Patricia Hewitt – 1997 Maiden Speech to the House of Commons

patriciahewitt

Below is the text of the maiden speech made by Patricia Hewitt in the House of Commons on 3 July 1997.

Thank you, Mr. Deputy Speaker, for giving me this opportunity to make my maiden speech during the debate on the Budget. It has been a pleasure to listen to such fine maiden speeches this afternoon. I listened with interest to the speech of the hon. Member for Tunbridge Wells (Mr. Norman). Having spent many a pleasant weekend with friends in his constituency, I was sorry to hear that “Disgusted of Tunbridge Wells” remains disgusted. I hope that he will make good his offer to assist my right hon. Friend the Chancellor of the Exchequer by ensuring that Asda, the company with which he has had such a long association, participates enthusiastically in our welfare-to-work programme.

This is, above all, a Budget for jobs and families, which is why it is being so warmly welcomed in the constituency that I have the honour to represent. I know that my pleasure in this Budget will be shared by my predecessor, Greville Janner, whom many right hon. and hon. Members will remember as an effective Chairman of the Select Committee on Employment.

Greville Janner is remembered and known more widely for his lifelong opposition to racism in all its forms, for his distinguished presidency of the Board of Deputies of British Jews, for his sponsorship of the War Crimes Act 1991, and for his relentless pursuit of the secret repositories of Nazi stolen gold. In the constituency, however, he is remembered above all as an outstanding constituency Member of Parliament.

I remember last year knocking on the door of one elderly woman, who told me most movingly how her grandson had died many years ago in a tragic accident swallowing the top of a biro pen, which, in those days, lacked the tiny hole that would have enabled him to breathe sufficiently to remain alive. It was Greville who led the successful campaign for that safety measure in product standards. It was that sort of campaigning on behalf of his constituents for which not only he but his father—his predecessor in this House—is remembered.

Greville was one half of a unique father and son team, who between them represented my constituency for 52 years. Greville’s father, who subsequently became Lord Janner, did not announce his decision to retire until after the 1970 general election had been called. Greville used to tell the story of his selection with great amusement. He claimed—I am sure quite wrongly—that he was assisted by the fact that the election posters, “Vote Labour, Vote Janner”, had already been printed. I am sure that he would have been selected under any circumstances. He will no doubt forgive me if I say how grateful I am that his son decided not to follow in his footsteps.

I also want to pay tribute to three other outstanding public servants who served my constituency. Councillor Paul Sood was one of the most outstanding fighters for the Asian community, not only in Leicester, but throughout the country. Tragically, he died last year, just a week after being re-elected to serve as the city councillor for Abbey ward in my constituency. It was an enormous loss, but I know how proud he would be to see his widow, Mrs. Manjula Sood, now serving in his place.

All of us in the constituency were sad to hear last month of the death of Councillor Martin Ryan, who for many years was leader of the Labour group on the county council. He served, among other capacities, as the county councillor for the Mowmacre ward in my constituency. Just two days ago, I was also extremely sorry to hear of the death of the former councillor, George Billington, who had only recently retired as my predecessor’s parliamentary agent. I will do my best to live up to the extremely high standards of public service which they and my predecessors have set.

I know that my hon. Friends the Members for Leicester, South (Mr. Marshall) and for Leicester, East (Mr. Vaz) will agree when I say that Leicester is a wonderful place in which to live and to learn. We are Europe’s first Environment City. We are home to two first-rate universities. Many of their students, especially those at De Montfort, live within my constituency.

Although it may distress some right hon. and hon. Members to acknowledge this, now that Leicester holds the triple crown of sporting achievements in football, rugby and cricket, we are indeed Britain’s sporting capital. I am delighted to say that, now that the Millennium Commission has chosen the project for the national space science centre, to be sited within my constituency, as the landmark millennium project for the east midlands, we will shortly be the space capital as well.

Leicester, West is a constituency of captivating variety. It stretches from the old industrial buildings along the banks of the River Soar and the Grand Union canal, which form part of the border of the constituency. It takes in a small part of the city’s old mediaeval centre—although, less happily, we also take in some of the inner-city ring road, built in the 1960s with a distressing lack of sensitivity for that old mediaeval heritage. It extends down the Belgrave road, which marks the border between my constituency and that of my hon. Friend the Member for Leicester, East, where the red brick cottages of 19th century weavers are now the heart of Leicester’s Asian community, and from there across to the new estate of Beaumont Leys and the longer-settled communities of Mowmacre, Stocking Farm, New Parks and North Braunstone.

I know that residents, especially on those estates, will warmly welcome my right hon. Friend the Chancellor’s announcement yesterday that he would rapidly begin the release of council house receipts, which will make possible desperately needed repairs and renovations to their homes.

Above all, Leicester is rich in its people. We are well known, and rightly so, for our cultural and racial diversity. By the year 2000, half the young people of our city will come from the ethnic minority communities. Leicester is fortunate to be home to many thriving businesses and to a variety of churches, temples, gurdwaras and mosques that are at the heart of the communities they serve. It is home also to a number of theatres, festivals and arts performances from a variety of different traditions.

Like many of my constituents, I am a citizen not only of this country, but of another—in my case, Australia. In this Parliament, I am the only Member also to be an Australian citizen. Like many of my constituents, I know what it is like to have families in two countries, so I know how much many families in my constituency warmly welcomed my right hon. Friend the Home Secretary’s early decision to abolish the odious primary purpose rule.

I must mention also the parks and open spaces with which my constituency is so richly endowed. Perhaps suitably for Europe’s first Environment City, Western park in my constituency is home to one of the country’s leading green charities and consultancies, Environ, along with the flourishing city farm on Gorse Hill—both of which will, I hope, play a considerable role in creating the environmental task force within the east midlands.

I regret to say, however, that our enjoyment of some of our open spaces is all too often spoiled by the arrival of unauthorised travellers, who themselves have too few authorised sites to which to turn. I hope that my right hon. Friend the Deputy Prime Minister will be sympathetic to the case that I will be making on behalf of my constituents for a badly needed review of the previous Government’s law and practice in this area, which has proved so disastrous.

Perhaps too often neglected in my constituency and others like it are the outer-city estates. Almost half of my constituents live on such estates. Listening to my right hon. Friend the Secretary of State this afternoon, I found myself thinking in particular of families struggling to bring up children in communities where anything up to one in four of working-age men are officially unemployed—and where, in reality, far more are out of work.

Young men all too often turn to destructive or criminal activities, because no creative outlet is offered for their energy. Children are growing up, as one grandmother said to me in fury and frustration, to believe that the only way they can earn a living is to sign on for a giro.

Those are the people whom the last Government locked into unemployment and poverty, and then derided as an underclass. The people I have the privilege to represent are no underclass. They want a chance of a job, a chance to earn a living, a chance to bring up their families decently, to live in safety and to retire with dignity. They want the same respect and opportunity’ as other people. That is what the Budget will begin to give them.

Listening to today’s speech by my right hon. Friend, I thought of Betty, for example, who is a parent governor at Wycliffe community college, which is located on one of the estates in my constituency. Recently, Wycliffe community college was inspected by the Office for Standards in Education. One member of the inspection team asked Betty how the school coped with local parents and with families living on income support—”you know”, he said, “with the underclass.”

Betty said, “I’m one of the people you’re talking about.” She told him, “I live on benefit—not because I want to, but because my husband lost his job and hasn’t been able to get another one, and because we bought our council house, just as the last Government encouraged us to do. Now we find that the only way we can pay the mortgage is to stay on income support.”

Betty left school at age 15 with no qualifications, returned to school, through Wycliffe college, and got herself five O-levels, which in itself is no mean achievement. She would love to train and work as a classroom assistant, and that school would love to give her the job. She cannot take such a job, however, for the simple reason that, as things stand, her family would no longer be able to afford their mortgage. It is such poverty traps, which were created by the previous Administration, that force families such as Betty’s to choose between the job they need and the home in which they live.

I know how much Betty’s family and families in a similar position will welcome the announcements made in the Budget, and today by my right hon. Friend the Secretary of State, about the Government’s welfare-to-work programme and their longer-term objective of creating a benefit system that will at long last reward rather than penalise hard work and effort.

I thought also of Bill, who is a manager at one of the employment projects on a local estate. Bill was a construction worker—a roofer—until he was injured in a fall from the roof on which he was working. He now says, however, that that accident was the best thing that ever happened to him, because it gave him a chance to discover within himself gifts that he did not know that he had. He is now running an employment advice project, into which he has introduced some wonderfully sophisticated software that, with his guidance, enables people who are lacking not only a job but the most basic confidence to start exploring their own real aptitudes and aspirations before taking that first step into training or a job.

Bill said, “I know how hard it is to change. But I also know that people can do it, because I’ve done it myself.” I believe that the Government’s welfare-to-work programme will mobilise community groups such as Bill’s, marrying the bottom-up energy and potential of millions of people across the country to the Government’s top-down strategy and vision.

I thought also of the lone mothers in my constituency who began another group, which they called Turning Point, because that is what it was for them. Originally, those lone mothers met to support one another over a cup of coffee around a kitchen table, but now they are running their own thriving voluntary organisation.

I thought also of the staff and parents—fathers and mothers—who run creches and playgroups that have been starved of funds, sometimes to the brink of closure, because of the previous Government’s local council budget cuts. They are able to offer not only child care places but—in response to yesterday’s very welcome announcement—training places for young unemployed people who wish to work with children.

I am sure that, like me, those parents hope that my right hon. Friend the Secretary of State will ensure that lone parents under the age of 25 who have spent six months or more out of work and on income support will be able to access the opportunities created by the welfare-to-work programme in the same way and on the same terms as other young people who have been on job seeker’s allowance.

After listening to yesterday’s Budget and to today’s debate, I thought also of the teachers working and living in my constituency. Their dedication was scorned by the previous Government. Our new unitary council shares the new Government’s determination to ensure that all our children have a chance to fulfil their potential, whether they live in inner cities, in suburbs or on outer estates.

I know that my right hon. Friend the Secretary of State will not be at all surprised if I say that several Leicester schools—including Dovelands junior school and Bendbow Rise infant school, which is in my constituency, and recently did its best to celebrate an anniversary while the rain poured in through the roof—will be early in the queue for the very welcome new capital funding and private finance initiative announced yesterday.

Finally, I thought of the hundreds of women and men, many of whom are retired, who are now volunteers in so many community organisations, such as social clubs, youth sporting groups, children’s bands and other organisations. I thought also of the sometimes wholly unrecognised individuals who, in their own homes, are looking after children and other relatives with profound disabilities. Our social fabric is woven from all their efforts.

Those men and women, and many others like them, are the heroes and heroines of my constituency. They and thousands of other people across the country will be the heroes and heroines of the new Britain that we were elected to build, and for which the Budget lays such a magnificent foundation.

Patricia Hewitt – 2006 Speech to Unison Health Care Conference

patriciahewitt

Below is the text of the speech made by Patricia Hewitt, the then Secretary of State for Health, on 24 April 2006.

It’s a real pleasure to be here today with so many Unison health service workers. And it’s a particular pleasure to be back in Gateshead – a wonderful example of a city renewed.

I know that our programme of NHS investment and reform is the cause of great debate amongst UNISON members. I know that you’ve had your rally today. I know from the regular contact I have with Dave Prentis, Karen Jennings and others of the concerns, the anxiety, even the anger that some of you feel.

I want to hear about that directly from you – which is why I’ve asked for plenty of time for comments and questions this afternoon.

This is a challenging time for the National Health Service and everyone working in it. Change brings both opportunities and uncertainties. So we all need to be honest and realistic about the challenges ahead, the tough decisions that need to be made – and why we are making further changes in the NHS. .

But let’s also be honest and realistic about what you, the staff of the NHS, backed by our programme of investment, improvements and reform have already achieved.

It is vital that, when we are debating the future of the NHS, we recognise the realities of how far we’ve come – as well as how much more we still have to do.

The best year ever for patients

That is why I make no apology for saying that from the patients’ point of view, the NHS – thanks to the efforts of all of its staff – has just had its best year ever for patients. The facts speak for themselves.

We can all remember what it used to be like.

March 1997 – 283,000 people waiting more than six months, in pain, for a hip replacement or other operation. Every winter an NHS beds crisis. Patients waiting on trolleys in A&E departments for hours and hours on end.

No wonder the public told us what their priorities were. More staff. Better paid staff. And cut the waiting lists.

And we’ve delivered. 307,000 more staff than we had in 1997. More staff – yes, and better-paid than ever before, and I make no apology for that either. Almost no-one waiting more than six months, and for most people far shorter than that – a target that people said was crazy when we promised it, and which the NHS delivered three months ago, in one of the coldest winters for decades.

Last year, the NHS treated more people, faster and better than ever before – and we saved more lives than ever before. 43,000 more people saved from cancer, over 60,000 more saved from heart disease.

No wonder, in every survey, patients tell us the health service is good – and it’s getting better.

These are huge achievements, I think you are entitled to be proud of them – and to get more credit for them in our media.

Financial problems

But if things are so good, why are the headlines so bad? If the NHS is getting more money than ever before – which it is – why are there deficits, jobs being cut and some staff facing redundancy?

Most of the NHS is not in deficit, of course. The majority of NHS organisations are in balance or surplus. The overall deficit in the NHS is just one per cent of the total NHS budget. That’s like someone on £20,000 a year having a £200 overdraft – it’s a problem, but it’s a manageable problem.

The real challenge comes in the minority – 7 per cent of NHS organisations which are responsible for 50 per cent of the deficit: It can’t go on.

We’ve written a very big cheque for the NHS, and we’re proud of that, But it’s not a blank cheque. It never has been and it never will be.

So over-spending hospitals and other organisations do have to put their house in order. Because in the old NHS, the over-spenders were always bailed out by the under-spenders. The under-spenders were usually from the poorest communities and the greatest health needs. It wasn’t fair. And part of our reforms means that every hospital and every area has to take responsibility for getting the best possible healthcare and the best possible value for the extra money that we have asked the public to contribute. That means every hospital becoming more efficient in how it uses precious NHS resources, precious staff time.

For some, that means cutting the money spent on agency staff – which as anyone will tell you is massively expensive. [West Hertfordshire] hospital, for instance, has a deficit of £17 million – and an agency staff bill of £16 million. So of course they should do what [many] other hospitals have done, re-organise their rotas to use their permanent staff better – and cut their agency bill.

Those aren’t redundancies – even though they’re included in the headlines. It’s common sense.

Most places will tackle their deficits and make themselves more efficient with few or no redundancies.

But we will have to face up to some difficult decisions. And in some hospitals, there are staff facing redundancy.

I met some of those staff a few weeks ago in North Staffordshire hospital, in Stoke. Utterly dedicated staff, working flat out – and working in two out of date, old-fashioned buildings. They’re now facing the shock and anxiety of a consultation on up to 1000 redundancies – although, as you’d expect, the hospital is doing everything possible to get that number down. But the problem they’re confronting is not just financial. The real problem is that the hospital isn’t organised in the most effective way possible.

I met A&E staff, for instance, who told me that there are four different places, on two different sites, where patients can arrive in an emergency. And then some patients – many of them seriously ill – have to be moved from one site to another, so that they can be assessed, and sometimes they have to be moved back again, so that they can be admitted. Thousands of patient journeys a year – distressing and risky for patients, and a waste of precious hospital resources. So they’re going to put all the emergency work onto one site. But that means they will need fewer transport staff. They’re going to do more day case operations, because that’s better for patients – but it will mean they need fewer beds and fewer staff on some wards.

This is a hospital that only last year was taking on new staff whom they couldn’t afford – staff who they wouldn’t in fact have needed if they’d organised their services better in the first place. I think that is grossly unfair on the staff, who were undoubtedly let down by the previous board of the hospital, a board that has now resigned. Thank goodness, it happens very rarely – but when it does, and when staff are left facing redundancies in a situation like that, I think they deserve an apology.

I know how devastating redundancies are. That’s why we are working with staff representatives and local management to ensure that the threat of redundancy is contained to as few people as possible.

That’s why we will support any staff member who loses their job to help them get new jobs and, if necessary, new skills.

That’s particularly important when new medical practice and technology is making it possible to shift far more care out of hospitals and into health centres and community hospitals and even patients’ own homes. So our chief nursing officer, Chris Beasley, is already working with UNISON and other organisations on Modernising Nursing Careers – making sure we have the right framework to train and retrain people for NHS careers that will be even more varied, even more flexible than in the past.

Engaging front-line staff

I know that, in every organisation, the people who really know how to do things better and how to get rid of waste and inefficiency are you, the front-line staff.

The best NHS managers are the ones who work most closely with clinicians and front-line staff – reducing the stress for staff, improving the care for patients.

Let me give you just one example. The hospital where patients complained that the porters dragged them around backwards like a sack of potatoes. It was demeaning and disorientating, particularly for elderly people. It turned out that the porters were using wheelchairs that were so old and decrepit they couldn’t be pushed forwards. The porters had been saying it for years – but no-one had listened. At last, managers did listen. They bought new wheelchairs, let the porters do a proper, professional job … and that one small change transformed the support and reassurance the porters were able to give to a worried patient.

I want every hospital, every manager listening to front-line staff, getting rid of waste – and making the improvements, small as well as big, that matter so much to patients.

The need for change

Let me turn now to the wider programme of improvements and reforms that we’re making in the NHS.

I know that Unison isn’t against change. You helped lead the way in negotiating Agenda for Change – the biggest job evaluation scheme in the world – which not only means higher pay for most NHS staff, but even more important, new opportunities for staff to get more skills, take on more responsibility and work in different ways.

I know there’s more we need to do to complete the implementation of Agenda for Change, including fair payments for workers doing unsocial hours.

We need to get the new Knowledge and Skills Framework into place for staff by October. It’s agreed with 90% of staff – but we need improved personal development and skills for every one of our staff.

We need to do more to persuade all trusts and contractors to sign up to the two tier workforce agreement – the new Code of Practice that I agreed a few months ago with Unison and the other NHS unions.

All part of the changes taking place in the NHS.

But there are other changes that are more controversial.

We are giving patients more choice and more control over their treatment. It’s what people expect in every part of their lives. And the people who want it most from the NHS and other public services are people on low incomes – like my constituents in Leicester – who’ve never had the choice that the best-off and the best-educated can take for granted.

We are bringing in the private and independent sector – not to take over from the NHS, but to contribute more capacity and even more innovation to the NHS.

That includes the independent sector treatment centres that introduced mobile surgery units to the NHS and helped us cut waiting times for cataract patients to just three months – four years earlier than we said we would.

We’re using private finance to build [70] new hospitals already – and the new hospitals we’ve just announced at Barts and the Royal London, St Helens and Birmingham, and many others to follow.

That’s not privatisation, that’s progress.

Every one of us in government, every one of us in the Labour Party, believes that the NHS must stay true to its founding values. Funded by taxation. Care based on clinical need, not your ability to pay. Treatment free at the point of need.

That’s non-negotiable, at least as far as we’re concerned.

But there are others who would abandon those principles.

Doctors for Reform demanding the introduction of social or private insurance, an end to ‘free at the point of need’.

The Daily Telegraph just last week, saying it doesn’t want progress, it wants privatisation.

If we are to succeed in defending the NHS, free at the point of need, then we can only do so by changing to meet the three great challenges that confront every healthcare system in every developed country. Rapidly rising public expectations. An ageing population. Medical technology and science changing faster than ever before.

That’s why the NHS has to go on changing.

So there will be more arguments and controversy over the next year, and more difficult decisions to be made.

But by the end of 2008, we will effectively have abolished waiting lists – the way the old NHS rationed care and kept within its budget. We will be giving patients a more personal service than ever before, with more choice about where you’re treated and appointments booked in advance to suit the patient, not just the provider. We will be treating more patients in the community and in their own home. And all of it free at the point of use.

That is how we will protect Nye Bevan’s legacy, the legacy of the great reforming 1945 government.

That is how we will persuade people that collective provision is not only fairer, but that collective provision can also meet people’s aspirations – 21st century aspirations – to be treated as an individual, to get personal services.

That’s how we will protect the founding values of the NHS for another generation against those who want insurance, charges and privatisation.

And that, friends, is a prize worth fighting for.

Patricia Hewitt – 2006 Speech at Royal College of Nursing

patriciahewitt

Below is the text of the speech made by Patricia Hewitt, the then Secretary of State for Health, in Bournemouth on 26 April 2006.

It’s a real pleasure to be here today with so many members of the Royal College of Nursing.

I want to hear what you have to say, which is why I’ve asked for plenty of time for comments and questions.

But there are a few points I’d like to make first.

I know you are angry about the prospect of redundancies amongst some NHS staff. Anyone facing the possibility of redundancy is entitled to be distressed and angry – and you are entitled to be angry on their behalf.

This is a challenging time for the National Health Service and everyone working in it. So we all need to be honest and realistic about the challenges ahead, the tough decisions that need to be made – and why we are making further changes in the NHS. .

We all know that the NHS is getting more money than ever before. But in that case, why are there deficits, jobs being cut and some staff facing redundancy?

To start with, most of the NHS is not in deficit. The majority of NHS organisations are in balance or surplus.

The overall deficit in the NHS is just one per cent of the total NHS budget. That’s like someone on £20,000 a year having a £200 overdraft – it’s a problem, but it’s a manageable problem.

The real challenge comes in the minority – 7 per cent of NHS organisations which are responsible for 50 per cent of the deficit: It can’t go on.

We’ve written a very big cheque for the NHS, and we’re proud of that, But it’s not a blank cheque. It never has been and it never will be.

So over-spending hospitals and other organisations do have to put their house in order. Because in the old NHS, the over-spenders were always bailed out by the under-spenders. The under-spenders were usually from the poorest communities and the greatest health needs. It wasn’t fair. And part of our reforms means that every hospital and every area has to take responsibility for getting the best possible healthcare and the best possible value for the extra money that we have asked the public to contribute. That means every hospital becoming more efficient in how it uses precious NHS resources, precious staff time.

Most places will tackle their deficits and make themselves more efficient with few or no redundancies. For example, cutting the money spent on agency staff – which as you always tell me is massively expensive.

Re-organising rotas to use permanent staff better, getting the agency bills down – that’s not redundancies – even though they are included in the headlines. It’s common sense.

But we will have to face up to some difficult decisions. And in some hospitals, there are staff facing redundancy.

I met some of those staff a few weeks ago in North Staffordshire hospital, in Stoke. Utterly dedicated staff, working flat out – and working in two out of date, old-fashioned buildings. They’re now facing the shock and anxiety of a consultation on up to 1000 redundancies – although, as you’d expect, the hospital is doing everything possible to get that number down. But the problem they’re confronting is not just financial. The real problem is that the hospital isn’t organised in the most effective way possible.

They’re not doing enough day-case surgery. Lengths of stay for some operations are well above the national average. Emergency care is split between two different sites and four different entrances. That’s not good for patients. And it’s not good value for money either.

This is a hospital that only last year was taking on new staff whom they couldn’t afford – staff who they wouldn’t in fact have needed if they’d organised their services better in the first place.

I think that is grossly unfair on the staff, who were undoubtedly let down by the previous board of the hospital. I think they deserve an apology.

I know how devastating redundancies are. That’s why we are working with staff representatives and local management to ensure that the threat of redundancy is contained to as few people as possible.

But we all recognise that new medical practice and technology are making it possible to shift far more care out of hospitals and into health centres and community hospitals and even patients’ own homes. Nurses are leading the way in making these changes. It’s what the public want … it was the central theme of our new White Paper, Our health, our care, our say that the RCN worked with us to develop.

So our chief nursing officer, Chris Beasley, is already working with you in the RCN and other organisations on Modernising Nursing Careers – making sure we have the right framework to train and retrain people for NHS careers that will be even more varied, even more flexible than in the past.

And as I said earlier this week, we need to do more to support any nurse or other staff member who loses their job to help them get a new job and, if necessary, new skills as quickly as possible … and we will work with you and others to make that happen.

Record improvements

Just as we should be open and honest with each other about the challenges we face, we should be open and honest about the achievements as well.

And I want to congratulate the RCN.

Next month, 12th May, you’re going to be celebrating Nurses’ Day.

Celebrating your milestone of 400,000 members – particularly impressive when union membership has been falling in so many other sectors.

You’re entitled to be proud of that … just as we’re all entitled to be proud of the fact that the NHS is employing over 85,000 more nurses than we were in 1997.. 34,000 more staff as a whole in the last twelve months alone, 307,000 more as a whole since 1997.

More staff – better-paid staff – treating more patients faster than ever before, more people’s lives saved. Let’s tell the public about that too.

Working together

I have no doubt at all that the NHS works best when we all work together.

We worked together on Agenda for Change – a ground-breaking agreement to ensure equal pay for work of equal value and to open up new opportunities and new careers to staff for the benefit of patients.

We worked together to extend nurse prescribing.

You pushed for a comprehensive smoking ban – and we will deliver that next year, even earlier than we originally planned.

And we listened to you and many others on Commissioning a Patient-Led NHS. You told us we were wrong on PCT provision. We listened. I agreed we had made a mistake – and I said so, I changed it last autumn and confirmed the position again in the White Paper.

So I want us to go on working together and listening to each other.

Of course there will be occasions where we won’t agree.

But there is one issue – the biggest issue of all – on which I believe we are completely agreed.

The founding values of the NHS.

Every one of us in government, and I am sure every one of you, believes that the NHS must go on being funded by taxation. Care based on clinical need, not your ability to pay. Treatment free at the point of need. The fairest healthcare system in the world.

That’s non-negotiable, at least as far as we’re concerned.

But there are others who would abandon those principles.

Doctors for Reform demanding the introduction of social or private insurance, an end to ‘free at the point of need’.

The Daily Telegraph just last week, saying it doesn’t want progress, it wants privatisation.

If we are to succeed in defending the NHS, free at the point of need, then we need to meet the challenges that confront every healthcare system in every developed country. Rapidly rising public expectations. An ageing population. Medical technology and science changing faster than ever before.

That’s why we’re giving patients more choice and a more personal service. That’s why we believe in more diverse providers, including NHS social enterprises and not-for-profit organisations – as well as the private sector – not to take over from the NHS but to give patients better, faster care. And that’s why we’re shifting services out of hospitals and into the community, to improve care for patients and free up more resources for new drugs and treatments.

So there will be more arguments and controversy over the next year, and more difficult decisions to be made.

That is how we will persuade people that it is worth paying more for the NHS. Persuade people that collective provision is not only fairer, but that collective provision can also meet people’s rising aspirations – 21st century aspirations – to be treated as an individual, to get personalised services.

That’s how we will protect the founding values of the NHS for another generation against those who want insurance, charges and privatisation.

And that is a prize worth fighting for.

Patricia Hewitt – 2006 Speech at HR in the NHS Conference

patriciahewitt

Below is the text of the speech made by Patricia Hewitt, the then Secretary of State for Health, on 27 April 2006.

It’s a real pleasure to be here today with you, at this important conference about the future of Human Resources practice in the NHS.

I want to hear from you this afternoon so I’ve asked for as much time as the conference programme will allow for your comments and questions.

But let me place our discussions today in the context of the programme of investment and reform that we have embarked upon. Starting in 2000 with the NHS plan, what we tried to do was build a patient-led, responsive to the demands of a changing society, and robust enough to prosper into this new century. But crucially, true to the founding values of the NHS: free at the point of need, available to all of us, and funded by all of us through a progressive system of taxation.

This is a challenging time for the National Health Service and everyone working in it. So we all need to be honest and realistic about the challenges ahead, the tough decisions that need to be made – and why we are making further changes in the NHS. .

But I also think we have to be honest and realistic about what the improvements and reform have already achieved.

The facts speak for themselves.

Almost no-one waiting more than six months, and for most people far shorter than that – a target that people said was crazy when we promised it, and which the NHS delivered three months ago, in one of the coldest winters for decades.

Last year, the NHS treated more people, better and faster than ever before – and we saved more lives than ever before. 43,000 lives were saved from cancer, over 60,000 more saved from heart disease.

No wonder, in every survey, patients tell us the health service is good – and it’s getting better.

I think you and all the NHS staff are entitled to be proud of these achievements. I think you deserve more credit for them than the media sometimes gives you.

We have 307,000 more staff than we had in 1997, including 85,000 more nurses and 33,000 more doctors.

More staff – yes, and better-paid than ever before, and I make no apology for that either.

And let me make it absolutely clear: I do not believe that we have too many managers in the NHS. I am fed up with people who talk about managers as if it is a dirty word. I believe we need the very best managers in the NHS, working with clinicians and other frontline staff to deliver the very best care for patients with the best value for money.

You can’t run an organisation of 1.3 million staff and a budget which will be £92 billion by 2008, without first rate management.

Financial problems

But if things are so good, why are the headlines so bad? If the NHS is getting more money than ever before – which it is – why are there deficits, jobs being cut and some staff facing redundancy? Why are you having to make some very difficult decisions?

Most of the NHS is not in deficit. The majority of our NHS organisations are in balance or surplus. The overall deficit in the NHS is around one per cent of the total NHS budget. That’s like someone on £20,000 a year having a £200 overdraft – it’s a problem, but it’s a manageable problem.

The real challenge comes in the minority – 7 per cent of NHS organisations which are responsible for around 50 per cent of the deficit: It can’t go on.

We’ve written a very big cheque for the NHS, and we’re proud of that, But it’s not a blank cheque. It never has been and it never will be.

And that’s why I am so clear that over-spending hospitals and other organisations do have to put their house in order. You know better than I do that in the old NHS, the over-spenders were always bailed out by the under-spenders. The under-spenders were usually from the poorest communities and the greatest health needs. It wasn’t fair. And part of our reforms means that every hospital and every area has to take responsibility for getting the best possible healthcare with the best possible value for the extra money that we have asked the public to contribute.

Hospitals have to become more efficient in how it uses precious NHS resources, precious staff time. And you know how to do that.

You’ve been telling me that you just don’t recognise these headlines about mass redundancies. Cutting down on agency staff, as many of you are doing, isn’t redundancies. It’s good management. And it delivers better care for patients.

And from figures published today, the cost of sickness absence: a cost of on average £5.4 million for every single NHS Trust. We can do better by our staff, and save money at the same time.

Most places will tackle their deficits and make themselves more efficient with few or no redundancies and the more you and we can explain that to our staff, and the media, the better.

But of course there are difficult decisions. And in some hospitals, there are staff facing redundancy.

I know how devastating redundancies are. That’s why I know you are doing everything possible, working with staff representatives to ensure that the threat of redundancy is contained to as few people as possible.

You, as HR professionals, know that every redundancy is a blow to the individuals, their families, and the people they leave behind. You understand the need for sensible, sensitive management processes, and a good dose of human compassion and common sense.

That’s why we will support any staff member who loses their job to help them get new jobs and, if necessary, new skills.

Explaining this is particularly important when new medical practice and technology is making it possible to shift far more care out of hospitals and into health centres and community hospitals and even patients’ own homes.

Every one of us here believes in the NHS – funded by taxation, free at the point of need.

But not everybody believes in these principles.

Doctors for Reform demanding the introduction of social or private insurance, an end to ‘free at the point of need’.

The Daily Telegraph just last week, saying it doesn’t want progress, it wants privatisation.

If we are going to defend the NHS, free at the point of need, then we can only do so by changing to meet the huge challenges that confront every healthcare system in every developed country. An increasingly demanding public. An ageing population. Medical technology and science changing faster than ever before.

That’s why the NHS has to go on changing.

That’s why, together, we have to make difficult decisions.

But look at the prize.

But by the end of 2008, we will effectively have abolished waiting lists – the way the old NHS rationed care. We will be giving patients a more personalised service than ever before, with more choice about where you’re treated and appointments booked in advance to suit the patient, not just the provider. We will be treating far more patients in the community and in their own home. And all of it free at the point of need.

We are making some structural changes. But what really matters is cultural change.

And you are the experts.

Your job is not a back office function. It is on the front line, supporting our staff with skills they need to give the best care to our patients.

Thank you.

Patricia Hewitt – 2006 Speech to NHS Confederation

patriciahewitt

Below is the text of the speech made by Patricia Hewitt, the then Secretary of State for Health, on 20 June 2006.

I want to thank the Confederation – Peter, Gill and all your team – for your leadership of the Confederation. The leadership you showed in your recent report challenging the idea that bed numbers are the measure of success. The leadership and support you have provided this week to this vital part of the NHS family.

I have learnt a great deal over the last year, and what I’ve learnt has deepened my admiration for NHS staff and my absolute determination to give you the support you need to give every patient and user the best possible care.

I am here, as always, to listen to you – which is why I’ve asked Ian to join me for a discussion with you. But I want to take the next 15 minutes or so to acknowledge the difficulties we are facing, talk about the change in culture we need and underline why the reforms are so important.

The last twelve months have been far more difficult than we anticipated. So I am here, first and foremost, to thank each of you for the leadership, the dedication and the sheer professionalism you contribute to the NHS.

And in thanking you, I am also here to celebrate with you the extraordinary achievements of the NHS.

Just one example. There is scarcely a family that hasn’t been affected by cancer. That’s why we made it a priority and asked you to get rid of the delays between the GP’s referral and the start of treatment.

And you’ve done it.

I also know that it is first-rate managers who make first-rate care possible. I spent a morning recently with the cancer team at the Whittington Hospital, sitting in on the multi-disciplinary team meeting, … I saw for myself, what you see every day, brilliant clinicians and front-line staff absolutely focussed on what each individual patient needed. And it was the clinical director (Mrs Celia Ingham-Clark, a consultant surgeon) who told me that the person who made the team’s work possible was Stephen Dunne, who helped patients navigate around the system, ensuring that everyone had the information they required.

It is people like Stephen, it is you and all your colleagues who have made it possible to bring down the waiting lists, get rid of the trolley waits in A&E, save the lives of thousands of cancer patients.

We put in more money. But you did the work.

I will go on championing your successes and telling people about the extraordinary achievements of the NHS in every part of our country. That’s part of my job as health secretary.

But I will also tell the truth about the difficulties we face.

As I look around at a world that is changing faster than most of us imagined even ten years ago, as I see the extraordinary potential of scientific breakthroughs to transform people’s health and well-being, as I find health services across the developed world learning from what we are doing here in the NHS, I am excited this about journey of change that we are on.

But I know that excitement is probably not the emotion most of you feel right now. Anxiety. Uncertainty. Weariness that change never seems to end – and that change seems to be done to you, not by you. That’s what I hear people telling me.

I know that the latest changes to the strategic health authorities and PCTs compound those feelings, even amongst those of you who believe we’re making the right changes. We are making the changes because we believe they will help make life better for patients and the public. But they are also making life very hard for many of you. Some of you here don’t know if you will have a place in the new structure or what that role might be. Together, we need to do more to support everyone who is facing that insecurity.

There is another reason why I want the opportunity for dialogue with you today. Some of the things you’ve taught me have shocked me. The senior member of a PCT, for instance, who told me that she knew last year’s financial plan was unachievable … but she’d been told submit the plan anyway, and if there were problems, that was her problem.

Of course it isn’t like this everywhere – but too many people have talked to me about a macho culture, bullying, not being able to give bad news.

Ian said yesterday that the centre wasn’t listening.

That has got to change.

So our discussions here are part of creating a new culture: leaders who listen – to bad news as well as good – a culture of openness, honesty and respect. I want that in every strategic health authority, in every PCT, every part of the NHS and throughout the department of health – and I will go on reinforcing that expectation with all my colleagues including the Boards of the new health authorities and Trusts.

From “top down” to “bottom up”

But if we’re going to keep on changing, it has to be the right kind of change. When we started making the investment, when we launched the NHS Plan, we needed national standards and targets to make sure the changes happened everywhere.

But you’ve taught me that there is now too much top-down micro management, too much emphasis on targets set by Ministers – and not enough support for managers and clinicians and other front-line staff to respond directly to patients and users and local communities.

The vision of the NHS plan, “care shaped around the needs and concerns of patients.” That’s the vision for today and tomorrow. And it can’t be achieved by diktat from Richmond house.

So we need to create a system with in-built incentives to improve and innovate. A system that supports you to look outwards to patient and users, rather than upwards to Whitehall and Ministers.

Of course there will still be national standards: without them, empowering front-line staff and local communities just creates inequality and a post-code lottery.

But within a framework of national standards, fair funding and proper accountability, we need to shift the whole emphasis from top-down targets and performance management from Whitehall to change from the bottom up.

And that’s exactly what this next stage of the reforms will do.

The four parts of the reform programme work together.

First, more choice for patients with stronger commissioning by PCTs and practices. We know the public want more convenient, more personal, more local services when they’re ill. But they also want the NHS to support them in becoming and staying as healthy and independent as possible.

As we build on the success that so many PCTs have already achieved, and deepen our understanding of what excellent commissioning means, you will have the tools to focus on the needs of every community, to do more – not less – on public health and prevention, and to work with local practices to design services around the needs of individuals not institutions.

By giving GPs and practices more freedom and more responsibility, with practice based commissioning, we are creating the right incentives to do that everywhere.

Of course, choice has to be within available resources. But for elective care, as we give more choice to patients, we also give every hospital a powerful incentive to focus on how to give patients faster access and better, more personal, more convenient care.

But for choice to be real – and for commissioners to get the best services – we need providers who are constantly looking for better ways of achieving the outcomes that patients, local people and commissioners want.

So the second element in the reforms is a greater diversity of providers, with more freedom to innovate and improve – but also more responsibility for their own success.

Its been there for a long time in mental health and care for older people. We’ve now extended it to acute services.

In primary and community services too, we will increasingly see new providers adding to the great diversity that already exists. Services provided by local authorities, PCTs, GP practices … but also nurse practitioner led services, private firms, social enterprises and the third sector.

When East Derbyshire PCT wanted new and better primary care services for one of their communities, they didn’t specify who was going to provide it, they specified the services people wanted – and they chose the provider who they believed would offer the best. We’re all patients and users ourselves, isn’t that what we’d all want our local NHS to do?

I have no doubt that this diversity brings great strengths to the NHS. But it also brings greater complexity. Sometimes different organisations will be competing to offer the best possible care. Sometimes you’ll be collaborating with other organisations to provide the care that an individual patient or a whole community needs. All within the NHS family. All of it free at the point of need.

And then we need the third element of our reforms, payment by results. We have to get it right, we have to give you proper time to plan – and we’ll work with you over the next few months to do both.

But the reality is that the tariff supports patient choice, it will empower practice based commissioners and it is crucial in both driving improved efficiency and liberating clinical staff , inside and outside hospitals, to develop the services that patients want.

And the fourth element, of course, is the Regulatory Regime that we need – particularly to guarantee safety and quality – so that we can promise the public that the services will be there for you, wherever possible you will have a choice and on the NHS you can’t make a bad choice. It’s not easy to design a light-touch regulatory regime that fulfils our promises to patients without stifling your ability to innovate. But we’re determined to do it and we will be saying more on this next month.

Meeting future challenges

We all know there are huge challenges facing every health service. People want more. Medicine can do more. And we have to cope with these new demands and new costs within a budget that will be higher than ever before because we’ve asked people to pay more than before. But even in 2008, when we will have trebled the NHS budget and reached European levels of healthcare spending, the NHS will still have to live within its means.

So what do we do? Do we cut back on the services that we should be providing? No. We’re not going to do that.

Do we make patients pay top-up fees – as some on the Right are demanding. Never, because that would destroy the values of the NHS.

Or we can do what you’ve been asking for this week: make services far more productive – improving care for patients and improving value for patients and the public too. That is how we safeguard the values of the NHS for another generation.

We will never turn healthcare into a business. But we can and we must be more business-like. Not because we care more about money than about patients but because, as the Prime Minister said this week: every pound wasted is a pound not spent on the values of the NHS.

Conclusion

The final point I want to make before our discussion is about my responsibility to you.

I believe my job is to create the space for you to do your job.

I will play my part with Ian in creating the different kind of leadership that is needed for the next stage of our journey.

Less day-to-day interference: more collaboration and empowerment.

Less instructing, more listening: to the bad news as well as the good.

Not ‘its your fault’, but ‘its the responsibility of us all.’

And I will make sure that if you have the best plan for patients but need to take difficult decisions to deliver them on the ground, we will give you the political support you need to make those changes happen.

Those are the targets you are setting me: the targets I am setting for myself.

And when we meet here again in twelve months’ time, we will know that we are on the right track – not just because we will be back in financial balance. But because, together, we will be creating the culture and the partnership that is right for you, right for patients and true to the values in which we all believe.