Gordon Brown – 2008 Speech to the Health Service Journal


I am honoured and delighted to be here this evening — to celebrate the 60th anniversary of the NHS with so many people who have done so much to make it what it is: Britain’s best-loved and most respected public service.

I was brought up to believe that the NHS reflected what Professor Richard Titmuss called the “gift relationship” — giving practical effect to people’s altruistic as well as self interested impulses. And for me, tonight is a welcome opportunity to do something we should do more often: to thank you and your many thousands of colleagues around the country for what you do for our nation:

The nurses and doctors who so often make the difference between life and death;

The clinical teams who work selflessly together for their patients – in surgery, intensive care and rehabilitation;

The staff the patients rarely see – working in laboratories, and in kitchens and offices – yet just as essential to the service and to patient care;

And of course the men and women on the boards and management teams that shape the NHS, lead it, hold it all together, all of whom are in public service because as they tell me they can make a difference.

And my own experiences have confirmed my instinct and belief that the uniqueness, indeed the greatness, of the NHS as a British institution is not just that it has cared for tens of millions of people and saved many hundreds of thousands of lives – and not only that it has been at the forefront of innovation, pioneering advances in medical treatment, in surgery and in imaging – but that with its unique guarantee of healthcare free for all at the point of need, it has liberated all of us from the fear of illness left untreated because the costs are beyond our means. A clear and enduring expression of the principle that healthcare is not a privilege to be purchased but a moral right secured for all.

There is scarcely a family in this country that does not owe either health or a life to the care of the NHS.

And I know I and my family owe it a great deal. When I was sixteen I was playing for my school rugby team against our former pupils; and sustained an injury that could have lead to blindness. Just as I was starting university, I spent many months in hospital as the NHS worked to save my sight. And it was the skills of a remarkable surgeon, the care of wonderful nurses, the attention and yes, the love and care of NHS staff that saved me from blindness. So when I say I am grateful to the NHS — for its existence, its principles, its staff, and the sometimes truly miraculous care it can deliver – I am speaking from the bottom of my heart.

And when I thank you and all your colleagues for what you do, I know I am speaking for millions of patients over the decades who are equally grateful for the care they have received.

Of course in its 60 years so far the NHS has had its ups and downs, but I like to think that – thanks largely to your efforts – the last decade has been one of the most lively, innovative and successful in its history.

And though as Chancellor for much of that time I had every confidence in you and in what you could deliver, it did occur to me that some extra funding might not go amiss.

So – as many of you will be aware – we managed to assist you in your endeavours. And together we have succeeded in reversing the effects of decades of underinvestment.

There are now 80,000 more nurses, 30,000 more hospital doctors, and 5,000 more GPs than in 1997.

Until 10 years ago the majority of NHS hospitals were built in pre NHS days. Now the NHS has 149 new hospitals and 90 new walk in centres either built or on the way.

The NHS now carries out a million more operations each year.

Its waiting lists are at their lowest level for a generation. Better NHS care for people with cancer and heart disease has saved 235,000 lives.

And just in the last year, we have increased GP opening times at weekends and in the evenings, put in place new measures to clean hospitals and tackle MRSA, moved the NHS from deficit to surplus and taken the first full steps towards a preventative health service with new rights to

And while a decade ago people wondered if the NHS at 50 had any future at all, it has not only survived; it has benefited enormously from a vivifying regime of more money, better management, and much patient-focused reform. And at 60 it is more firmly than ever part of the fabric of British national life.

But even as we celebrate, the challenges of the next decade are already upon us, and are utterly different from those the NHS faced 60 years ago.

In the early decades of the NHS people were just glad to have free health care when they needed it. Today, people want healthcare services which are tailored to their individual needs and their busy lifestyles.

Sixty years ago the main concerns were infectious diseases, acute medical and surgical illness, and the long struggle against cancer. Today, with the ageing population and a rise in so-called ‘lifestyle diseases’, the NHS finds itself having to support many more patients with long-term conditions – to provide the best of acute care when they need it and at the same time support their independence.

In the early decades, high-cost, high-technology interventions were rare or very rare. Today, costly but effective technology has opened up vast new areas of diagnosis and treatment: much of it – for example, heart transplantation – proven to be highly cost-effective. And new cutting edge science – from genetics to stem cell therapy – brings with it huge new potential for earlier diagnosis and dramatic new interventions.

But far from these challenges meaning we should abandon a universal health service free at the point of need, the NHS is today even more relevant. Because when the cost of some of the more effective health interventions is now far beyond ordinary family resources – and when there is a risk that genetic conditions will lead to people being excluded from private insurance – families more than ever need a system of funding like the NHS that insures everyone as comprehensively as possible against the risks of huge medical bills and ensures that the cost of that care will be absorbed not by us as individuals but by all of us together – pooling and sharing the risk in a comprehensive healthcare system publicly funded by taxation. The modern rational choice for healthcare: what I call the best insurance policy in the world.

But it is also right to acknowledge that for too long the NHS has been able to do too little about prevention; and has sometimes offered services that have been criticised as suiting the providers of care better than they suit the patients.

Now, the record levels of investment over its sixth decade have opened up the potential for us both to provide an excellent hospital and GP service and to fund new preventative programmes and care far better tailored to individual need.

In future, the NHS will identify your clinical needs earlier; the better targeted to keeping you healthy and fit, and will give you far more control of your own health and your own life.

And just as the formation of the NHS in 1948 was seen as a bold and daring leap forward, so the move to the preventative NHS will be another bold and daring leap forward.

It was to map out the next steps towards that vision of a personal, preventative health service that, almost a year ago this week, the Health Secretary Alan Johnson and I asked a clinician not a politician – Professor Ara Darzi – to carry out a fundamental review of the NHS. And let me thank him for his work which has involved engaging 2000 clinicians.

His vision is of an NHS of quality and excellence:

  • a world-class NHS with world-class services and worldclass care;
  • an NHS that provides personalized services that help people lead healthy and active lives;
  • an NHS where patients can take greater control over their own health and where professionals are empowered to become advocates for this new ‘patient

So building on our plans for check ups for over 40s and new rights to screening – for example for colon cancer and for breast cancer – and to preventive vaccines, our priority now is to develop much more comprehensive wellbeing services and to give patients much more control over the treatment and care they receive.

Everyone with a long-term condition will have their own personalised care plan; millions will be able to make the choice to become part of active patient programmes; all patients will now be guaranteed access to the most clinically and cost effective drugs and treatments – removing the last vestiges of the postcode lottery in the prescription of medicines in the NHS; and just as people can now choose which hospital they go to for their operation, so they will now have a right to choose which GP they register with for their day to day care.

And because we know that first class quality of care cannot be mandated from the centre but requires us instead to give NHS staff the opportunity to lead change themselves, Ara Darzi has also made recommendations for how we can empower and set free NHS staff.

Clinical advisory groups will be set up at every level of the NHS, and there will be new incentives to encourage and reward innovation at the front-line, greater freedoms for high performing GP practices and hospitals to develop new services for their patients, and a commitment from government that wherever staff and clinicians can show that changes will improve services for patients we will back you to the hilt. And all this will be supported by an NHS constitution setting out – for the first time – the rights and responsibilities of both patients and staff.

So if in the last generation progress in health care was seen simply in terms of the doctor administering antibiotics, in the coming generation it will be patients, doctors and NHS staff working together to improve health and manage conditions.

  • the doctor not just physician but adviser;
  • the nurse not just carer but trainer;
  • patients more than consumers — partners.

And I believe that the NHS is almost uniquely well placed to deliver this transformation: one of the most trusted organisations in British society, its doctors, nurses and staff recognised by everyone as a force for good in our country.

It is these strengths that we will build on for the future.

Our goal: to create for the next decade an NHS that is:

  • here for all of us but personal to each of us;
  • focused on prevention as much as cure;
  • fully prepared for the challenges of caring for an ageing population;
  • and strong and confident enough to put real control into the hands of individuals and their clinicians.

So with reform, modernisation and investment, our aim over the next six decades is to make the NHS not just the best insurance policy in the world but the best health service in the world.

This is a worthy mission for an institution as great and as significant in our lives as the National Health Service — and it is a transformation I ask you all to be a part of.