten regulation and reduce bureaucracy. I’m serious about having a real debate here. There is nothing more frustrating for those of you engaged in running good quality schemes than feeling as if the system is working against you. But equally, our duty to protect the saver is also crucial.

As with the National Pensions Debate, people have to come to this debate prepared to achieve a consensus; and to compromise. But be clear about one thing. Now is the chance to make a real difference on this agenda. There is a genuine opportunity here for real change.

Thirdly and finally, information and guidance.

Embedding a new pensions savings culture will depend critically on being able to offer people the right information and guidance.

But the challenge is wider still. Because people don’t just want pensions advice, they want to talk about their money in general. That’s why the Generic Advice Review being led by Otto Thoresen is so important.

In developing Personal Accounts, we need to consider carefully the relationship between any generic advice service and the Personal Accounts board; and the appropriate protocols on which to base generic advice. Further, to consider who would monitor the advice provided and how any generic advice service could get the balance right between communicating the uncertainties inherent in pension saving and the simplicity that most people want in practice.

These are real challenges. But your PensionsForce project report today shows the appetite of savers for good quality information and advice. Funded by my Department’s Pensions Education Fund, since last September we’ve seen 1000 employees in over 70 meetings for employers of all sizes. This can be particularly important for women and many in small and medium sized companies who can tend to be bypassed by the traditional adviser community – as well as, of course, for workers who already have access to a workplace pension and employer contribution but who do not take full advantage of it.

And therein lies the ultimate challenge of embedding a new pensions savings culture in Britain. Enabling each and every individual to take control of their retirement planning; to make informed choices over their retirement provision and to save for that retirement with confidence.

The last year has seen tremendous progress in building a consensus on a new foundation for long-term savings. I am clear that in taking decisions on the next stage of legislation, we must now go further in not only maintaining our commitment to consensus – but actually deepening that consensus around the details of the Personal Accounts system. The coming year could be the most important of all in getting this right.

After 80 years at the heart of occupational pensions in Britain, I know I can count on the NAPF to work with us in rising to the challenge. And with it we can not only secure – but actually revitalise the workplace pension as the foundation for retirement savings for generations to come.