Mike O’Brien – 2009 Speech to the National Association of Primary Care

Below is the text of a speech made by the then Health Minister, Mike O’Brien, on the 17th November 2009.

I am very pleased to be here.

Over 60 years ago, the people of this country made a bold and historic choice. Amidst the ruins of war, they chose to unite under a common cause and rebuild their shattered land. They chose to create a society where the needs of the many were put ahead of the needs of the wealthy elite. A welfare state where the success of a government would be judged against how effectively it battled Beveridge’s five giants of want, idleness, ignorance, squalor and disease. Where someone’s future would depend not on their family’s lineage and wealth but on their own talent and industry.

This is still very much a work in progress. But one of the greatest achievements in this battle to tackle Beveridge’s giants was the National Health Service – what Donald Berwick, of Harvard Medical School, has called the “bridge between the rhetoric of social justice, and the fact of it.”

Giving people access to the healthcare they need, free at the point of need, has transformed the quality of countless lives. And it has saved millions more. But this is not a political choice made once and then forgotten. It needs to be constantly renewed. The NHS was forged in the heat of political controversy with massive opposition to it. Again and again political controversy has swirled around it and its values. Like it or not the NHS is a political creation and will continue to be a matter of political debate.

A service to the public, free at the point of need, funded through taxation is about values. The consequences of a lack of commitment to its values were made clear in the 80s and 90s when a chronic lack of investment brought the NHS into crisis. Crumbling buildings, old equipment, over-worked and under-paid staff and patients waiting in pain and distress for a year, sometimes two, for operations. So the public was faced with a choice. This time between abandonment of NHS values and a move to private health care or renewal. They chose renewal. The result of which has seen massive and sustained investment in the NHS since the turn of the century. Again, amidst controversy. The increase in funding through national insurance rises was bitterly resisted by the Opposition.

In the last decade, investment that has given the Health Service in England, 40,000 more doctors, 80,000 more nurses, rebuilt or refurbished buildings, and given patients access to the latest NICE approved drugs and treatments guaranteed through the NHS Constitution, pushed through Parliament into law last week.

Most importantly, it saves tens of thousands more lives every year.

33,000 fewer deaths from cardiovascular disease, 40% fewer deaths caused by stroke, and almost 9,000 fewer deaths every year from cancer.

Of course, I suppose you would expect a Government Minister in charge of the NHS to wax lyrical about its achievements. But this is not spin or a case of looking at the world through some kind of rose tinted spectacles. We all know, for example how this morning’s report on Alzheimer’s’ care shows there are still big issues that need to be addressed.

For proof that the NHS is a truly impressive, world class provider of health care you need look no further than the esteemed Washington based think-tank, the Commonwealth Fund. Each year it compares the healthcare systems of various developed countries. They ask the people who deliver healthcare, the clinicians on the front line, what they think about their own system. It published two weeks ago and this year the focus was on Primary Care. Once again, the NHS has come out rather well. Of the eleven countries – including Australia, Canada, France, Germany, The Netherlands, New Zealand and the United States – the United Kingdom was;

Top for low waiting times for specialist care,

Top for the use of multi-disciplinary teams,

Top for the use of financial incentives to reward patient experience,

Top for quality of clinical care,

Top for management of chronic diseases,

Top for the use of data on patient experience,

Top for reviewing doctors’ clinical performance, and

Top for the benchmarking of clinical performance.

This is the NHS that you are responsible for and as a Health Minister I want to thank you for your hard work in transforming the Health Service and making sure it comes out top in all these categories. This report is a real vindication of the work you have been doing.

When it comes to primary care, it is hard to find anyone who does it better than the NHS anywhere in the world. It’s also hard to find anyone with more drive and ambition for doing more and getting it better, and for improving quality and improving the patient experience.

Of course, it’s great to know that we do things better than others. It’s gratifying to watch as Britain moves up the league of nations, vindicating our efforts. But it is not an end in itself. Our mission is to give every single patient the highest possible quality of care and the best experience of the National Health Service that they can possibly get. Why stop at just being better than everyone else?

It is testament to every person in this room and to the people you all represent and work with back in your communities that we have come so far and achieved so much in the last decade. That when the public chose renewal, they made the right choice.

But the next 10 years will be different.

If the last 10 years or so has been about quantity – more money, more doctors, more nurses, more hospitals and more clinics – we know we need to ensure that the next decade has to be about quality. Ara Darzi’s bottom-up review of the NHS, High Quality Care for All, has given us a vision around which we can all unite. A vision of a clinically-led Health Service where quality is always and everywhere the organising principle.

Staying true to this vision will be increasingly important in the years to come as budgets start to level out. We need to find ever more creative ways for releasing funds to the front line. Now of course working more efficiently and cutting waste is important in the future direction of the NHS. But also working more effectively, continuing to improve the quality of care for patients.

Clinical leadership 

We will do this not by Whitehall diktat but through local clinical leadership. In many cases that means your leadership. You are the ones closest to patients, you are the ones who know where the waste and duplication lie. This government has done what it could do best, to push through the reforms needed to lift the NHS from poor to good. But the government cannot achieve quality through central mandate. It is now your turn to do what you can do best. To move the NHS from good to great.

Practice Based Commissioning

One of the principal ways of making this happen is Practice Based Commissioning. Practice Based Commissioning is about putting clinicians at the heart of PCT commissioning, giving them greater power both to transform the quality and the efficiency of local services. Where it has been embraced, the results have been impressive. In Bexley, major schemes include a cardiology service where virtually all aspects of the specialty, other than interventions, are carried out in the community.  Practices now receive hard, delegated budgets for prescribing. If practices make savings then they can use them, but they are also responsible for any losses. Through PBC, Bexley has so far saved £4m, money they can now spend in other ways for their patients, on more integrated, community-base care.

Many other PCTs such as Nottinghamshire County and Hampshire are actively drawing up autonomy and delegation schemes in collaboration with their PBC groups. Enabling practices to take on greater responsibility as their capability grows. But we have to acknowledge that Practice based Commissioning has not taken off everywhere. Even where it has, it is a way off reaching its full potential.

So you may well ask, if it hasn’t yet then why will this happen now, in the future?   Why will it be different this time?   My answer is it will be different because it needs to be. Because this is the only way to deliver High Quality Care for All. And, most dramatically, because the financial context has changed. This level of clinical leadership, of local leadership, will be the single most powerful way of driving up quality whilst releasing funds for further services. There is nothing to stop PCTs and Practice Based Commissioners from working together and devolving hard budgets to GPs. Nothing to stop every PCT in the country being bolder and more imaginative in how they work with GP Practices. Nothing to stop Practice Based Commissioning from transforming community-based care.

This isn’t just about holding hard budgets, it’s about giving practices real responsibility for the design of local services and then holding them accountable, so the hard budgets can be there. It is about more than that however. It is about requiring organisations to work together. There is nothing to stop us, but ourselves.

I would like to thank James Kingsland [President of the NAPC] for his work, independent of the NAPC, in leading the National PBC Clinical Network, doing what can be done to encourage the expansion of PBC. PBC is right for many surgeries. But it should be a matter of choice. Some GPs want it and their practices can cope with the administration it brings. Some GPs don’t want it. Particularly some small practices may want to focus on patient care not budgets. They may benefit from coming together with other practices. But some small practices could be broken if budgets are forced upon them. Lets leave the choice with GPs – rather than forcing GP budgets on all of them as some would do.

The NAPC manifesto for the election, which was published just an hour or so ago I believe, has a core proposal for Community Health Collaborations, which is a really interesting idea. Aimed at raising the quality of primary care. Bringing GPs together with some going on to become Foundation Practices with greater independence for leading high quality practices. I welcome these ideas. I promise to look at them.

Primary and Secondary

And our changes are not just in primary care. Increasingly, acute trusts are devolving budgets directly to specialist clinical leaders. Enabling them to spend money in a similar way to Practice Based Commissioners. The next step is to join these two up. And to allow us to devolve acute budgets to primary care. I am not saying you must do this, it is not a new target. But I am saying that surely it is the logical next step. For clinicians in primary and secondary care to work ever more closely together to create a truly integrated patient care pathway. Imagine the impact of this sort of partnership.

We talked for several years about moving care into the community, but the funding practices have not always encouraged this. We need to find better ways of doing this, with for example COPD to prevent repeated admissions when people take a turn for the worse but instead allow them to be cared for at home.

This is done in large parts of the country but not in others. We need to find ways of spreading good practices more quickly across the NHS. We must ensure collaboration between the acute and primary sectors, then we can get better outcomes for patients, which are more effective and cost less. The work to reduce C Diff and MRSA has saved  £240m in the NHS. Quality saves money.  But it needs true clinical leadership providing a better service for patients and better value for the taxpayer.

Innovation

I am certain that this sort of cooperation will lead to all sorts of new and innovative practices. Strategic Health Authorities now have a legal duty to innovate. Here in the West Midlands, GP practices are working with the Met Office to ensure over 6,000 people with respiratory diseases are given warning of bad weather and helped to take simple steps to take care of themselves and to avoid a hospital admission. In Halton and St Helens PCT, GP practices are working together to deliver an award winning rapid access home visit service.   I understand that with their Health and Social Care Award safely displayed in their trophy cabinet, they’re up for another award at this conference too. Recognition that is richly deserved. A detailed analysis of their Acute Visiting Scheme revealed a 30% drop in hospital admissions and a saving of about £1 million in its first 6 months.

Patients have better access to primary care,  the option to receive their care at home,  and are less exposed to the risk of infection in hospital.

Patients as a result report a 90% satisfaction rate and one GP said it was, “the best thing to happen in my 37 years of General Practice.” Best of all, it’s ripe for adoption and spreading across other PCTs.

We’ve been good at identifying best practice, but bad at spreading it further, and we must do better to spread innovation. In April, to encourage innovation across the whole of the Health Service and at every level, we announced the new £220 million Innovation Fund. The first round of awards have now been issued to SHAs. In Yorkshire and the Humber, they’re accelerating the uptake of telehealth technology to improve care for people with long term conditions. East of England SHA is encouraging practical solutions around long-term conditions, patient safety and keeping children active. And South Central SHA is funding a joint project between Milton Keynes PCT, Razorfish and Microsoft to support diabetic self-care. All providing a better service for patients and better value for the taxpayer.

Rights and entitlements

Last week, we announced the introduction of a new set of patient rights as part of the NHS Constitution. We propose that from April next year patients will have the legal right to start their treatment with a consultant within 18 weeks of GP referral, and to be seen by a cancer specialist within 2. If the NHS can’t deliver, then it will have to find an alternative provider that can. This means that patients will receive the same high standards of care wherever they live.  And, more controversially, working with the profession, we are looking at how we can give patients greater choice when it comes to registering with a GP practice. Perhaps one that is more convenient for them to get to, one with higher quality care or one with longer opening hours. It depends on what the patient wants.

As the NHS has been given more money, people are expecting more to be done and greater choice. The information is there for all to see on NHS Choices, and the choice will be theirs for the making. Improving the patient experience and driving up quality through competition is important.

In the next decade, the NHS must move towards being a preventative, people centred service.  So from April 2012 we want to give people over 40 the right to a 5-yearly NHS Health Check to assess their risk of heart disease, stroke, diabetes and kidney disease.  By identifying the risks early and provide a better service for patients and better value for the taxpayer. We’ll also soon consult on a legal right for a person to choose where they want to die and on personal health budgets, giving people power over their own care. These proposals, building on the NHS Constitution, are part of decisive shift guaranteeing standards for patients and putting power in their hands.

Targets in the NHS remain controversial. In 1997 the NHS budget was £35bn. It is now £103bn having almost tripled. Targets are a way of ensuring people get tangible returns for their money.  There is a choice here. The Opposition would end those targets. Some people would say ‘good’. But cancer patients would say otherwise. The right for suspected cancer patients to see a specialist within 2 weeks and get diagnostic tests in a week – gone. A maximum 18 weeks for an operation – gone. All A+E patients to be seen in 4 hours – gone. By contrast we would convert targets into patients’ rights. It’s a choice.  They would end extended hours access to GPs. Some GPs would say ‘good’. But patients wouldn’t. There are some difficult choices here. We would extend it. We support the GP-led health centres. They don’t.

We need to ask – where is the patient in all this? Where are they getting better care? Where are the real values of the NHS? The NHS faces tighter budgets than in the last decade. But more than ever we need to choose the kind of NHS we want.

Conclusion

Patient rights, patient choices, innovation and joined-up local clinical leadership need to become as deeply ingrained in the psyche of the NHS as being funded by the tax payer and being free at the point of delivery.

For this is about values. And if we are to maintain the values of the NHS, if we are to maintain the public’s confidence in the system for another 60 years, if the public are to continue to choose renewal, then we must always and everywhere be looking to make the Health Service better, more efficient and higher quality.

The investment is there. The mechanisms are there. The opportunities are there. It will never be a done deal. There will always be a need to improve. We have already gone from poor to good. Now, with your leadership, the NHS moves from being good to great.

Mike O’Brien – 2004 Speech on the UK and China

Below is the text of the speech made by Mike O’Brien, the then Foreign Office Minister, at the Dorchester Hotel in London on 19th January 2004.

Thank you for inviting me to speak here this evening.

I should start by wishing you all GONG SHEE FAR CHAI (long life and prosperity) in this, the year of the Monkey.

TRADE

Britain is one of the most open and one of the most successful trading nations in the world. Millions of jobs depend on our ability to export around the rest of the world.

UK exports to China from January to September 2003 stood at £1.4 billion showing a rise of nearly a quarter on the figure for the same period in 2002.

Countries who complain that they are losing out on investment or on jobs because of China’s success, fail to see the benefits that China’s success is bringing to global markets. Yes, China’s exports were up last year by 32%, but imports were up more – by 41%. Of course, there is still some way to go – Intellectual Property Rights need to be enforced more rigorously, and some trade barriers are still too high. But huge progress has been made.

The reality is that as developing countries become richer, they contribute more to the global market – they buy more, they have more to invest.

China’s new open approach to the global economy and its membership of the WTO are important steps along the way.

I’m sure the British businesses amongst us here tonight agree, and I am looking forward to presenting the award for exporter of the year later in the evening.

I was in Beijing and Shanghai last summer and saw for myself the level of involvement that Britain has in China’s awesome development as potentially the world’s major economic force.

Just last year P&O signed an $800 million contract with COSCO and Maersk to create China’s biggest container port at Qingdao and British Architect Lord Foster and Arup are part of the successful consortium developing the new terminal at Beijing airport.

For the Beijing 2008 Olympics Arup, British consulting engineers, are working on the National Stadium and the new aquatics centre; HSBC, Allen & Overy, PWC and PMP – all great British firms – are working alongside the Chinese in this ambitious project.

These are just some of the impressive, large scale projects that shout China’s presence on the world stage. I know that more are in the pipeline and I hope that UK firms continue to be valuable partners for China.

Just before closing, a quick mention for the China Britain Business Council’s 50th anniversary coming up in June. The CBBC has assisted thousands of British companies in China. As an organisation they are continually adapting their services to meet market demand.

CLOSING REMARKS

China is no longer the ‘sleeping tiger’ it once was – it is now a vibrant open and dynamic economy playing an important role in the global family of trading nations. And the UK looks forward to enhancing our trading relationship with China even further over the coming years.

Mike O’Brien – 2003 Speech on the Future of NATO

Below is the text of the speech made by the then Foreign Office Minister, Mike O’Brien, at Salter’s Hall in London on 24th January 2003. The speech was made at a conference debating the future of NATO.

I am grateful for this invitation to talk to such an impressive audience about one of the most interesting and topical issues in the European security field today. Lord Robertson’s remarks set the context for the day’s discussions. Before I begin, may I pay tribute to him for his leadership of the Alliance through the remarkable changes of the last three and a half years.

The NATO peace-keeping mission in Kosovo; the rapidly developing relationship with Russia; the transformation of the Alliance’s command structures; and the historic enlargement agreed at the Prague Summit. Any of these would constitute a significant achievement. All of them together represent a genuinely exceptional record. I would like to wish Lord Robertson well for the remainder of his time as Secretary General and for his future beyond NATO.

Today I should like to focus on the European dimension of strengthening the Alliance, in particular on the UK vision of the strategic relationship we are building between the EU and NATO.

UNDERPINNING EUROPEAN DEFENCE

The decisions at the Copenhagen European Council and in the North Atlantic Council just before Christmas represented the culmination of two years’ work to secure the agreements between the EU and NATO to underpin European Defence. These will allow the EU to start conducting military operations with support from NATO and will lead to a strengthening of European capabilities, which will reinforce NATO.

European Defence is, of course, NATO’s core business. NATO was created to defend Europe. It was – and remains – the basis for the American political and military commitment to the security of Europe.

Despite the end of the cold war which removed the threat of conflict between east and western Europe, this transatlantic link remains central to NATO’s purpose and thus every bit as central to European Security in the 21st century as it was in the second half of the 20th. But neither NATO nor European security can afford to remain frozen in time. The threats we face, sadly, have not remained static. Europeans are no longer confronting each other in a cold war on the Central European Plain but we do face fragmentation in the Balkans, terrorism and threats emanating from other countries.

MODERNISING NATO

NATO has modernised itself continuously and impressively over the past decade and a half since the fall of the Berlin Wall. That process will continue, as Lord Robertson has told us. NATO has enlarged and is continuing to grow. It has shown its value as an active military alliance, peace making and peacekeeping in the Balkans. As the Prague Summit demonstrated, it is transforming its structures to cope with the new tasks and challenges it faces, particularly the threats from terrorism and WMD. But NATO, though necessary, is not sufficient for all aspects of European security.

It is neither fair nor reasonable for Europeans to expect the Americans and Canadians always to contribute military forces to problems involving our security interests. Nothing would be more certain to place a strain on the health of the Alliance than continuing European dependence on American support at every turn. We must be prepared to bear our fair share of the burden. Also, the European Union has a Common Foreign and Security Policy, which should be underpinned by the ability for EU nations to conduct military operations.

It was because of this understanding of the need for Europeans to do more for their own security and because we wanted this to happen through the EU as well as through NATO, that the Prime Minister proposed the development of a European Security and Defence Policy. Today, I should like to set out the UK’s vision for European Defence in NATO and in the EU.

UK OBJECTIVES FOR ESDP

The UK conceived and has developed ESDP to meet three main objectives:

– to strengthen the European contribution to NATO by enabling European forces to take a fairer share of the European Security burden in circumstances where NATO as an Alliance was not involved;

– to set a target for European nations to make their military forces more rapidly deployable, effective and sustainable – this will also be highly relevant to the modernisation of NATO’s force structures agreed at Prague;

– to enable the European Union to play its full role on the international stage, recognising its uniquely wide range of external policy tools, from political dialogue, trade and aid to JHA co-operation and now civilian and military crisis management operations.

DISPELLING MYTHS

EU initiatives in this country tend to get a distorted reception from the Eurosceptic sections of the media and the political debate. ESDP has been no exception. It has been portrayed as everything from a Euro-Pentagon to a Euro-Army and a dagger at the heart of NATO. It is of course nothing of the sort.

Too often the debate about the EU/NATO relationship treats the two organisations as if they were institutional monoliths – or two boxers circling in the ring, the experienced one warily eyeing up the new kid on the block, fearing his next shot.

In reality we are talking about 23 nations, 11 of whom belong to both organisations. After enlargement it will be 32 nations of whom 19 belong to both.

Deployment of military forces – for EU, NATO, UN or any other operation – will remain a matter for national governments. Javier Solana, let alone Romano Prodi, will not be ordering troops into Euro-battle on the basis of EU directives.

The command, control and planning of ESDP operations can be done by NATO for the EU under the so-called Berlin Plus agreements now being finalised. Berlin Plus means that the EU has guaranteed access whenever it wants it to the resources of NATO’s operational and strategic planning capabilities.

The EU also has the strong presumption that when it asks for it, NATO will supply the EU with command structures and capabilities to support an EU-led crisis management operation. This does not mean the EU can act militarily only when it has support from NATO. The EU will act either in operations using NATO’s assets and resources, which will be planned for by NATO, or in operations, which do not require NATO assets and resources, which will be planned for by the national headquarters of an EU nation. In all cases the EU will act on the basis of consultation and coordination with NATO to determine the most appropriate form of response to a crisis.

THE FUTURE

What then is the future for ESDP and what does it mean for NATO?

The UK has a positive, ambitious and wide-ranging agenda for moving ESDP from the institutional to the operational phase. Much of the gestation of ESDP has been about institutional structures and bureaucratic rules-writing. This is necessary but it is not sufficient. ESDP also requires the development of military and civilian capabilities and the political readiness to put these into action.

OPERATIONS

The first opportunity is likely to come in a few months’ time, when an EU-led military operation replaces NATO’s Task Force Fox in Macedonia. This will be an EU operation based on planning done by NATO and with an operational commander provided by NATO. Given the crucial role that NATO and the European Union, in particular Lord Robertson and Javier Solana, played in preventing conflict in Macedonia, it is right that a NATO force should be replaced by an EU mission in that country.

It is also right in terms of the wider EU engagement in the future of Macedonia, which was the first of the former Yugoslav states to have a Stabilisation and Association Agreement with the EU. These agreements open the perspective of eventual membership of the EU for the countries of former Yugoslavia and Albania. The Agreements will help prepare the way by encouraging reform and modernisation across the board, including in the security sector.

A bigger task for ESDP, but one which this Government thinks the EU should be ready to take on, will be replacing the NATO-led Stabilisation Force in Bosnia. The European Council at Copenhagen in December declared the EU’s willingness to take over from NATO in due course in Bosnia.

We would anticipate that force also being an EU operation planned, commanded and conducted with recourse to NATO planning, assets and capabilities. This would not mean the end of a NATO presence in Bosnia. NATO should continue the Partnership for Peace activities, which are so important to developing European standards in that country and in its former Yugoslav neighbours. These states should develop their relationship with NATO in parallel with the European Union.

As I just said, the scale and complexity of the operation in Bosnia would be more significant than that in Macedonia and the EU would want to be well prepared militarily and strategically to take on the task. But it would be consistent in our view with the strategy of Lord Paddy Ashdown, as the international community’s High Representative and as the Special Representative of the European Union, to help move that country in a European direction.

The Macedonia operation from this Spring, in testing out the EU structures and the links to NATO, will be useful preparation for a potential operation in Bosnia. Also, towards the end of this year, the EU and NATO will conduct an exercise premised on an EU operation with recourse to NATO assets and capabilities. Coming after the operation in Macedonia and before that in Bosnia, this will be a useful opportunity to test and refine the links between the two organisations and their internal structures at top level.

CAPABILITIES

The crucial underpinning for ESDP and for the European pillar at NATO has to be continuing improvements in European national capabilities.

At the heart of the ESDP process, the UK and France proposed and the EU adopted the so called ‘Headline Goal’. This is that European Nations should, by the end of this year, be able to deploy at 60 days notice a force of up to 60,000 and sustain such a force in operations for at least a year. This was a deliberately challenging target.

The signs are that EU nations will be able to match the simple quantitative requirement, but aspects of the qualitative element, especially in terms of readiness, logistic support and sustainability may not be reached at full by the end of 2003. So work to improve our military capabilities will need to continue across Europe.

NATO, under Lord Robertson’s leadership, has stressed the importance of investment by all Allies in modern defence capabilities. At Prague, NATO leaders agreed to the Prague Capabilities Commitment – specific undertakings to improve the ability of our armed forces to deal with new threats. The UK has pioneered work in the European Union and NATO to provide a mechanism to link the capability development processes of both organisations to ensure that, in particular for countries like us who are members of both, the efforts we make nationally to develop military capabilities will inform, and be informed by, EU and NATO requirements.

RAPID REACTION

The other element of the equation is, of course, ensuring that appropriate and capable force packages can be put together, if necessary at short notice, to conduct EU or NATO operations in the field.

To this end, NATO, at Prague, agreed on an ambitious transformation towards rapidly deployable and flexible forces, able to deploy wherever needed, to deal with the security challenges of the 21st century. At the heart of this concept is the NATO Response Force. This will enable NATO to field a highly effective force of up to 20,000 troops, able to move very quickly to wherever it is needed.

The UK strongly welcomes the NATO Response Force. It plays to our national strengths and it underlines the requirements in particular of rapid deployability that we think are crucial for NATO and ESDP. It complements work going on in the EU to place more emphasis on the rapid reaction elements of the Headline Goal.

THE DEMISE OF NATO?

Some commentators during the Prague Summit chose, paradoxically, at this moment of great success for NATO, to question the Alliance’s relevance to the post-11 September world. NATO has a role.

Of course there will be occasions where the UK and other nations will act in coalitions of the willing. This was the case of the Gulf in 1991 and in Afghanistan in 2001. But five years after the 1991 Gulf conflict, NATO deployed to implement the Dayton peace settlement in Bosnia and three years after that, NATO ended Serb repression in Kosovo and deployed a peacekeeping force to that province.

For each crisis that arises it is the responsibility of the governments whose interests are concerned to decide which is the most appropriate form of response. This may be a UN operation as in East Timor, a NATO operation as in Kosovo, an ESDP operation now that the EU/NATO links are in place, a national operation, as the UK conducted in Sierra Leone or a coalition of the willing as in Afghanistan. It is right that this range of options should be at the disposal of the governments concerned. This has always been the case and will continue to be the case.

In no way does it change the fundamental relevance of NATO to European security. Nor does it change the argument, in which the UK believes strongly, that a European Union Common Security and Defence Policy can lead to fairer burden sharing between NATO and the EU and can simultaneously strengthen both organisations by enabling the countries involved to strengthen and modernise their round forces and their ability to operate together.