Rosie Winterton – 2017 Speech on Withdrawal from the EU

Below is the text of the speech made by Rosie Winterton in the House of Commons on 31 January 2017.

I am rather nervous about following that extraordinary double-act.

The debate has shown once again how important it is for Parliament to scrutinise properly the Government’s approach and actions in respect of leaving the European Union. It has made the Government’s attempts to thwart that scrutiny through the Supreme Court look even more ludicrous.

I want to make four points. First, I shall support the Bill. I did not want us to leave the European Union, but the majority of those who voted in the referendum thought differently, including nearly 70% of people in Doncaster Central. It is important that we respect that decision, as was stated so eloquently by my right hon. Friend the Member for Leeds Central (Hilary Benn) and the shadow Secretary of State.

Secondly, we must do all that we can to get the best deal for Britain from the negotiations. That deal must benefit all parts of the UK. The Government have focused on strategies for Scotland, Wales, London and Northern Ireland, but we need to make sure that all our regions have input and a proper analysis of the effects of leaving the European Union.

People in Yorkshire and Humber want to know what the effect will be on our businesses—small and large—universities, science and technology sectors, local authorities, trade unions, representatives of the third sector and others in our region. During proceedings on a recent statement, the Secretary of State said that the other nations would of course be involved in those discussions, adding that he would also be inviting representatives from the regions to a meeting in York. I hope that the Minister will be able to give us more detail about exactly how that will work. Who will represent the Yorkshire region? Will any analysis be done of the effect of Brexit on Yorkshire, what we will need to see from any deal, and how an ongoing dialogue will be maintained? Each nation and region will have an interest not only in trade deals, but in the Government’s so-called great repeal Bill.

My third point is about employees’ rights and conditions. The Government have said that they will guarantee that current employment rights will be incorporated into UK law once we have left the EU, but they need to go further by strengthening UK employment law if they are to deal with the issues of undercutting and exploitation. British manufacturing, the agricultural industry and our public services, especially the NHS, will need workers—skilled and unskilled—from European Union countries.

Concern about immigration was a key factor in many people’s minds during the referendum. A lot of that concern revolved around a feeling that workers’ wages and conditions were being undercut by migrants, especially those from eastern Europe. I know from my constituency that many of those workers are on zero-hours contracts, often being offered only about 10 hours’ work a week even though they want to work for longer, and at the minimum wage—sometimes even below it. The employers are not just about breaking even; they are big companies that often use agencies to supply their workers and effectively use the state—through housing benefit, for example—to subsidise cheap labour while seeing big profit margins.

Some call some of that a form of modern slavery. We need to use the opportunity before us to look again at how the labour market operates. If the Government are to address the concerns that I have set out, they will have to improve the whole way in which our labour market works. I believe that countries across Europe have concerns about this issue and we will be discussing it at the Labour party conference on Brexit in a few weeks’ time. It would help if we could talk to our European neighbours about the issue in respect of gaining as much access as we can to the single market.

My final point is that, as we saw yesterday, huge concern has been expressed in this country and throughout the world about the actions of President Trump. That has shown how essential it is that the UK does not withdraw from the world stage because of Brexit. I am a member of the Parliamentary Assembly of the Council of Europe. Last week, I saw at the Assembly how valuable it was to show that the UK has not withdrawn into itself, and that we understand the importance of working with our European neighbours and advancing our common cause on human rights. I know that Government Members feel strongly about that issue as well.

I hope that the Minister will reassure the House, once and for all, that the Government will not be withdrawing from the European convention on human rights and the Council of Europe. We need to lead the debate on how we leave the European Union, and the Bill should be an opportunity to do that.

Rosie Winterton – 2004 Speech to the National Pharmaceutical Association Triennial Dinner


Below is the text of the speech made by Rosie Winterton, the then Minister of State for Health, on 29 November 2004.

It is a great honour to be asked to respond to your address tonight. I know the Triennial Dinner has been a landmark of the Association over many decades.

And, given that I believe we have reached a historic moment for community pharmacy, it is particularly apt that we meet in such historic surroundings.

I understand that the Apothecaries’ Hall in which we meet tonight was rebuilt after the Fire of London. So I thought I would find out what you were all up to at that time. I couldn’t quite get back that far but according to the internet, in the 18th century apothecaries – and I quote:

– provided medical treatment

– prescribed medicine

– trained apprentices

– performed surgery

– and served as man-midwives

Is that familiar or what?!

At the time of the birth of the NPA I think you may have still been dishing out laudanum or some other potion to help people sleep but soon cottoned on to the fact that a much better cure for insomnia was inviting Government Ministers to speak to you.

I’m very pleased that the NPA has been at the forefront of developing pharmacy as a clinical healthcare service. The prominent position it played being illustrated by the fact that within four years of being set up the NPA had over 7000 members – a great tribute to your first Secretary, George Mallinson. And I am sure he would be very proud to see the expansion since then

I would like to take this opportunity to congratulate you all here and your association for its dedication and commitment to promoting pharmacy and its role in providing direct patient care.

I also want to thank you for the support you are giving today to a number of important national initiatives – not least our Keep Warm This Winter campaigns and working closely with NHS Direct to promote pharmacy as an alternative source of advice and help for others.

So whether it be producing a Survivor’s Guide to the new framework (which I found a slightly alarming title!), supporting and developing training for pharmacy staff, being an active and – dare I say – persistent watchdog and champion for community pharmacy contractors – all that is testimony to the resolve of the NPA.

Now much has happened since the last Triennial Dinner. Then I think we were getting on with our implementation of the NHS Plan and Pharmacy in the Future. Repeat dispensing, minor ailment schemes, medicines management schemes – three years ago these were in their infancy or still at the planning stage. Now they are poised to roll out across the health economy.

Chairman – you have touched on these in your address. I recognised in what you said your enthusiasm for moving forward, your determination to transform the patient experience which I find reflected across the country in the many pharmacies I visit. What comes across to me very clearly tonight is that the goals and aspirations I have are shared by you too.

And since I came to be Minister for Pharmacy we have:

– reaffirmed our ambitions for pharmacy within the NHS in the Vision I launched in Summer 2003;

– made clear in Building on the Best pharmacy’s vital role in improving access to medicines and patients’ use of their medicines;

– have seen 250 (two hundred and fifty) pharmacists qualified as supplementary prescribers – and Chairman you were one of the first to qualify – and I am very pleased to reaffirm tonight our intention to introduce independent prescribing for community pharmacists;

– launched guidelines for pharmacies to use the NHS logo – a clear signal to all that community pharmacy is truly part of the NHS. If we want community pharmacy to be in the NHS, we want that sign up there so that people readily recognise it as such;

– and announced our plans to reform the control of entry system which has addressed a number of concerns and is now, I believe, a truly balanced package of measures.

And through the NHS Improvement Plan and the White Paper Choosing Health we have signalled a new direction that will lead to action based on the principles of informed choice, personalised services and collaboration. In fact I can not think of a better place to start than the local community pharmacy. So I want to see community pharmacy at the heart of those efforts working closely with others to make the NHS a real health-promoting service – not an ill-health service. I want to turn those perceptions round and we can do that because of your daily contact with the public. We know that from the Big Conversation and the desire of the public for us to make much more of your role.

Of course, I am very pleased with the outcome last week of the ballot of contractors. That overwhelming vote in favour is a ringing endorsement of and, quite frankly, impressive testament to the months of hard work, hard talk and hard bargaining that achieved that result. My thanks to everyone who worked so hard on it. But I also believe it is an endorsement of the Vision we have for the role of pharmacy in the future and its closer integration with the NHS. I am therefore sure we are on the right track. I am committed to doing everything necessary to make this a reality from next April.

I am very pleased to hear Chairman that the NPA, will be playing its full part play in this. I appreciate your efforts to secure the new framework.

There are details still to sort out. But I think that with goodwill and determination on all sides, we can make it happen.

This is a new era for community pharmacy. There are real opportunities ahead not only to make differences in the way community pharmacies work but also to transform services for patients.

And we can expect yet more significant advances in the next 3 years. Full implementation of repeat dispensing, pharmacy connected electronically to the rest of the NHS, electronic transmission of prescriptions to name but three areas. Our document on pharmacist access to patient records is nearing completion and we hope to begin consultation on that soon. In your address Chairman you mentioned a number of the very complex issues associated with electronic prescription transmission which we are keenly aware of. I want to reassure you tonight we continue to seek solutions to these.

Change and the pace of change will therefore certainly continue. So I’m sorry to say that I haven’t come tonight with promises that the pressure is going to ease off. If anything, it is going to increase.

I know your organisation, your staff and representatives will respond with professionalism, enthusiasm and commitment to the challenges that lie ahead. And even if we don’t always see eye to eye on every issue, I very much look forward to working with you in the exciting months ahead!

I will fight my corner for community pharmacy and I know my colleagues in Parliament will too. But there is also the work you can do with your members to encourage them to strike up and continue dialogue with PCTs.

It gives me enormous pleasure to invite everyone to join me in celebrating your achievements and to anticipate your future contribution to what lies ahead.

My Lords, Ladies and Gentleman, at 83 years young, the National Pharmaceutical Association.

Rosie Winterton – 2004 Speech to the PSNC Conference


Below is the text of the speech made by Rosie Winterton, the then Minister of State for Health, on 3 November 2004.

My sincere thanks to Barry for his warm welcome.

We have reached a critical – an historic – moment. This is probably the most significant turning point for the NHS and for community pharmacy in the history of NHS pharmacy services.

That is why today’s conference is key to achieving the progress we all want to see in the weeks ahead.

There are dynamic opportunities ahead to forge new partnerships, new working relationships for the benefit of patients.

I hope that Local Pharmaceutical Committee representatives and NHS delegates will use today as a springboard to develop these relationships. I have consistently said how important it is to talk.

The future holds exciting prospects – but we all recognise there are challenges too. That will mean fresh approaches. Fresh commitments. Fresh ideas if we are to turn this to our mutual benefit and advantage.

Thank you Barry for recognising my commitment and enthusiasm for making sure this does happen.

Since taking up this post some 15 months ago, I have wanted to see community pharmacy fully involved, fully integrated and playing its full part in our modernisation of NHS services.

In the four years since we published the NHS Plan and the subsequent Pharmacy in the Future, I believe the patient experience has transformed. To take just three examples, access has much improved across all sectors, more than half a million people have successfully quit smoking through NHS smoking cessation services and more than half of all PCTs now have collaborative medicines management programmes. Quite frankly, these sort of achievements just would not have happened without community pharmacists playing their part.

But there is a long way to go. Our NHS Improvement Plan promises even more radical developments, backed up by significant new investment in NHS services. With £90bn plus being spent on the NHS by 2007-08 we must make sure that investment is backed up by modernisation and reform. People will want to see 21st century services meeting their needs.

I want to see services, which put patients in the driving seat. Where they have more choice and control over what is available to them. A NHS which fits the services to the patient – and is held accountable to them – and not the other way round. Improving access is essential to achieving this

And I want to see an NHS which offers full support for people with long-term health conditions. Those services must be responsive. They must enable people to get the best out of their lives, understanding their needs, testing what works and learning from the experience.

We also want a NHS which helps promote the best health for all. A much greater focus on improving health, to reducing the health inequalities that quite frankly still persist and to preventing ill health generally. Not an NHS which caters for ill health, but an NHS that caters for promoting health.

That’s where community pharmacy has shown already how much it does offer here – and holds out the opportunity to offer so much more. Provision of emergency hormonal contraception, smoking cessation schemes and substance misuse services. These are just three examples where pharmacy makes a direct, relevant contribution to the health of local communities and helps reduce the health inequalities I have just referred to.

And it can do so much more. So our forthcoming white paper on public health, and our pharmaceutical public health strategy, to be published next year will reflect that contribution and the potential pharmacy offers to open up new ways of delivering services.

Tackling antibiotic resistance is important to public health. Later today, as part of Ask About Medicines Week, I will be launching an information leaflet for the public on antibiotics. I’ll be doing that from a nearby pharmacy, to highlight this issue. Produced jointly with the Royal Pharmaceutical Society, this recognises one of community pharmacy’s key attributes – its ability to communicate health messages to people who are well as well as sick. We will build on this strength in the new contract.

Developments in last 12 months

As Barry and Sue have already mentioned, the last 12 months have been momentous. The pace of change probably more rapid than at any other time in living memory. I know some people fear change and transition. But change and transition are inevitable and must be faced up to if we are to achieve the transformations the new framework promises.

I also know from many visits to pharmacies in the last year how enthusiastic and committed to the framework you are.

And not a little impatient too! Pharmacists have said to me “We’re ready. We’re committed. Give us the tools the framework promises which will really enable us to deliver”. I’ve appreciated that sense of frustration.

But I also appreciate your professionalism and dedication. It is that sure basis I am determined to build on – maintaining that confidence and trust but also invigorating the drive to liberate pharmacy’s potential.

There have after all been a number of achievements on the pharmacy front this last year.

We have reaffirmed our plans to improve pharmacy’s role in the Vision I launched in Summer 2003. That identified and aligned our ambitions for pharmacy clearly and rightfully alongside our ambitions for the NHS as a whole.

We made clear in Building on the Best pharmacy’s vital role in improving access to medicines and patients’ use of their medicines;

We extended coverage of medicines management collaboratives and repeat dispensing, underpinning closer working between pharmacists and GPs to improve medicine taking;

We have seen 250 (two hundred and fifty) pharmacists qualified as supplementary prescribers;

And we launched guidelines for pharmacies to use the NHS logo – an important step for better integration and a clear signal to all that community pharmacy is truly a part of the NHS. Something that has been very dear to my heart.

And community pharmacy’s potential has featured more prominently in discussions about how to improve services – how it can be more widely utilised by the NHS and other health professionals – and its ability to respond innovatively and creatively more openly acknowledged. Not just in primary care but across other sectors too – in accident and emergency and in the field of mental health. That is all positive news.

Because patient expectations are rising and will continue to do so. NHS services in the future must fit those expectations. We can achieve that where we maximise the potential and skills of NHS staff. We cannot achieve that if we perpetuate old-fashioned notions that professionals only do what they’ve always done. We have to revolutionise the way services are offered. In doing so, we can revolutionise the patient experience of the NHS.

Pharmacy is not stuck in a time warp. It has faced up to and indeed embraced considerable change in this new millennium. Some of that was catch up because community pharmacy lagged behind other areas of primary care. It is still not as prominent as it should be

But views and perceptions have shifted – pharmacy is increasingly recognised as an indispensable element in primary care delivery. Pharmacy of course already has a proud history of breaking new ground which I’ve already outlined.

I know that imagination and innovation are not in short supply. I want to see that groundbreaking talent utilised in other areas:

– In helping patients with long-term conditions such as diabetes

– In helping patients with asthma or mental health problems

– By building on the best we’ve already seen in medicines management schemes

– In treating patients with minor ailments

– In supporting better use of medicines

These illustrate what is key – community pharmacists better integrated in the NHS, working closely with other primary care professionals, using their skills to deliver quality healthcare services to patients.

This would not work if patients did not trust their local pharmacist. I know they do. I know that from the Big Conversations earlier this year. People see pharmacies as an essential part of the local fabric of health services. Easily accessible, reliable and often the first port of call for patients needing advice and help.

Now I do know that some remain anxious about the reforms to the control of entry rules. Let me say I do believe these will benefit patients, with greater choice, and improved and more convenient access.

But it is a balanced package of measures. I know there were worries. But we have made changes. The right competitive edge will still be there for existing contractors to enhance service delivery and new entrants to fulfil unmet needs. But there will be checks and balances to ensure community pharmacies’ vital role is maintained, safeguarding in particular ready access to pharmacies in poorer and rural areas.

“Control of entry” remains – and must at all times do so – a tool to securing our aims – not an end in itself.

Which brings me to the heart of today’s event. Reaching agreement on the contractual framework.

Sue has already set out the details of that. I will not go over them again. But I would highlight some points which I think are critical

First the categorisation of services which mirrors so closely that for GPs is as sure an indication you can have of pharmacy’s integration within the NHS

Second, the breadth and depth of services which will be open to you to provide sends the clearest possible message that community pharmacy is first and foremost a clinical health care profession – not another retail identikit.

That does not mean I wish to ignore your entrepreneurial skills. I want to capitalise on them – using the resourcefulness and imagination you have to invest in new ways of service provision.

Third, the funding structure – more transparent, more secure than the current system ever has been, which I believe will enable you to invest with confidence for the future

Fourth there are real opportunities for pharmacy to be a fully paid up member of the NHS as I’ve said. Pharmacy’s role in attaining local performance targets & national PSA targets, addressed within local delivery plans will be pivotal. Pharmacists, utilising their undoubted skills to best effect, can really impact on other pressure points within the NHS. This is a message I hope NHS delegates will be taking back today.

Now to achieve that there must be support for PCTs and pharmacies to implement the new framework. Sue and Barry have already mentioned the support pharmacy is getting

I want implementation to be a wholehearted success for the NHS too. That is why I am pleased to announce today a programme of continuing support for that process for PCTs

The Department has worked closely with a number of organisations including the National Primary and Care Trust Development Programme (NatPaCT), the National Primary Care Development Team, the Medicines Management Service of the National Prescribing Centre and the Centre for Pharmacy Postgraduate Education as well as NHS colleagues from SHAs and PCTs and others.

I am pleased to announce publication of a prospectus today to publicise this substantial package of support. These include:

– guidance on the new framework and control of entry reforms

– a series of 5 roadshows for PCTs in December

– further in-depth training events by early 2005 for those with day to day responsibilities for the control of entry reforms

– a help-line to deal with questions and queries

– support and information through web-sites, including the answers to frequently asked questions and service improvement guides
tool-kits to support PCTs in undertaking pharmaceutical needs assessments to inform commissioning and their role in supporting and monitoring

– the development of strategic tests to guide the monitoring of the implementation of the new framework

– training for pharmacists and their staff on repeat dispensing, risk management etc

The Medicines Management Service at the National Prescribing Centre will also be refocusing its efforts to establish a collaborative programme specifically to support the new contractual framework. Local teams that participate will be supported in making their own improvements, as well as quickly sharing their learning with neighbouring organisations. Further information will be available in the coming months.

The prospectus is the first version. Other versions will be published as further elements of support are identified and added to the package.

My agenda is ambitious. I make no apology for that. I believe the new framework will come to be recognised as a watershed. It promises significant benefits for patients, a secure and stable basis for pharmacists and their staff to invest in delivery and make best use of their skills. It will help the NHS deliver the modern services and promote better health for all.

I would like to add my thanks to everyone involved in the new framework – PSNC, the NHS Confederation and officials at the Department. I believe the new framework is what contractors have wanted for so long. That is why I very much hope for the same outcome and unanimity as last year when you vote on the framework. I believe it to be a very good deal indeed – good for contractors, for patients and the NHS and for taxpayers. I think it will fulfil the potential for community pharmacy services in the 21st century, which I hope you want and which patients and the public want.

I wish you a very successful and rewarding day.

Rosie Winterton – 2004 Speech to the All-Party Pharmacy Group


Below is the text of the speech made by Rosie Winterton, the then Minister of State for Health, on 25 October 2004.

Many thanks to Howard Stoate and the All Party Group for inviting me. I am sorry I could not be here for the start.

The Group has been unstinting in its support for community pharmacy and particularly for our theme tonight. I am very grateful for your work here.


Since taking up this post some 15 months ago, I have wanted to see community pharmacy fully involved, fully integrated and fully playing its part in our modernisation of NHS services.

We are well into that journey. In the four years since we published the NHS Plan and the subsequent Pharmacy in the Future, I believe patient experience has radically transformed. To take just three examples, waiting times have improved across all sectors, more than half a million people have successfully quit smoking through NHS smoking cessation services since April 2000 and more than half of all PCTs now have collaborative medicines management programmes running. These sort of achievements just would not have happened without community pharmacists playing their part.

Our journey isn’t over yet. There is a long way to go. Our NHS Improvement Plan promises even more radical developments, backed up by significant new investment in NHS services. With £90bn plus being spent on the NHS by 2007-08 we must make sure that investment is fully justified in terms of what a 21st century service should provide.

A NHS where patients have more choice and control. A NHS which fits the services to the patient – and is held accountable to them – and not the other way round.

A NHS which offers full support for people with long-term health conditions. Those services must be responsive. They must enable people to get the best out of their lives, understand their needs and learn from the experience. Those are the sort of services that are going to make the real differences in the future. Health services, not “ill-health” services.

So we also want a NHS which helps promote the best health for all. We must give a much greater focus to improving health, to reducing the health inequalities that sadly still persist and to preventing ill health generally.

Community pharmacy already does offer so much here. Provision of emergency hormonal contraception, smoking cessation schemes as I mentioned already and substance misuse services are just three examples where pharmacy makes a direct, relevant contribution to the health of local communities.

And it can do even more in the future to improve public health. So our forthcoming white paper on public health, and our pharmaceutical public health strategy, to be published next year will reflect pharmacy’s true potential.

Developments in last 12 months

In the last 12 months, the pace of change for community pharmacy has probably been more rapid than at any other time in the last 50 years. I know some people fear change. But I would also say that in that same period, community pharmacy has probably featured more prominently in discussions about how to improve services, how its potential can be more widely recognised by the NHS and other health professionals, and its ability to respond innovatively and creatively has been more openly acknowledged.

That can only be a good thing. It is what I hoped for when I launched our Vision for Pharmacy last year. That identified and aligned our ambitions for pharmacy clearly and rightfully alongside our ambitions for the NHS as a whole.

At the same time we also made clear our intention to reform the current structure governing who can provide services and the control of entry system – largely unreformed in the last 20 years.

So I hope it is recognised that the package of reforms which I announced this August is a balanced package. It will open up the market. I do expect it to be easier for new entrants to come in. But they will do so because they are improving access to, and the choice of, local pharmacy services for patients, putting their needs first.

Increasing regulatory freedoms will encourage greater innovation and excellence by all – whether an existing or a new contractor. But checks and balances will ensure community pharmacies’ vital role is maintained, safeguarding in particular ready access to pharmacies in poorer and rural areas.

New contractual framework for community pharmacy

Which brings me to the heart of the meeting tonight. The new contractual framework. I have been wanting to talk about this for a very long time – as many of you will know. So I am delighted to be able to say – for the first time – that the PSNC, the NHS Confederation and the Department have agreed the final details of the framework. I would like to congratulate all those involved in the negotiations who have made this happen.

For more than anything else, this will bring home to community pharmacy the significance of the wider innovations and developments I have been talking about this evening. And it will do so in the most meaningful and positive way. Nationally agreed essential and advanced services, underpinned by clinical governance and continuing professional development requirements, will provide the bedrock. And, in addition, PCTs will be able to commission enhanced services to meet specific local needs.

I believe this heralds significant benefits for patients. For example, people will no longer have to make frequent visits to their GPs when they need their next prescription. Their local pharmacy will be able to offer the support people need to self-care and manage common ailments. And pharmacies will be a convenient alternative to the GP surgery for people who need regular checks on blood pressure or blood glucose levels

Now we have reached agreement, we will be working just as hard towards the new contractual framework going live from 1 April 2005. This of course assumes a positive response to the PSNC’s ballot, which is what I very much hope we will see in late November.

Given this, the way will be clear for community pharmacy to take up its rightful place as a full partner in the provision of NHS primary care services. There are very real opportunities for PCTs and pharmacies to grasp here. Pharmacy service providers can make a real contribution to achieving local performance targets and the Government’s national public service targets, addressed within local delivery plans.

So I would urge those from the NHS here tonight to build on this exciting news, to press ahead with forging new and dynamic relations with community pharmacy and to explore the potential for transforming patient services. The Department will work with the NHS to provide support and training in the months ahead. But the time to act is now. The new framework offers opportunities as never before.

Rosie Winterton – 2004 Speech to Forensic Psychiatric Nurses’ Association Conference


Below is the text of the speech made by Rosie Winterton, the then Minister of State for Health, at the Imperial Hotel in Blackpool on 14 October 2004.

Thank you very much for inviting me here today. Hope you have had a good conference so far.

It is a particular pleasure for me to be here today – not least because nurses make up the largest staff group working within the NHS.

And there are around 45,000 nurses working in mental health in England today providing treatment to some of our most challenging patients – as nurses working in forensic settings, you don’t need reminding how challenging this work can be, and how important it is to get it right.

So thank you for the invaluable work you do. I know that in the past mental health nurses’ skills have often been undervalued. I know this has contributed to difficulties in recruiting and retaining nurses – and to difficulties that you, as nurses have experienced in delivering the quality of treatment and care you were trained to deliver.

Yet nurses are absolutely essential to the delivery of effective mental health services – essential to our plans to modernise and improve care and treatment for people with mental health problems.

And why do we want to that? Why have we made mental health one of the top three priorities for the NHS? For me as a politician it is about a belief – a belief that people with mental health problems are some of the most vulnerable in our society – some of the most socially excluded. And I believe that our society should be judged by how we treat vulnerable people – how we eradicate social exclusion. And that’s why I believe we should strive as a government to ensure we provide high quality mental health services, assessable to all who need them. That we create a working environment where we value our staff and maximise their potential. No longer a cinderella service but a service people have confidence in using and real satisfaction in working for.

And I believe we have the means to make that happen. When we came to power in 1997 £30 billion was spent on the NHS each year. By 2007 that will have risen to £90 billion. That is a huge increase. But for that people will expect good, high quality services – and not just for a few but for everyone.

And in 1997, we made reform of mental health services a key priority – tackling years of underinvestment and neglect.

The national service framework for mental health, the first NSF to be published, was a major milestone. For the first time ever, it set standards for mental health services.

It gave a clear message that mental health was important. But we also know that change would take time – up to ten years. We knew it would take money; and we knew it would take support for our staff.

That is why we backed up the NSF by £300 million extra investment on mental health services. And that is why we developed the National Institute for Mental Health in England to support local services.

So where are we, five years on?

The Local Delivery Plans submitted to us by Strategic Health Authorities show a commitment to deliver all the mental health targets in the NHS Plan that build on the NSF.

Already we have :

Over 253 assertive outreach teams

– 41 early intervention teams – supporting young people with the first signs of psychosis

– The caseload for community mental health teams has increased to 310,000 from 252,000 in 2001.

– 174 Crisis resolution teams

– Improvements mental health care for people in prison is improving

– We are creating 140 high security beds and more medium security places for Dangerous and Severe Personality Disorder pilots.

– There are also more places available for people who no longer need secure care.

– Perhaps most importantly of all – the suicide rate is starting to fall. The latest three-year average [a rate of 8.9 people per 100,000] was the lowest rate yet compared to the baseline in 1997.

And this is possible because of the work that you do, in partnership with us and with other parts of the service.

I am very aware of the pressure that there can be on staff. There is much more to do but we have worked to try to relieve some of those pressures.

We now have half as many more psychologists as there were in 1997. Over a third as many more consultants in psychiatry. And almost six thousand more nurses – an increase of over 14%. In absolute terms, this a good number. But in relative terms, it suggests we have more to do

We must keep up our overall recruitment programme – but obviously my concern is mental health. So what can we do to recruit and retain?

First, we must protect the work that nurses and only mental health nurses can do. This is why many in-patient units are helping to ensure that nurses are free to nurse by introducing housekeepers onto wards.

Some Trusts are also developing roles for support workers. This means qualified nurses to concentrate on activities where their skill and experience are most needed.

Second, we must ensure that our nurses working in a safe environment, and, of course, that they themselves are managing their patients safely. This is why, in 2002, we set up the Cross-Government Group on the Management of Violence in Mental Health Settings, and why in January of this year, NIMHE and the National Patient Safety Agency employed two project managers to offer a consultancy and advice to help service providers review their current policies and procedures on education, training and the safe and therapeutic management of aggression and violence.

We have commissioned the National Institute for Clinical Excellence to produce guidance on the short-term management of violence. Their interim guidance has been issued for consultation and the final guidance is due later in the year.

The National Patient Safety Agency has also identified patient safety in acute mental health settings as a priority. They launched the mental health programme of work at the end of June and their emphasis will be identifying and understanding the complex inter-relation of systems that exist on acute psychiatric wards and how these can be managed to improve safety.

Third, we can support and develop nurses to work in an increasingly diverse range of non-traditional settings, in new role, including in new community teams. This is one reason we have put in place a comprehensive workforce programme, led by NIMHE, to support further development of nurses’ roles.

I believe that work to develop new roles will strengthen the mental health care system as a whole, but it will also help us to respond to individual nurses’ needs for personal and professional development. In particular, I think it will:

– support the delivery of health promotion

– promote early intervention so we can prevent more serious

– problems developing in the future – particularly in relation to the pathways into the criminal justice system that some troubled young people take help in the long term to reduce dependence on traditional psychiatric beds as the mainstay of the mental health service;

– and last but not least improve the quality of care, promote choice, and promote social inclusion for people with mental health problems who can too easily get disconnected from work, education, their families and friends.

Of course, I am aware that nurses already work in a wide range of different settings, and that nurses roles are already very diverse. I am also aware that this has sometimes been portrayed as professional weakness. I absolutely disagree. More than any other group of NHS staff, nurses have the in-depth knowledge of service users as individuals that comes from working in the closest proximity for the most extended periods of time.

By showing a willingness to adopt new ways of working, nurses show that their priorities lie in improving the quality of care for their patients, and that they are keeping pace with modern practice and a newly emerging evidence base about the most effective approaches to care.

In this way, nurses are helping to ensure that nursing remains at the forefront of modern mental health care – for example, I know that there are more Nurse Consultants in Forensic Care than in any other mental health speciality – and this is something you should be proud of.

Fourth, I believe there are changes in the law that will make a significant difference to the lives of nurses working in mental health settings. I’d like to highlight two – the new Mental Health Bill, and growth in the scope for Nurse Prescribing

The Mental Health Bill

As you know, the draft Mental Health Bill was published for pre-legislative scrutiny by a Parliamentary committee last month.

“This scrutiny committee is made up of 24 members of the House of Commons and House of Lords, from across Government. It is very important that this committee should scrutinise the Bill, because there have been a lot of misunderstandings about the Bill, and the committee will ensure that there is an informed, constructive debate.

For example, there have been claims that the Bill has been driven by public safety. This is not the case. What this Bill does is to make significant improvements to patient safeguards; to provide a modern legal framework more in line with modern patterns of treatment and with human rights law; and to protect the health and safety of patients and others by enabling the right treatment to be given at the right time. Like the 1983 Act, the Bill balances an individual’s rights with the need to prevent harm. It provides for the lawful application of compulsion to people with mental health problems where it is necessary for their health and safety and/or for the protection of others.

There have also been claims that the Bill creates new powers to detain people who have not committed an offence. This is not true. The power to detain people who have not offended, but who need treatment to protect them or others, has been with us at least since 1959. It has also been said that the Bill will enable people to be detained without treatment if they are dangerous, because it has removed the “treatability test” from the 1983 Act. Again, this is not true. The Bill does not permit anyone to be detained without treatment. Instead of the small minority of patients to whom the treatability test currently applies under the 1983 Act, under the Bill nobody can be made subject to compulsion unless there is treatment available which is specifically addressed to their personal needs.”

The Bill – like the current Act – makes provision for people with serious mental disorders who come before the courts. I know that this is a group of patients with whom many of you, as nurses working in forensic settings, are very familiar.

The purpose of this part of the Bill is to make sure we deal appropriately with offenders who have mental health needs, so that they can get the treatment they require. These parts of the Bill are generally similar to those in the current Act.

But one important change, is that the Bill will allow mentally disordered offenders who are not dangerous to be given mental health disposal in the community as an alternative to prison. This will mean that those for whom this is a safe and meaningful option can more easily receive the mental health treatment they need, and support to reduce the risk of re-offending.

The Bill also proposes ways to open up new roles for you in the future – including the role of Approved Mental health Practitioner, Mental Health Tribunal member, or Clinical Supervisor. As the number of nurses working in new community teams continues to grow, I am optimistic that there will be a positive and constructive synergy between these things. I am confident that there will be important opportunities for nurses with experience of work in forensic settings to develop and extend their role outside traditional hospital environments.

Nurse prescribing

Supplementary Prescribing will, I believe, allow you as nurses, make better use of your knowledge and skills. I am very pleased to be able to announce that the Department of Health is to invest £140,000 on a research project specifically to look at Supplementary Prescribing by Mental Health nurses. This demonstrates the importance we attach to this new role for nurses and its huge potential for the future. It also shows that we are determined to check that new developments are safe and beneficial to service users. It will help to promote the delivery of choice by service users, and will improve the responsiveness of service as a whole.

One example of someone making the most of the new roles available to nurses is well known to many of you. Barrie Green is a Nurse Consultant from Humberside Regional Secure Unit. He combines clinical work, for example in the area of anger management, with research interests, and he has a professional leadership role across a number of forensic and other services.

Now, Barrie is about to take on another role to complement these – as a Nurse Supplementary Prescriber. I believe this will help him make the service more responsive to service users and help to build on the therapeutic relationships that Barrie and his colleagues strive to maintain.

BME programme

Before I finish, I want to mention one other area of work that has recently received extra attention. It concerns race equality. It concerns the evidence we have had for some time that people with mental health problems from black and minority ethnic communities receive a less than equal service.

There are complex reasons for this. However, the research and service users tell us that people with mental disorders from BME communities are more likely to be detained under Section of the Mental Health Act if they have a severe mental disorder; they are less likely to be offered a psychological therapy, and more likely to be offered a drug treatment. Overall, they are less likely to receive services that are tailored to their needs and less satisfied than their White counterparts.

This is why race equality is an issue of central importance to the work you do. And why it has a very high priority for me.

As many of you will be aware, we issued Delivering Race Equality in October last year for consultation. This was a major milestone in the development of our thinking. We intend to publish the final version later this year – taking the necessary time to ensure that we get it right – and incorporating the Government’s response to the inquiry into the death of David Bennett.

We also began a significant programme of work through the National Institute for Mental Health, reporting directly to the Secretary of State, consisting of:

– 80 Community Engagement Projects

– a target to develop 500 Community Development Workers by 2006

– A diversity package for services

– A census of service users so changes can be monitored

– Nine senior Regional Equality Leads in NIMHE to support and assist local service development and

– Work to look at pathways to care and suicide prevention

More recently, I am delighted to report that Professor Kamlesh Patel, Head of the Centre for Ethnicity & Health at the University of Central Lancashire, has agreed to oversee our work to deliver this. He will help us make sure that work to assure race equality in mental health services connects to the wider Government programme on equality and human rights.

Many of you will be aware that Kamlesh is a prominent national figure who currently chairs the Mental Health Act Commission. He is also a Board member with the new Healthcare Commission and the National Treatment Agency for Substance Misuse. He has led the work undertaken by NIMH(E) since its inception. He has enormous experience, which will be of immeasurable value in the challenges ahead. And of course he’ll be working closely with Surinder Sharma, the first ever equality and human rights director for the NHS.


Let me finish by emphasising something I believe very strongly. It is you – not me – who hold the ability to mobilise the passion and power of the NHS to improve people’s lives; it is what you do that makes the difference.

I will continue to fight my corner for better mental health services, and to secure the resources and the support I know you need. I will continue to encourage managers to work with you – not around you – to raise quality and deliver efficient and effective care. I hope you will be encouraged by the place that mental health issues continues to have in the new Planning Framework.

Thank you once again for giving me the opportunity to be here with you today. I hope you have an excellent conference, and that it provides the opportunity to network and to have some fun as well as to work. I shall look forward to hearing how it goes.

Rosie Winterton – 2004 Speech to NHS Chairs Conference


Below is the text of the speech made by Rosie Winterton, the then Minister of State for Health, at the Queen Elizabeth II Conference Centre in London on 6 October 2004.

It is a real honour to have been invited to speak to all of you here today.

You all know the priority that this government has attached to the improvement of our National Health Service and so on behalf of the Secretary of State, John Reid and all the ministerial team I would like to first of all thank you for the work you have done so far.

However, as I am bound to say, there is much yet to do!

In a modern society collective strength is developed through a series of interdependent networks – each of us relying on the other for the commodities and services that enable us to function effectively and to make progress.

But what makes us strong also makes us potentially vulnerable. If the bonds that hold together our society are ever broken, then the consequences for us as a society are potentially catastrophic.

And that is one of the primary reasons why such importance has been attached to the modernisation of the NHS.

That’s the reason why people like Tony Blair and John Reid are prepared to invest such political capital into it. They know, as each of us in this room knows, that the effect of inter-generational underinvestment was beginning to endanger the very existence of our precious National Health Service.

That trend has been reversed.

Investment in the NHS is now rising faster than ever. Spending has risen from £33 billion in 1997 to over £58 billion this year.

It will continue rising and by 2008, will have reached a staggering £90 billion.

Real terms spending in the NHS is increasing at very nearly three times the rate achieved under the previous Government.

Of course such investment alone means little – it’s what you do with it that counts and while I am sure that you are all very familiar with the following figures, I’m equally sure they warrant just a little repetition!

• 77,500 more nurses working in the NHS, compared with 1997;

• over 19,000 more doctors;

• 68 major new hospitals built, under way or planned, as part of the largest ever hospital building programme.

Impressive though these figures may be, we must never forget that they are only a means to an end – what do the all these statistics mean to the people who use the NHS?

Well, there are now:

• Over 284,000 fewer people on the inpatient waiting list compared with March 1997;

• Virtually no waits of over 9 months for a hospital admission – down from the previous maximum wait of 18 months;

• Over 98 per cent of people seeing a GP within 48 hours; and

• 19 out of every 20 people being seen, diagnosed and treated within 4 hours in A&E departments.

There has been a 23% reduction in heart-related deaths since 1997, and a 10% reduction in the rate of premature deaths from cancer since 1997.

Such progress is a real testament to the commitment of government, the leadership of all of you and the sheer dedication of the 1.2 million people who work so hard to ensure that our National Health Service remains the envy of the world.

Well, everyone except the press it would seem!

Don’t worry; I’m not going to enter into a long and bitter tirade against some of the frankly disgraceful ways in which the media has portrayed our service.

It wouldn’t make any difference anyway.

But what I will say is this:

The fact that such extreme examples of personal or organisational failure make the front page of the newspapers should, paradoxically, give us grounds for optimism. It is precisely because these cases are exceptional that they do make the front page – the norm is good services – the exception is a failure.

Let’s never see the day when the exception of good service makes the news because that would clearly mean that the norm is failure.

Equally, such incidents present all of us with a reminder that while great progress is being made – a great deal remains to be done.

In June, John Reid set out plans for the next four years.

Built around continuing investment and reform, waiting times are set to fall to weeks not months. And for the first time, we will target long waits for tests and scans.

This is about helping the NHS become the service we all want it to be – one where patients are rightly offered greater choice and flexibility over when, where and how they are treated, but where we preserve and protect the fundamental principle that care should be provided free at the point of use and on the basis of need rather than ability to pay.

We will also extend the greater personalisation of patient care to people with chronic and long-term medical conditions. Some 17.5 million people have their life dominated by conditions that cannot be cured – diabetes, asthma, heart failure, and some mental health problems. Providing them with the personalised support and care that they need and deserve, to live fulfilling lives, will be a priority.

We will do this by providing thousands of community matrons, rolling out the Expert Patients Programme across the country and ensuring that the new contract for GPs delivers the best care for patients.

The very reason we are able to celebrate such remarkable progress is because you have made things happen, through strong and clear local leadership.

You have successfully harnessed the creativity and skills of your Boards, your staff, your partners and your communities to get behind this transformation.

The improvements have been hard won.

The management challenges are complex and demanding, requiring attention to detail.

The leadership task has required you to help everyone involved understand and hold on to the wider vision of improved health and transformed care – to keep the future clearly in view as we grapple with today’s issues.

So thank you for all you are doing – your commitment, your focus and time and your enthusiasm to make what I know will amount to a lasting legacy.

The Prime Minister’s message to you today paid tribute to your role in making a very real difference to the lives of so many people. I echo that. As Minister of State at the Department of Health, I have had many opportunities to see for myself just how far-reaching the improvements are for all patients and service users.

I also want to say a few words about the public service values that will guide the NHS on the next stage of our journey; and, in particular, how I see these values impacting on the work of Boards as we broaden our focus to embrace health and inequalities as well as improvements in services.

For me, the test of our progress goes beyond the statistics, impressive though they are.

It is about how well we are doing to improve the care and treatment of people who are socially disadvantaged or less well off; the care and treatment of people of different ages, ethnicity or gender; and the care and treatment of people who are marginalised or stigmatised in our society. It is about how we are tackling the inequalities in our healthcare system. I am sure these are your tests too.

A central tenet of the NHS is that care for all means care for all.

Not just some.

And care delivered according to need, rather than ability to pay. This is not a new value, but one that is still not felt or experienced by everyone using our services.

Equally important is that we must put people at the heart of all we do. This means listening to those we serve and acting on what we hear – a key role for Boards.

It means offering choice. Not choice between good and bad – but rather choice between excellent and excellent.

It means ensuring that care is personal to every individual. It means strengthening partnerships to deliver a more person-centred and value-driven pattern of care.

The next stage of our journey is all about local action and how that satisfies our quest for improved health, improved services and improved care.

Locally, between you, you can release the energy, power and innovation not just of your fellow leaders or the staff in your own organisations, but of local communities, local partners and local people as well.

We have different strengths and perspectives.

But we are all bound by the same values.

Our partners in local government can draw on their detailed knowledge of local communities and their experience of working through influence to deliver improved outcomes. Primary Care Trusts, by forging wider partnerships, can help raise ‘health’ higher on other agendas, such as Housing and Transport. Providers of care touch the lives of thousands of people every week, and can have a direct impact on the quality of life for many, many people.

And together, the more we share the challenge of modelling the way we want all employers to behave in promoting health and wellbeing – giving staff the strong signal that we value them and take their health seriously – the more this will have a direct influence on how they work with local communities, families, patients and service users.

So, through partnership and shared enterprise, based on the core NHS values, you are well equipped to develop and communicate a compelling local vision of how care will improve in your community.

You are equally well placed to practise what you preach in the way it is delivered.

Now is the time to use Local Strategic Partnerships and other partnership mechanisms to the full.

The time to construct a shared agenda and shared leadership.

The time to pay attention to the wellbeing of our own staff and their health.

And the time to focus ever more on listening to our communities and acting on what they say.

Good partnerships always require the trading of priorities and the need to transcend organisational boundaries.

We need – together – to devise better ways of creating incentives and rewarding effective partnership between health and social care, across the public sector, with communities and within healthcare.

We know that at local community level many people do not make distinctions between the Council and the Primary Care Trust or the different management arrangements in the Primary Care Trust, the surgery or the hospital. Frankly, they couldn’t care less!

They just see us all as part of public services and expect us to work together.

And where we show them that we can do this well, the reputation of the whole public sector benefits.

So, together, we should build a high trust system and avoid fragmentation.

We should stand united through our shared values and use the greater independence, localism and partnership to really benefit users and patients.

The next few weeks and months will bring new opportunities through the White Paper on public health and also through the developing vision for adult social care.

We have some immediate challenges to guard and enhance the reputation of the NHS – not least the cleanliness of our buildings, the quality and safety of the care we give, the way we support our staff, the way we demonstrate efficiency in the use of taxpayers’ money, the way we introduce new technology into clinical practice, and the critical importance of continuing to deliver on our targets.

You will play a key role in guiding your part of the NHS on this journey.

You will also be able to set the compelling vision for the future, building on local issues and priorities, in partnership with each other and with all those who can impact on the health of our population.

And I wish you well in this next stage of reform.

Finally, I want to use this opportunity to articulate a message on behalf of the whole government, through you, to all the people who work in our health service.

It’s a simple message, but one that we perhaps don’t use enough.

Thank you.

Thank you for what you have done.

Thank you for what you will do.

Thank you for all the times you have done that bit extra and thought that no-one had noticed.

And thank you for being great ambassadors for not only our National Health Service…. But also our country.

Thanks for listening.

Rosie Winterton – 2004 Speech to National Kidney Federation Conference


Below is the text of the speech made by Rosie Winterton, the then Minister of State for Health, on 2 October 2004.

1. I would like to thank the NKF on all the work they have done on advising us on strategy regarding renal services. It is so important that we have patient input – we must take notice of what patients and staff are saying on the frontline. I am grateful to the NKF for all their hard work with the All Party Parliamentary Kidney Group and for raising awareness in educating the public and patients.

Setting the Scene

2. We launched the NHS Plan four years ago. The Plan recognised it would take time to deliver a genuinely patient-centred service. That is why from the start it was a ten-year programme of investment and reform. Among other things, it identified the need to increase dialysis capacity by an extra haemodialysis stations by 2004. The NHS has exceeded that target. The latest data from the National Survey of Renal Units carried out by the UK Renal Registry shows that the number of stations increased by almost 700 between 1998 and 2002.

3. Kidney services are entering a new era. The Renal National Service Framework (NSF) was published 10 months ago. It put forward a clear vision of a truly world class renal service to be developed over the next ten years. All this is being be supported through greater capacity, and better and faster services.

4. The NSF is changing things for kidney patients, placing them and their families at the centre. It is ensuring they are consulted and involved in important decisions about their care. It aims to:

– give all patients a personalised care plan agreed with their clinician.

– provide access to information about the different treatment options – including a pre-emptive transplant if possible.

– make sure that any related operations are carried out in good time before dialysis starts; and

– give people a real choice about which treatment best suits their personal circumstances.

5. Back in June this year we launched the NHS Improvement Plan to take us into the next stage of reform. It set out plans for this personalised care and support for people with long term conditions, including people with kidney disease. Our vision is clear, our direction is set, and it is now down to all of us, including you as patients, to make the very best of this opportunity.

6. But we cannot have that vision without additional resources and we are doing that through,

More investment – By 2007/08 we shall be investing £90 Billion pounds per year in the NHS – up from £34 Billion in 1997. That is over 150% more investment in 10 years.
more capacity – as I said earlier the national survey of renal units found dialysis capacity expanding fast, exceeding the NHS Plan aspirations.
20,000 more doctors since 1997.
77,500 more nurses since 1997,

Modernisation Pilots (focusing on Vascular Access Surgery)

7. But we know there is more to do, for example we are working to identify and remove any blockages in the system around vascular access surgery. We know this is a real concern for dialysis patients. We have established two workforce pilots – in Exeter and Birmingham – that will follow patients through each point of their treatment, looking in detail at the tasks and staffing skills required to see if the process of care can be improved , but concentrating especially on vascular access surgery to get that speeded-up.

Renal NSF Part Two (not yet published)

8. I can assure this conference that we are determined to deliver further improvements through Part Two of the Renal NSF, which will follow soon. It will concentrate particularly on prevention and early management of kidney disease where so much difference can be made if we get it right. Donal O’Donoghue has spoken about some of the key areas we will be addressing in Part Two and I won’t say any more on that. But the NSF is key to supporting improvements in service quality and making services to suit you.

9. In July this year the Government launched National Standards: Local Action – the first ever national standards for the NHS. The standards provide a common set of requirements applying across all health care organisations to ensure that health services are both safe and of an acceptable quality. They also provide a framework for continuous improvement in the overall quality of care people receive.

10. The standards are supported by the all the National Service Frameworks and guidance about best practice from the National Institute for Clinical Excellence (NICE). These will provide a clear steer to implementing the national standards in renal services. It is the NSF and NICE guidance that the Healthcare Commission will use to develop criteria to assess the performance of NHS renal services, including kidney transplant units.


11. The NSF aims to give patients more say in the type of treatment they have. It means that NHS staff need to respect each patient’s values and preferences. Patients should be able to choose a treatment that is most appropriate for them at any particular time taking in account of their lifestyle.


12. As part of that choice agenda, we need to ensure that those people who choose to have a transplant and where it is clinically appropriate, are able to do so.

13. But as I am sure you know only too well demand for organs currently outstrips supply. In July 2003 we launched Saving Lives, Valuing Donors – a ten year framework identifying a four-fold challenge for Government the NHS and the public to:

– reduce the long-term need for organ transplants by preventing the ill health leading to organ failure – including kidney disease
increase the number of organs available
– design services around patients and allocate organs to people most likely to benefit
– optimise the effectiveness of organ and tissue transplantation.

14. The framework set out actions for Government and UK Transplant to take to encourage people to donate organs and tissues. These were to:

– raise quality and effectiveness

– improve clinical outcomes and quality of life

– increase the supply of organs

– accredit all tissue banks

15. And today I am launching a report of the progress made by Government and UK Transplant in meeting the commitments in Saving Lives, Valuing Donors and the challenges that remain.

16. Last year Government provided £3.6 million via UK Transplant to support initiatives in hospitals and specific publicity campaigns to increase transplantation rates and raise the profile of organ donation and the increased number of living kidney donor programmes alone has created a 21% increase in living kidney transplants.

17. I am delighted to say that, as a result of the investment, the dedication of staff in the NHS and UK Transplant and the generosity of donors, 2003/ 04 has been a record year.

18. In the UK between 1 April 2003 and 31 March 2004, we saw the highest number of kidney-only transplants for fourteen years, with living donation now representing one in four of all kidney-only transplants:

2,867 transplants were carried out, thanks to the generosity of
1,240 donors and 860,000 people were added to the NHS Organ Donor Register.

19. Non-heartbeating donation increased by 20%, meaning that more people than ever received a transplant from these donors.

20. These are all great successes and I am very proud of them. However, with over 5,000 people currently waiting for a kidney transplant we cannot be complacent. The report launched today also outlines the challenges that we need to address. These include,

• minimising relative refusals, by developing a better understanding of the reasons why relatives do not give permission for organ donation,
• increasing the number of people on the Organ Donor Register, through for example continued publicity such as the upcoming 10th anniversary celebrations of the Organ Donor Register
• and continuing to work with the renal industries and the voluntary organisations to raise awareness about the benefits of transplantation

Human Tissue Bill

21. It is also important to continue to demonstrate that our transplant services are based on strong ethical principles, which will encourage more people to agree to donation.

22. The Human Tissue Bill currently before Parliament will provide a consistent legal framework for donation and use of organs and tissue. In particular, the Bill will streamline and update current law on organ and tissue donation, to correct current anomalies and gaps. It provides safeguards and penalties to prevent a recurrence of the distress caused by the retention of tissues and organs without proper consent. The Bill will also help improve professional confidence, so that properly authorised supplies of tissue for research, education and transplantation can be maintained.

23. Amongst other things the Bill will make clear that the consent of the individual, given while alive, to organ or tissue donation, will be paramount. Surviving relatives will not have an automatic right of veto. But in the absence of that prior consent, the Bill will make clear whose consent will be needed for organ donation to proceed.

24. The Bill will also make clear that, subject to the Coroner’s agreement, steps can be taken – normally this would be cold perfusion – to preserve organ function immediately after death while the family’s view on donation is sought.

25. Taken together, these measures in the Human Tissue Bill will help to build and improve public confidence, which was undoubtedly damaged following the revelations of organ retention, so that an increasing number of people will be willing to agree to donating organs and tissues.

ALB Review

26. I wanted to say a few words about the Arms Length Body Review. A new national Blood and Transplant Authority is to be established to support the donation and safe use of human tissues. The new authority will replace the National Blood Authority and UK Transplant.

27. Both organisations have a proven track record of delivery and efficiency and welcome the opportunity to work together to pool their experience of promoting donation, collection, allocation and distribution of blood, organs and tissues on services to help save and improve patient lives.

28. Additionally Human Tissue Authority (HTA) will be merged with the Human Fertilisation and Embryology Authority, to create a new Human Fertility and Tissue Authority. This will take place following the completion of the current Human Fertilisation and Embryology Act 1990 review is complete. In the meantime the HFTA will be established, and will work on the development of procedures, protocols, and Codes of Practice


29. Over the next ten years we want to see renal services taken to a new level. There is a real opportunity to make a cultural change and with it, the opportunity to make a lasting difference. We want to see a patient centred service where patients are able to make real choices about when and where to receive their treatment which I realise is so important to all dialysis patients. In particular we need to continue to build on the significant successes of the last year. There have been real improvements but there are still gaps we need to address. Central Government can provide resources but we need to work with organisations such as the NKF to involve patients and staff to make a real difference to create a 21st century service.

Rosie Winterton – 2004 Speech to the Occupational Health and Safety Conference


Below is the text of the speech made by Rosie Winterton, the then Minister of State for Health, on 25 February 2004.

Thank you for inviting me to your first national occupational health and safety conference. I have heard that the first day was really successful and I hope those of you who were able to go to the dinner last night enjoyed the splendid meal. Deborah Veal’s story is truly inspirational and we can all learn from her attitude and approach.
I want to spend a little time looking at what has been done in Occupational Health. But rather more, I want to look forward – what does the future of Occupational Health look like?

But first I do want to say how important Occupational Health services are to delivering the NHS of the future. We employ 1.3 million people in the NHS in England, and recruiting more. The importance of an effective occupational health and safety service has never been more obvious. We value the dedication and commitment of NHS staff and we should be showing it by providing Occupational Health services which demonstrate that. Whether in preventing workplace illness or in ensuring staff are offered speedy rehabilitation back into work, Occupational Health services help deliver first rate care. It makes good business sense and meets our legal duties. But it is also it is simply the right way to support our staff.

But it is you and your colleagues, and the work that you do in hospitals and Primary Care Trusts, that makes the difference on the ground. I do want to congratulate you on the work you do, day in day out.

Let me turn to NHS Plus which was introduced two years ago. I know that many of you signed up to the NHS Plus initiative and the standards that went with it. Indeed, over half of you are currently involved with this project.

NHS Plus was based on improving standards. That is why one of the first steps was to set up an evidence-based guideline project. I am pleased today to announce that Dr Nadia Sheikh, from the Royal Free Hospital in north London, has been the first to be awarded funds from the project to develop such guidelines. Her proposal to review the evidence about risks to health at work for pregnant staff and nursing mothers returning to work – and how we can avoid these risks – was excellent. When the guidelines are produced they will make a crucial contribution to this important area.

This is only the first step in what I hope will be a series of guidelines that will ensure that we put quality at the heart of Occupational Health practice.

It is not only about developing new advice. I know that many of you have said that it can be difficult to find the existing information. From today, you will find existing guidance brought together for you in one place, on the NHS Plus website. The website is an integral part of NHS Plus, and was created to provide information for employers and employees. It continues to receive between 5,000 and 6,000 visitors per month. It is a cheap and accessible way of giving out health messages.

What should a high quality occupational health service for the NHS look like? Firstly, I want to see a service where there is equality of access for the entire NHS workforce. For example, like never before it is essential that those working in Primary Care are provided with comprehensive occupational health and safety services. PCTs have been provided with £8million to fund services for GPs and their staff in 2004/05. What’s more, an additional £3million on top of that, rising to £3.7million in the following year, has been given to PCTs for the provision of services to general dental practitioners and their staff. This means that from this coming year PCTs will have an additional £11million to fund services for those working in the primary care sector, which should ensure that they receive high quality occupational health care.

Providing services to our entire workforce is important. But so is the quality of occupational health care that is delivered. That is why I was pleased to see Louis Appleby yesterday launch ‘Mental Health & Employment in the NHS’. It is important that the NHS takes the lead in the field of good employment practice and no organisation is better placed to take the lead in the employment of people who have had mental health problems than the NHS itself.

Only 50% of people of working age with disabilities are in work and for those with a mental health disability, the figure falls as low as 15%. This is not just a tragedy for the individuals concerned and their families, but represents a waste of opportunity for the whole country.

The guidance launched yesterday has been lauded by the Disability Rights Commission as the biggest employer in Europe leading by example. It confirms the Department of Health’s commitment to anti-discrimination principles.

An example of how this can work in practice is being presented here at the conference. Norfolk Mental Healthcare NHS Trust and Meridian East, a local mental health charity, have entered into partnership to help previous service users back into work, and for some this means back into work in the NHS. For example, one individual with long-standing mental health issues is now employed as a care worker on an acute ward looking after very ill patients.

All of this follows on from the pioneering work carried out by Dr Rachel Perkins and her colleagues at the South West London and St George’s Mental Health NHS Trust and their Pathfinder Charter. This Charter sets out the principle that no one is discriminated against other than on their ability to meet the requirements of the job.

I know many of you contributed to the process of drawing up the new guidance, and I would like to thank you for your support and commitment to this important project. Stigma against mental health is still prevalent at work, even in the NHS, and anything we can do to counter that stigma can only be for the benefit of the NHS and for us all. One of the barriers to employment and job retention is the fear of managers. Often they feel they don’t have the skills to deal with staff who have a mental health problem. The Department of Health, together with the charity MindOut, published a managers’ toolkit a few weeks ago to overcome some of the imagined difficulties. Although written for managers in all workplaces, I am sure you will find it of value in the NHS.

Our work must be based on best practice. At an event a fortnight ago I was asked by someone working in a PCT whether we put unnecessary barriers in the way of employing people with disabilities. The tone of the question left me in no doubt about the questioner’s view! She was right to raise the question. We must constantly look at what we do and the consequences of our actions. Patient safety is of course vital. But it must not be misused as an excuse to stop otherwise good candidates from working in the NHS.

I am therefore pleased to announce that the Department of Health is to review the evidence base behind pre-employment health checks. Do they do what we want them to do? Do they put up unnecessary barriers? What do staff – and more importantly those who want to work in the health service – think of them? I want the review to report its findings this year and provide a basis for the development of an evidence-based system that is fit for purpose.

Some changes in Occupational Health practice have already been introduced. One example of such change is the occupational health smart card. Introducing the cards for NHS doctors in training provides a secure, streamlined and reliable system of recording health clearance for NHS Trusts and for the doctors themselves. Once data is on the cards and accessible to Occupational Health colleagues, this will act as a much-needed catalyst to closer inter-Trust co-operation and standardised clinical practices between Occupational Health units. For you, this ought to reduce your workload each time a new group of doctors joins your Trust.

Ministers are now committed to extending the scheme to all medical staff, including locum doctors, and this will link automatically to the GMC registration database to access current information on doctors’ registration and licence to practise.

Looking forward, what will Occupational Health look like in the next few years? I start with an Occupational Health service for the whole NHS workforce that is based on quality and with a strong evidence base. I understand many of you have been talking with Kit Harling about other changes – larger departments that can exploit economies of scale; more focused management; better career development opportunities; and increasing capacity. I am looking forward to seeing some proposals worked up shortly.

But in a sense, looking internally is the easy bit. What might the wider role be for Occupational Health? How can NHS Plus develop? How can your professional expertise – and that of your colleagues outside the NHS – benefit not only the health of our citizens but also the UK economy and the wider society?

There are nearly 3 million people who are not in work because of their health. Sickness absence costs the UK enormous sums of money – there may be arguments about precisely how much, but it is measured in billions. People falling out of the labour market suffer poorer health, increased illness and earlier death. But the good news is that regaining work reverses many of these problems. That is why workplace health is an important part of the public health agenda. The Secretary of State, John Reid, has recently announced a major consultation on public health, and workplace health will be part of it.

We in the Department are working with others. You will all have seen the new Health and Safety Executive strategy for 2010 and beyond published on Monday, and our joint work with the Department for Work and Pensions to help incapacity benefit customers back to work. So part of the vision is more joined up working. We have to find a way for the NHS to link with other providers of occupational health services in the voluntary and commercial sectors. We have to get clinicians thinking of ‘return to work’ as a specific outcome. There are innovative schemes out there at the moment, and I know many of you are involved with them. But we must do more and NHS Plus will, I am sure, have a key role to play.

We must also find ways to deliver occupational health support to all those who need it, not just those whose employers currently pay for services. This is what the Government will be doing over the next few months and we are committed to producing a framework for vocational rehabilitation by the summer.

Thank you once again for inviting me to your conference. I want to thank you for the tremendous work you all do in supporting our workforce. I hope you enjoy the rest of your day.

Rosie Winterton – 2003 Speech on Mental Health

Below is the text of the speech made by Rosie Winterton on mental health on 28th October 2003.

I am delighted to have the opportunity to address this fifth annual mental health forum organised by the SCMH. It is a good moment to take stock, and to set out the direction for the future in this time of transition for mental health care.

As most of you know when this government came into office, mental health was set as a priority for reform alongside cancer and CHD. Why? Because we inherited a legacy of under-investment in mental health services; a host of damaging inquiries into service failures, and a de-moralised under-supported workforce. Community services were in a sorry state.

There are no short term solutions to what needs to be done. This is a challenging time for mental health services.  It needs investment to build capacity – in new services and in the workforce, but it also needs reform in the way that those services are provided and that workforce cares for and treats people – modernised in-patient facilities, services that reach out into the community, making a reality of user involvement and recognising the key role that primary care needs to play in mental health services that treat people when and where it is most appropriate to do so.

This is why we have set out on a radical programme of modernisation so that the NHS and social services can improve access to effective treatment and care, reduce unfair variation, raise standards, and provide quicker and more convenient services.  We produced clear and comprehensive plans for improving mental health services that present the best opportunity and the biggest investment to improve the lives of a large and neglected group of people.

Thus underlining the importance of developing modern mental health and social care services for the one in six people, at any one time, who suffer from a mental health problem.

Our National Service Framework for Mental Health, developed in partnership with service users, professionals and stakeholders set out the action that was needed. It was the first NSF to be published and set out standards across the full spectrum of care from stigma and self care, to the action needed to prevent suicide amongst those with the most severe conditions.

But in publishing the NSF we knew the service faced a legacy of under-investment and a de-moralised workforce. This is why, though I am pleased we are making progress, I know that progress will not be easy or quick. I want to set out some of the steps that we have taken.

Over £300m new investment has been allocated for mental health services to ‘fast forward’ the national service framework  – over and above the 2001/02 baseline.

Second, we are directing it towards new teams and services for the most vulnerable: at Crisis Resolution and Home Treatment Teams, and Assertive Outreach teams; at services for people with severe personality disorder, and to improve mental health services in prisons.

We have also prioritised recruiting new staff, new ways of working and we are taking action to reduce stigma and strengthen primary care. Why? Because this is what service users and carers and other expert stakeholders said was most important.

I want to address directly the criticisms made of this ambitious plan. It is said that new money has not gone where it was supposed to go.  However, the Autumn assessment of mental health services shows absolutely unequivocal evidence of very significant increases in spend in the last financial year. For example, we know that £262 million went in to modernising mental health services in 2002-03. We are continuing to monitor this carefully.

With a number of major NHS Plan targets deadlines looming and resource pressures hitting hard, services in many areas are finding it hard to keep up. It is said that progress is slow on meeting targets. But there are now over 100 crisis resolution teams and over 200 assertive outreach teams in place, and targets for early intervention teams, and new staff and new ways of working are progressing. Mental health trusts have taken some very significant steps towards providing alternatives to inpatient care, where this is appropriate and safe. And I know that most people prefer treatment and care provided in this way. Home treatment, where possible and safe, helps avoid the stigma associated with hospitalisation and ensures people can stay in touch with their families and social networks.

It is said that workforce issues represent a risk to the programme – and I agree that this is a major challenge. But I am pleased to say that the number of consultant psychiatrists has risen by over 20% since 1997; the number of nurses by over 25% and the number of psychologists by over 50%. Work with the Royal College of Psychiatrists and the NHS Leadership Centre is progressing well. I am also very encouraged by plans being developed to employ new kinds of workers and by the establishment of 12 new training schemes to support primary care mental health.

We are now beginning to see Graduate mental health workers being employed to provide talking therapies and Gateway workers helping people access the full range of services they need. Early intervention in psychosis services are making a real breakthrough – we are now able to reach out to young people experiencing a first episode of psychosis faster and improve their treatment outcomes. And where they operate, Home Treatment services are giving people real choice in where they get the help and treatment they need.

It is said that commissioners and managers fail to give mental health the priority afforded to other areas; that Shifting the Balance of Power diverted attention away. But we shifted the balance of power so that resources could be more closely matched to the needs of local people; so that PCTs and their partner organisations could take full account of strengths or gaps in their area. Mental health is a priority and I believe we are starting to see some of the benefits. But local support is vital.

This is why we are putting in more effective systems– such as better information systems – and we are supporting growth in capacity through the National Institute for Mental Health in England.  We are doing this: –

– Through careful deliberation of Local Delivery Plans

– Through quarterly meetings with mental health leads in all SHAs

– Through support for Local Implementation Teams to make effective partnerships between health and social care

– Through action to promote engagement amongst people with mental health problems from black and minority ethnic (BME) communities (and not forgetting the BME implementation document I launched last week)

– Through the promotion of self-management of illness via NIMHE’s expert by experience programme

And when things go wrong – as they sometimes do – we will intervene. By the end of this month there will be an NHS Improvement Programme in every zero, one and two star NHS organisation that sets out how sustainable improvements in performance will be achieved. The Department has established a Recovery and Support Unit which can, in partnership with the Strategic Health Authority, help zero star trusts to:

– set up staff exchanges to bring additional support and help introduce new ways of working

– bring in expert providers from within or outside the NHS to advise on and implement improved systems and management practices

– and, as a last resort, to introduce new senior managers

But what about the future? We have to ‘mainstream’ health and social care services; to prevent problems developing, and promote healthier lives, and this goes much wider than the Department of Health. We have taken action to tackle poverty and low incomes; we are breaking down the barriers preventing people on Incapacity Benefit from getting back to work and the Supporting People programme is giving local authorities greater flexibility to support vulnerable people, including people with mental health problems, to retain tenancies and stay in their own homes.

So I am particularly pleased that the Prime Minister and Deputy Prime Minister asked the Social Exclusion Unit to consider what more can be done to reduce social exclusion amongst adults with mental health problems. This will help us think about how to improve rates of employment, social participation, and better access to services – of central importance to mental health service users and carers.

I would also like to mention the Choice Consultation being undertaken this autumn to listen to the concerns of service users and carers and to explore the scope to make services more responsive and more fair. I am personally very excited by the opportunities that both the Social Exclusion Unit Project and the Choice consultation provide. In working closely with service users and carers, they will help us understand what makes a real difference to people with mental health problems – a model for how I think we should be working in the future and I look forward to working with you to make that difference.

Finally, I’d like to come on to the draft Mental Health Bill. It is important that we get a Bill that more accurately reflects and supports modern health services, not only as they are today, but as they will be in the future.

We want to see a modern legislative framework for mental health service initiatives and investment to reflect modern patterns of care and treatment and human rights law. I want to see significant improvements to patient safeguards. But also to protect public safety by enabling patients to get the right treatment at the right time.

I would like to spend a moment to highlight some of the new safeguards which were set out in the draft Bill.

For the first time, all compulsion beyond 28 days will be authorised independently by the new Mental Health Tribunal.

For the first time, wherever possible the patient’s own choice of a nominated person can help and represent them.

For the first time, patients will have access to new specialist mental health advocacy to support them and their nominated person.

Under the changes there would be a requirement for every patient to have an individual written care plan.  And tribunals and courts will be independently advised by experts drawn from a new expert panel.

These are significant steps forward in ensuring a transparent system and support for people with a mental disorder.

I am aware that there has been a long silence following the consultation last year, and I appreciate the frustrations that many of you have felt.  We have been evaluating your response to consultation very carefully, and will be publishing our response before the Bill is introduced.  However, the dialogue with key stakeholder groups has continued over the last few months.

Before joining the Department of Health, as part of my work in the Department of Constitutional Affairs, I was responsible for bringing in the draft Mental Incapacity Bill. During this process, I met with as many stakeholders as possible to obtain their views.

However, there is some overlap, and work is continuing to ensure that there is consistency between the Mental Incapacity Bill and both the Mental Health Act and the new Mental Health Bill.

In my new job, I have made it a priority to meet with people concerned with the Mental Health Bill.

In recent months I have been participating in a series of meetings with stakeholders to road-test issues in some detail – issues such as how the Bill’s powers will work in the community and improving patient safeguards.

These meetings have been highly focussed, and have brought together service users, clinicians, managers and other interested parties.

Real progress is being made in these meetings – sometimes giving solutions and at other times just a much clearer idea of the problems!

I have found the meetings incredibly helpful, and have been impressed with the commitment of participants- many of whom feel strongly about the Bill- to look for practical solutions that will benefit service users.  This work is still ongoing.

While we may not always agree on the difficult issues that are involved in reforming the Mental Health Act, we must work together. Many of you in this room will have already influenced the Government’s plans for the better.

Of course there will be differences, but my suggestion to you today is that we build on the positive work that has already been done and keep looking for those practical solutions together.

Rosie Winterton – 1997 Maiden Speech in the House of Commons

Below is the text of the maiden speech made by Rosie Winterton in the House of Commons on 17th June 1997.

I congratulate my hon. Friend the Member for Regent’s Park and Kensington, North (Ms Buck) on her evocative and passionate speech. Her experience as a Westminster councillor has made her an expert on housing and local government. I am sure that her constituents will appreciate that. I am grateful for the opportunity to make my maiden speech on this important Bill, which will benefit directly the lives of many of my constituents in Doncaster, Central by improving housing provision and generating much-needed jobs.

In making a maiden speech, it is customary to refer to one’s immediate predecessor. I would like to go much further by paying a heartfelt tribute to Sir Harold Walker. He turned a Conservative seat into a Labour one in 1964, and served the people of Doncaster, Central loyally for 33 years. The people of Doncaster returned that loyalty with not only deep respect but true affection. Those feelings did not stem only from the fact that Sir Harold was an excellent constituency Member. Doncaster people are proud of Harold’s national work. He was the longest-serving Employment Minister and piloted through Parliament the Health and Safety at Work, etc. Act 1974, the Employment Protection Act 1975, and the Equal Pay Act 1970. He reformed the Merchant Shipping Acts and introduced many other pieces of legislation that bettered the employment conditions of millions of working people. Sir Harold went on to occupy with great distinction the position of Deputy Speaker and Chairman of Ways and Means for nine years.

Sir Harold’s one shortcoming is his time-keeping, which is due only to the fact that he so enjoys talking to people that he is often delayed in getting to meetings. He takes jokes about it in good heart, and during the general election campaign he apologised to an assembled company for his delayed arrival by saying, rather proudly, “I am of course known throughout Doncaster as the late Sir Harold Walker.”

During the general election campaign, I was reminded time after time by constituents of what a hard act to follow Harold would be. That was an unnerving experience, but Harold and his wife Mary did everything possible to help me during the campaign. They both worked tirelessly on my behalf; I could not have asked for more. Harold is not the tallest of men, and perhaps derives some pleasure from the thought that whilst he cannot tower over many people, he can at least tower over his successor.

Doncaster is renowned for its coal mining, its railways and its thoroughbred horse racing, which takes place on the Town Moor course. The Grand St. Leger, as I am sure hon. Members know, is one of the highlights of the racing calendar. There is one other fact about Doncaster that I hope will cause Ministers to look favourably on my constituency. In 1899, the Doncaster branch of the Amalgamated Society of Railway Servants sent a motion to the Trades Union Congress meeting in Plymouth. The motion called on the TUC to organise a joint conference with socialist and co-operative bodies to discuss Labour representation. Thus it was really in Doncaster that the Labour party was conceived. I am sure that hon. Members will be delighted to learn that the foundation meeting of the society was held at the Good Woman inn at St. Sepulchre Gate in Doncaster.

For me, being the area’s Member of Parliament is a special honour, as I was brought up in Doncaster. My mother Valerie was a nursery school teacher, and my father Gordon a local head teacher—and, later, an elected representative on Doncaster council. Let me take this opportunity to thank not only the electors of Doncaster, Central for giving me the privilege of serving them, but the members of the constituency Labour party for campaigning for me in the recent historic general election, with its Labour landslide.

Yorkshire people are famous for the warmth of their welcome, and the people of Doncaster are no exception. Since the election, I have been overwhelmed by people’s generosity and kindness, and I intend to repay that by doing my best to represent their interests in the House.

The Bill that we are discussing is about achieving two of the Government’s important objectives, jobs and social justice. When it is passed, councils such as mine in Doncaster will at last be able to use some of the money that they have in the bank from the sale of council houses to modernise existing homes and to build desperately needed new ones. The consequent building and refurbishment programme can be used to provide much-needed jobs and training in Doncaster. I believe that the Bill will end 18 years of unremitting underinvestment in housing in Doncaster.

More than 5,000 people in my constituency alone are victims of Tory neglect, waiting for homes and worried about accommodation for themselves and their families. They deserve better, and the Bill will help them in their aspirations for a better life. Too many people in the Doncaster area are out of work, alienated and disaffected because they see little hope or future. The knock-on effects on society, in terms of crime and the growing drug culture, are frightening to witness.

Much of the drive for change that will be brought about by the Bill is due to our two Ministers’ lifetime commitment to decent housing for all, and to local government. I understand that the Government will be looking to the construction industry to provide a significant number of new jobs and apprenticeships, but let me take that further, and ask whether the Ministers will visit my constituency to hear at first hand from a cross-section of representatives of my local authority and the voluntary and private sectors what Doncaster can do to assist in achieving the Government’s stated aims—securing jobs and social justice.

Britain’s housing problems cannot be eliminated overnight, and unemployment cannot be made to disappear immediately, but both difficulties can be alleviated through the regional development planning to which my right hon. Friend the Deputy Prime Minister and Secretary of State for the Environment, Transport and the Regions and his Ministers are dedicated. The Yorkshire and Humberside region could become the most exciting growth area in the country. From Sheffield to Humberside stretches a conurbation of great economic potential, where considerable growth could take place. Through the policies of my right hon. Friend and his Ministers, that growth will be encouraged, cultivated and fashioned to bring about a regeneration of Yorkshire and Humberside.

The Bill makes a start by tackling the basic issue of people’s right to decent homes. I believe that, if we can sort that out, many of society’s other problems can be tackled effectively. That is why I welcome the Bill, on behalf of my constituents in Doncaster, Central.