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Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at the Virginia Mason Hospital in Seattle on 26th March 2014.

Introduction

Let me start by saying what a huge pleasure it is to be here in Seattle, and how grateful I am to Gary Kaplan and Virginia Mason for hosting us today.

This hospital is one of those remarkable and special places that faced deep tragedy and yet somehow turned things round to achieve something extraordinary. Under Gary’s inspired leadership you are now rightly regarded as one of the safest hospitals in the world.

Which is why I wanted to come here to see it for myself.

The same transformation happened on much larger scale in a number of safety critical industries. Those names now familiar to us all – Bhopal, Chernobyl, Three Mile Island, Piper Alpha, Exxon Valdez – have become bywords in their industries as turning points which heralded a profound change in culture.

Yet strangely the healthcare sector itself has not collectively embraced that change.

Too often it has been a byword for an endeavour where avoidable safety failings end up being accepted as unavoidable. “These things happen” and “we did everything we could” seem to be acceptable responses, even though they would be intolerable in other contexts.

This makes your achievements here at Virginia Mason even more impressive.

Here the tragic death of Mrs Mary McClinton ten years ago – and its impact on her family, her doctors, the hospital and the wider community – became a turning point. Your resolve in choosing to learn and change as a response is an inspiration for healthcare professionals the world over. Just as in aviation or automobile manufacturing, when something goes wrong, you “stop the line”. And as a result much harm has been avoided and many lives saved.

We too, in the UK National Health Service, face our own turning point.

The appalling cruelty and neglect that happened between 2005 and 2009 at Mid Staffordshire hospital – and failings in care subsequently uncovered at other hospitals – have profoundly shocked our nation.

Just as Mrs McClinton’s death was a turning point for this one hospital, I want to make Mid Staffs a turning point for an entire health economy.

Not for one second do I underestimate the challenge of delivering change in 260 hospital Trusts employing 1.3 million staff across the system. But I believe we can do it.

As Professor Don Berwick – who wrote an outstanding report on improving safety in the NHS last year – said, in a unified system you have the ability to make systematic change on a national scale.

We also have something else: the extraordinary dedication of the NHS staff I meet every week, who have shown in the last year a profound commitment to learning the lessons of Mid Staffs and making our care world-class in its safety, effectiveness and compassion.

And we have good foundations to build on too, with impressive improvements already made in areas like cardiac surgery, hospital infections and the safe use of medicines.

What Price Safety?

“Fine words” say the sceptics, “but where’s the money? With all the pressures we face, it is simply not affordable to raise safety standards in way you ask”.

Nothing could be more wrong.

Wrong ethically, because it can never be right to condone a system in which patients suffer harm unnecessarily.

But wrong economically too.

Because our starting point must be to recognise that unsafe care ends up being more – not less – expensive, particularly if you look at the costs to the healthcare system as a whole.

Every year the NHS spends around £1.3 bn on litigation claims, money that could and should be spent on frontline staff. At a hospital level the figures are even more startling: in recent years North Cumbria paid £3.6m to just one individual. Bromley paid £7m to another. Tameside paid a staggering £44m in compensation over just four years.

System-wide, the financial impact is much greater than simply litigation awards. Whether in England, the US, Canada, France or Germany we know about one in ten patients experience harm when they are in hospital. For England one study found that this added three million bed days a year at a cost of £1 billion, with consequential costs adding a further billion pounds – and according to that same study around half of that harm is preventable.

The best hospitals deliver safe care on tight budgets not because the two contradict each other – but because gripping safety is an essential part of gripping budgets.

At Salford Royal, they estimate they have saved £5m per annum and 25,000 hospital bed days by the introduction of safer care. Here in Virginia Mason, I understand that you have saved as much as $15m through your improvements to patient safety.

More than a financial cost

Money matters, of course, but look at the impact on staff – and above all patients and their families.

There can be no greater breach of the trust between clinician and patient than when a patient is harmed unnecessarily. There may be a profit motive in no-fault manufacturing but there is a moral motive for zero-harm healthcare. And we should welcome that – because that is what healthcare is: the privilege of helping human beings at their most vulnerable, the noble purpose that motivates doctors and nurses the world over.

And the effect on frontline healthcare workers is profound if unsafe care is not checked.

Not only does it take up huge amounts of clinical time when mistakes have to be corrected and hospital stays prolonged. It has – as I have seen for myself – a devastating effect on staff morale and self-confidence. Avoidable harm does more than damage institutional reputations – it is a violation of the values and ideals that unite everyone in the provision of health.

Financially, reputationally and morally unsafe care carries a price – a price we cannot and should not pay.

Sign up to Safety Movement

So today, I sign up to safety.

I want today to mark the start of a new movement within the NHS in which each and every part of our remarkable healthcare system signs up to safety, heart and soul, board to ward.

Professor Berwick said the heart of safe care is a culture of learning.

So the engine room of this new movement will be a new national network housed in NHS England, a collaboration of all NHS organisations and local patients, who share, learn and improve ideas for reducing harm and saving lives.

The first 12 vanguard hospitals signed up to the movement this week. Within the next few months I will write to every NHS organisation in England, inviting them to join and sign up to safety. I hope over time that every hospital in England will rise to the challenge and join the campaign.

Every hospital Trust that chooses to join will commit to a new ambition: to reduce avoidable harm by a half, reduce the costs of harm by one half, and in doing so contribute to saving up to 6,000 lives nationally over the next three years.

I have asked NHS England, Monitor and the Trust Development Authority to work together to put in place support for hospitals to develop their plans to do this. They will provide advice to ensure that each plan takes full account of the international evidence as to what measures have the most impact. For those hospitals that sign up, The Chief Inspector of Hospitals will include progress against these plans as important evidence to inform the inspection and ratings regime. They will also be reviewed by the NHS Litigation Authority, which indemnifies trusts against law suits, and, when approved, they will reduce the premiums paid by all hospitals successfully implementing them.

Starting this year, the campaign will recruit 5,000 safety champions as local change agents and experts – safety ambassadors, safety agitators, safety evangelists – a grassroots safety insurgency across England which will seek out harm, confront it and help to fix it.

We will go beyond institutions to seek to sign as many staff in the NHS as we can to the safety campaign. Just as more than 500,000 people this month made individual pledges to improve care for patients on NHS Change Day, the movement will seek to harness that great well of values and expertise in the NHS to a common endeavour on safety.

Members of the campaign, which will be formally launched in June, will be supported by a new team, Safety Action For England, consisting of senior clinicians, managers and patients with a proven track record in tackling unsafe care – people frontline staff will respect, listen to and work with. They will ensure fast, flexible and intensive support when the line needs to be stopped and a lesson needs to be learned in England.

A whole system will be wired together so that where unsafe practice is detected at one end of the country, the lesson is learned at the other end as well.

An Open Culture

Critical to the success of this movement will be a culture of openness and transparency.

Again, though, “easy to say”.

Because being open when something is going wrong demands change. It challenges established practices to which people are attached. It shakes up the consensus that develops in some places that poor care is normal – the “normalisation of cruelty” as I have called it.

Openness acknowledges problems, studies them and fixes them. It doesn’t shrug. It “stops the line”.

So we must start by acknowledging that the NHS has not always done the right thing by people who speak out about poor care. Relatives like Julie Bailey and James Titcombe, campaigning after the loss of a loved one. Whistle-blowers like Helene Donnelly and Kay Sheldon. And politicians like Ann Clywd and Andrew Davies who have spoken out about poor care in Wales. Never should speaking out be confused with a lack of commitment to NHS values or “running down the NHS”. The highest form of commitment to our NHS is surely the courage to speak out against the system when the system gets it wrong.

So we have already taken a number of important steps to nurture an open and transparent culture.

First, I have implemented a series of measures to help staff speak up when they have concerns about poor care. I have banned “gagging clauses” in severance agreements when staff leave their employers, which prevent them from talking about harm to patients. There will be a new duty of candour in professional codes, making clear the need for all doctors and nurses to come clean quickly when things go wrong – and to encourage a blame-free culture, agreement that early candour should act as a clear mitigating factor in any investigation of misconduct.

I am also introducing a new statutory duty of candour on organisations, giving them a clear legal duty to tell patients when they have been harmed. Today I can announce the start of a consultation to include all significant harm – death, serious and moderate harm – in the new duty, as recommended by Professor Norman Williams, President of the Royal College of Surgeons and Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust. This will help to make English NHS hospitals amongst the most open and transparent in the world and mark the start of a transformation in our safety culture.

Legislation, however, is not enough. We also need to equip staff with the skills and confidence to speak up. So today I am announcing two important additional measures. First, I have asked Health Education England to work with brave whistleblower Helene Donnelly to ensure that raising concerns about patient care and safety becomes part of mandatory training requirements for all NHS staff – her current role at Staffordshire and Stoke on Trent Partnership Trust, incidentally, is a model for what the new cohort of safety ambassadors should aspire to. And secondly, we will also ensure that the new Care Certificate we are introducing for healthcare assistants includes training on how to raise concerns about poor patient care.

Safety in Numbers

To support that drive for openness, we have overhauled our national regulator, the Care Quality Commission, to underline its independence and reinstate thorough and expert inspection of hospitals to ensure the quality of their care. The safety and culture of a hospital will be critical subjects of the scrutiny, as will complaints handling, incident reporting, falls, pressure sores, staffing levels and so forth.

The inspectors are also listening to staff and patients and the board to get a proper feel for a place – and make an expert judgment about whether its leaders really are alert to safety and keen to learn when things go wrong.

I suspect Virginia Mason would be assessed by our regulators as “outstanding”.

Whilst I suspect it, I think you know it – because you have the numbers to prove it. Once we have our culture in the right place, the next thing we reach for is the data. It allows us to manage improvement. It allows us to ring alarm bells. And it provides evidence to patients that they can place their trust in us when they are at their most vulnerable.

So for many organisations, the first step will be to collect safety data more reliably. And as that happens, the level of reported harm will increase. Not because avoidable harm is actually increasing – but because it is being properly reported for the first time. Indeed, halving avoidable harm may mean doubling reported harm.

I am pleased that Professor Sir Bruce Keogh is currently working with senior clinicians across the system to develop an indicator so that we can properly understand whether particular reporting levels indicate the right reporting culture in an organisation.

And from June a dedicated section of the NHS Choices website – “How Safe is my Hospital” – will allow the public to compare hospitals in England on a range of safety indicators. For safe staffing, from this June it will be at ward level, every month, allowing the public to check the wards used by their own loved-ones.

They will also be able to check incident reporting levels, MRSA and C difficile rates, pressure ulcers, falls, and compliance with patient safety alerts. Here, the power of peer pressure should spur hospitals to ever higher standards of safety and patient care.

But I intend to go further still. We need to ensure that unsafe care has nowhere to hide.

We need a much more reliable measure of actual harm that allows proper comparisons. So NHS England are developing a new system based on external reviews of the case notes of where people have died or experienced harm. Together with new independent Medical Examiners, this will give us, for the first time, a more reliable national average of avoidable hospital deaths and a more effective “smoke alarm”, triggering closer scrutiny of the outliers.

Conclusion

Let me finish on an optimistic note. Because progress on safety has not gone unnoticed.

In our latest annual survey of public opinion on the NHS, public confidence dipped a little: unsurprising in the wake of the Mid Staffs scandal. But 77% of the public agreed with the statement: “if I was ill I would feel safe in an NHS hospital”, the highest level ever recorded. And 73% agreed that people are treated with dignity and respect in the NHS, again the highest ever.

We still have further to go, but this is real progress and a sign of what can be achieved if we really focus our efforts.

Today, 12 hospitals in England have ‘Signed up to Safety’. They are the pioneers. Throughout this year, the movement will be signing up more champions, more hospitals and more staff.

So let us make today the moment we stopped the line on wasteful and unsafe care in the NHS and reaffirmed our conviction in everything it stands for. Let today mark the moment when we resolved the NHS should not only be the fairest healthcare system in the world, but also the safest.

Thank you.

Below is the Christmas Message made by Jeremy Hunt, the Secretary of State for Health, to NHS Staff on 23rd December 2013.

As we go into the Christmas period, I want to start by thanking the many of you who will be working over the next two weeks. You are giving up precious time with your families so that everyone else can enjoy Christmas secure in the knowledge that a superb NHS is there for them if anything goes wrong. I know the public are incredibly grateful – and I also know how much you will be doing to cheer up people in your care who would rather be home with their families even if they can’t this year. A & E departments in particular can be busy in the festive period and I am urging people who use the NHS to take the trouble to thank staff for the sacrifices they are making.

This month we held the world’s first ever G8 Summit on dementia. I remember meeting an NHS care home manager in north London, who told me the efforts she went to for her patients: “If I can put a smile on their face, they won’t remember it tomorrow but I will – and I go home with an even bigger smile on mine.” There is so much amazing care – but also a lot of misunderstanding of dementia.

That’s why it is so significant that the leading countries of the world have agreed not just to work together to find a cure or a disease modifying therapy for dementia by 2025, but also to collaborate on ways of improving care. France in particular has a care model that I want to study carefully, to see what we can learn. In the meantime, I hope as many of you as possible will speak to your family and friends about dementia and spread the word about becoming a Dementia Friend. The training only takes a couple of hours, but will help raise everyone’s understanding of this very challenging condition.

Finally, I would like to say a particular thank you to district nurses who will be spending the festive period visiting vulnerable and often lonely older people. You do an inspiring job not just over Christmas but throughout the year and we need more of you!

We need to be better as a society at looking after lonely older people, particularly the 5 million people who say their main company is TV. I would encourage everyone to sign up to NHS England’s fantastic Winter Friend scheme, and take time this winter to look in on an elderly friend or neighbour to check they are warm, well and safe.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, on 11th December 2013.

Ladies and gentlemen,

It is fantastic to see you all here today for the world’s first G8 Dementia Summit.

And it is right we should be here. As life expectancy goes up, our generation has a unique challenge: will those extra years at the end of our lives be ones we can look forward to with anticipation – or will they be ones we end up dreading?

One in three of us will get dementia. And if we don’t do better, for one in three those later years could be years of agony, heartbreak and despair – not just for those of us with the condition, but for our families, friends and loved ones too.

9 years ago Britain hosted the G8 in Gleneagles in Scotland. And we faced up to a different health challenge – HIV/AIDS. We did a brave and wonderful thing, declaring that anti-retroviral drugs should become available to all who needed them. Thanks to that, we have turned the global tide in the battle against AIDS.

Now we need to do it again.

We will bankrupt our healthcare systems if we don’t. Here in the UK the cost of dementia is £23 billion and globally it is approaching $600 billion. One in four people in UK hospitals have dementia, but the costs extend well beyond hospital care into social care, community care and the opportunity costs for carers.

But the real reason to do something about dementia is not financial.

The real reason is human. Everyone deserves to live their final years with dignity, respect and the support of loved-ones. That was the dream of universal healthcare coverage when we founded the NHS in the UK 65 years ago. Now with an ageing population we need to reinvent the model.

So let us focus on three areas of action for this summit.

Firstly to redouble our efforts to find a drug that can halt or reverse the brain decay caused by dementia. We thought we could never combat HIV. But just 9 years after the Gleneagles summit and with the involvement of some of Britain’s best universities, we are talking about a potential vaccine. We need that spirit of scientific endeavour for dementia and Alzheimer’s as well – and there is some fantastic work going on in our universities and research laboratories.

Secondly we need to improve diagnosis rates. In this country, despite our brilliant NHS, less than half of dementia patients get a diagnosis. Too many people – even some doctors – think there is no point. But with a diagnosis we can give out medicines that help some people; we can put in place support for families; we can encourage lifestyle change – all of which can mean people live at home happily and healthily for many years longer.

Thirdly let’s fight the stigma around dementia in society. When I was born in the 1960s, people didn’t like talking about cancer. The first step to improving treatment was to make it normal – we need to do that for dementia. So following the inspiring programme in Japan, we are trying to recruit one million dementia friends in England – people who know the basics and can be ambassadors for fighting stigma.

Right here we have the A team. Health ministers, science ministers, pharmaceutical companies, researchers, voluntary organisations, the OECD and the WHO. And we have some even more special guests: people who themselves have dementia and have had the courage to come today. Let us recognise them.

Let us today match their courage by daring to aim big. By showing future generations we were up to this challenge, ready to do what it takes to harness science, research and humanity to turn one of humanity’s greatest threats into one of its greatest achievements.

Thank you.

Below is the text of the speech made by the Health Secretary, Jeremy Hunt, on the 18th October 2013.

Introduction

Last month I visited the superb Woodside Care Home in Bath.

Woodside has a scheme where GPs make regular, proactive visits. This provides great reassurance and has reduced hospital admissions by 40 per cent.

The Care Quality Commission has praised Woodside for its kindness and warmth, regular assessments of residents’ needs, joined-working, and encouragement of activity and independence.

That’s exactly what I saw.

Staff who treated residents as they would their own parent or grandparent.

Managers who had braved difficult conversations about end of life care with residents and their families.

GPs who visited residents regularly with a seamless interface of care between the home and the local NHS.

Thoughtful, proactive, skilful, world-class care.

I was put to work helping with sandwiches, cakes and drinks – fantastically straightforward compared to many tasks the professionals face. But the kind of job that makes a real difference to quality of life if it is done with humour and kindness, as it clearly was there.

Dealing with complex medical conditions takes real skill. Developing a bond with someone who may not have long to live takes courage. Helping a person with intimate tasks demands both respect and compassion. And devoting yourself to the care of others – often with little public recognition – takes moral fibre. So let me start by thanking you and your teams for the remarkable, unsung contribution you make to our national life.

The forgotten million

Everyone’s care matters equally. I am deeply moved and hugely impressed by the best of children’s services, who help to ensure that everyone – whatever their background – has the right start in life. No work could be more important than that. But I want to focus on older people today.

And inspiring though the care at places like Woodside is, we all know there are many places that do not meet those high standards.

We also know there is a broader problem of loneliness that in our busy lives we have utterly failed to confront as a society.

There are now around 400,000 people in care homes. But according to the Campaign to End Loneliness, there are double that number – 800,000 people in England – who are chronically lonely.

46 per cent of people aged 80 or over report feeling lonely some of the time or often.

Some five million people say television is their main form of company. That’s 10% of the population.

And apart from the sheer cost of human unhappiness, there are massive health implications too.

Loneliness is as bad for one’s health as smoking fifteen cigarettes a day.

It is actually worse for you than obesity because it increases the risk of heart disease, blood clots and dementia.

Lonely people have poorer function in daily activities. They drink more. They are more likely to undergo early admission into residential or nursing care.

And perhaps we should talk not about the cost in terms of human unhappiness, but the cost in terms of avoidable human unhappiness. Because each and every lonely person has someone who could visit them and offer companionship. A forgotten million who live amongst us – ignored to our national shame.

This challenge cannot be solved by ministerial or local government diktat. But there is a great deal we can do to make things better and today I want to talk about three areas in particular.

Raising standards

The first is the need to apply rigorous, unflinchingly high standards of care – not just in the NHS, but in the social care sector too.

Last month a court found that an 86-year-old Bedfordshire care home resident with Alzheimer’s was picked up by the scruff of his neck and dumped in a wheelchair, having initially been ignored on the floor after a fall. He has since died.

His name was Albert Riches.

It is an outrage that anyone should be treated like this, let alone a vulnerable, older man. But it was not an isolated case.

112,000 cases of alleged abuse were referred to English councils in 2012-13, the majority involving over-65’s. And of those that have been investigated, nearly half have been partly or fully substantiated.

Something is badly wrong in a society where potentially one thousand such instances are happening every single week.

I totally reject the notion that such talk undermines the workforce as a whole.

In reality, the opposite is true.

When failings are not tackled head-on, dedicated staff face the double whammy of both having to deal with the individual tragedies and taking the hit to their own profession’s standing.

An Age UK survey this year found that just 26% of the general public are confident that older people who receive social care are treated with dignity.

What is worse is when lecturers in ethics legitimise such behaviour by saying – as was reported last month – that “compassion is not a necessary component of healthcare.” If compassion does not run through every vein of the health and social care system then we are betraying not only an entire generation of vulnerable older people, but our own values too.

Transparency

The only way to deal with poor standards is total transparency.

Which is why I am delighted that this year, for the first time, we have appointed a Chief Inspector of Social Care, Andrea Sutcliffe. She is putting together a comprehensive new rating system for social care providers, working closely with the sector. Like all our new chief inspectors, she will act as a champion of the people who use the services.

The nation’s whistleblower-in-chief.

From April 2014, there will be new style inspections against five key questions – is it safe; effective; caring; responsive and well-led – and Andrea will start giving ratings to care homes from October 2014. All locations – some 25,000 in total – will be inspected by March 2016 and then receive official ratings. These will be accessible to the public online and easy to understand.

She is absolutely right to demand that they all pass a “good enough for my mum” test and to denounce a tick-box culture. The involvement of “experts by experience”, residents, carers, and specialist inspectors will make a huge difference.

Andrea is also going to gather opinions on covert filming. It is of course vital that people’s privacy and dignity are fully respected. But covert filming has already helped to uncover abuse, inspectors need solid information, and I understand why more consideration is being given to this.

Andrea’s determination to combine her role as whistleblower-in-chief with celebrating the best of care is something I fully endorse.

Just as we know how good all our local schools are thanks to rigorous, independent inspections by Ofsted, I want us all to know how good our local care is. Simple, resident-focused inspections which look at the things that really matter, rather than simply the boxes that have been ticked.

And end up with an Ofsted-style rating that tells us in plain language if a service is outstanding, good, requiring improvement or inadequate.

And we will underpin this by legislating in the Care Bill to give the CQC statutory independence over the content of its inspections. Ministers must never again lean on the CQC over the issuing of news about quality inspections. Sunlight is the best disinfectant, and the biggest weapon we have to drive up standards, making sure failings are exposed as quickly as possible.

Training and development

1.6 million people work in the care industry, so the second area we need to focus on is improving their training and development.

Lyn Romeo, the newly appointed and first Chief Social Worker, will support and challenge social workers to ensure that vulnerable adults get the best possible help, with improved safeguards for residential and domiciliary care.

Camilla Cavendish’s review into healthcare assistants and support workers expressed deep concern at variations in training standards, and she wrote, damningly, that she had “been struck by how disconnected the systems are which care for the public,” adding “the NHS operates in silos, and social care is seen as a distant land occupied by a different tribe.”

We will issue a formal response soon but hope to adopt many if not all of her recommendations.

My department is also spending £12 million on the Workforce Development Fund for training and we will work closely with Skills for Care and the National Skills Academy Social Care to improve skill levels in adult social care. And we are doubling to 100,000 the number of apprentices that get high-quality training and support by 2017.

All of which I hope will make a big difference.

Social care funding

The third area we need to address is funding.

I recognise there have been cuts in funding to local authorities as we seek to deal with the deficit. Perhaps less recognised is that funding per head for adult social care fell under the last government too. But politicians of all parties need to be honest that the pattern of gradually reducing funding in the face of an ageing population is simply not sustainable – and we need to change the model.

Let’s talk about the money we have allocated first.

We have committed an additional £7.2 billion, including a contribution from the NHS budget, for adult social care over the course of this parliament.

On top of the Dilnot reforms, we are committed to increasing government investment in social care through a £3.8 billion pooled budget for health and social care in 2015-16. It comes on top of an extra £200 million for social care in 2014-15.

But those reforms do something else as well.

By implementing a cap on care costs of £72,000, they make it possible for people to plan for their social care costs in the same way they plan for their pension. Which will lead to a dramatic increase in planned funding being put aside to fund end-of-life care costs.

Our objective is to be one of the first countries in the world where, as part of their pension plans, most people save throughout their lives for their likely care costs.

But even additional financial support will not be adequate unless we also change the model.

It is high time we closed the gaps that see people being sent round the houses, breakdowns in communication, and wrangling over budgets.

Which is why rather than simply adding £2 billon to existing support for social care in 2015-16, we are combining both into a £3.8 billion single health and social care transformation fund. To access this, each local plan will have to offer genuinely integrated care: joint commissioning, joint provision, seven-day services, full record-sharing and professionals accountable for seamless, joined-up care.

I have asked for all integration plans to be approved and in place by next April because although the funding does not start until April 2015, many authorities will want to start earlier as the potential for both improving care and making savings is immense.

A social solution

But this is not just a government – or even a local government – solution.

There has to be a social solution too.

My wife is Chinese and I am struck by the reverence and respect for older people in Asian culture. In China and Japan, it is quite normal for elderly parents to live with their children and their families. The Indian government has even announced recently that it plans to name and shame people who abandon their parents.

Let me be absolutely clear. There are occasions where it’s right and necessary for older people to go into care homes and no family should feel condemned for taking that difficult decision.

In those countries, when living alone is no longer possible, residential care is a last rather than a first option. And the social contract is stronger because as children see how their own grandparents are looked after, they develop higher expectations of how they too will be treated when they get old.

If we are to tackle the challenge of an ageing society, we must learn from this – and restore and reinvigorate the social contract between generations. And uncomfortable though it is to say it, it will only start with changes in the way we personally treat our own parents and grandparents.

Conclusion

Professor Tom Kirkwood of Newcastle University’s Institute for Ageing and Health talks of a 29-hour day. For every decade we live, life expectancy goes up two years – which works out as five hours for every 24 we live.

So we are putting aside five additional hours at the end of our lives for every day we live.

And the cruel irony of the pockets of failure that let the whole system down is that old age can be wonderful. Freed from the responsibility of work – and having cast off some of the stresses and preoccupations that can dominate earlier years – many older people thrive like never before, even as they battle infirmity.

Not everyone can have healthy last years. But our ambition must be that everyone has happy ones.

And all of us in this room share that ambition – indeed are dedicating their lives to meeting it.

We may have different roles to play, but together we can challenge society, celebrate and promote best practice, and agree that “good enough” is never enough.

And if we persist, we can do something even more amazing: really and truly make this country the best place in the world to grow old in.

Thank you.

Below is the text of the speech made by the Secretary of State for Health, Jeremy Hunt, to the 2013 National Conservative Convention on 19th March 2013.

When I became Health Secretary in September I said the job was the biggest privilege of my life.

That’s because the NHS is one of our most cherished institutions.

We can be proud that for 65 years our health service has ensured that everyone is entitled to treatment regardless of their background or income.

Over the last six months I have visited hospitals, surgeries and care homes across the country.

I have seen world-leading clinical practice, innovative use of technology and wonderful care from the dedicated doctors, nurses and healthcare assistants who look after 3 million people every week.

This Conservative-led government has shown our commitment to the NHS time and time again: by our protection of the NHS budget; by putting doctors and nurses in charge of two thirds of the budget; by funding the Dilnot proposals so people never have to sell their house to pay for social care; and by fighting to make sure vulnerable older patients are always treated with dignity and respect.

And we can be proud that our policies are making a real difference to people’s lives: on broadly the same budget as the last government, we are doing 400,000 more operations, 1 million more diagnostic tests and three million more outpatient appointments every year than happened under Labour; and 28,000 patients have benefited from the Cancer Drugs Fund they refused to set up.

Although I am proud of those achievements, I am even prouder of the contribution made by the extraordinary staff who work on the NHS frontline.

Let me give you one example: A & E departments now see 1 million more people every single year than when we took office.

I know the incredible pressures the doctors, nurses and healthcare assistants who work there are facing to deal with this surge in demand.

24/7 they do an extraordinary job and on behalf of everyone here I want to thank them for their remarkable dedication and commitment.

But it’s my job as Health Secretary not just to praise the best of the NHS but also to be honest about the failures.

If you care about something you don’t try to sweep problems under the carpet – you expose them, sort them out and make things better.

And by criticising us when we do that, Labour show extraordinary complacency about the treatment suffered by some of the most vulnerable people in our society.

As Conservatives, our instinct is to stand up for the individual. And that applies to the NHS.

We must never allow the needs of an institution to become more important than the needs of the patients it was set up to serve.

That’s why Andrew Lansley was so right to set up a public inquiry into what happened at Mid Staffs Hospital, something Labour refused 81 requests to do.

And we should never forget what they allowed to happen on their watch:

Patients left unwashed for days, sometimes in sheets soiled with urine and excrement;

Relatives having to take bedsheets home to wash because the hospital wouldn’t;

Patients with dementia going hungry with their meals sitting right in front of them because no one realised or cared that they were unable to feed themselves.

Things that make your stomach turn. And we must never allow our love of the NHS to dent our determination to hold systems and individuals to account.

So, where does that accountability lie? Most recent focus has been on Sir David Nicholson.

As a manager in a system that failed to spot and rectify the appalling cases at mid Staffs, he has been held accountable in both parliament and the media.

But he also led the campaign to bring down hospital waiting times and MRSA rates and we should not delude ourselves that Mid Staffs was all down to one man.

Others have far greater responsibility.

Like the board of the Trust, whose members astonishingly seem to have melted into thin air, some moving to other jobs in the system and others with generous payoffs.

We need to restore accountability to hospital boards. That includes an end to gagging clauses – which I announced earlier this week.

And we must look at measures to make boards criminally liable if they deliberately manipulate key patient data like mortality rates or waiting times.

We need openness and transparency and there should be no hiding place for those who hide the truth and fiddle the figures.

The Francis report rightly says that Ministers were not personally responsible for what happened at Mid Staffs.

No minister of any party would have sanctioned or condoned what happened.

But we also know from the report that the pursuit of targets at any cost was one of the central drivers of what went wrong.

And it is Ministers who are ultimately responsible for the culture of the NHS. During this period a culture of neglect was allowed to take root in which the system became more important than the individual.

The pursuit of targets stopped frontline staff treating people with dignity and compassion and betrayed what all of us believe the NHS is there to do.

Of course there is a role for targets, whether in A & E or for waiting times.

But not at any cost.

And Labour Ministers made three huge policy mistakes which contributed to the culture of neglect we are now putting right.

First, they failed to put in place safeguards to stop weak, inexperienced or bad managers pursuing not just bureaucratic targets, but targets at any cost.

This is exactly what happened at Mid Staffs, where patient safety and care was compromised in a blind rush to achieve Foundation Trust status.

Secondly, they failed to set up proper, independent, peer-led inspections of hospital quality and safety which told the public how safe and how good their local hospital was.

And thirdly, they failed to spot clear warnings when things went wrong.

The Francis Report outlines around 50 warning signs – so why did Ministers not act sooner?

If those warnings were not brought to the attention of Ministers, why did they not create a system where they were?

Instead there was a climate where NHS employees who spoke out about poor care were ignored, intimidated or bullied.

Until we have a proper apology from Labour for those catastrophic policy mistakes, no one will believe they would not make the same errors of judgment again.

This Conservative-led Government is absolutely clear about the steps we need to take to ensure accountability, compassionate care and respect for patients, particularly older people, are embedded in every corner of the NHS.

These include a proper independent peer-review inspection regime led by a new Chief Inspector of Hospitals that won’t just look at targets, but also make judgements about whether hospitals are putting patients first.

And it isn’t just about failure – we must recognise excellence.

When Ofsted started recognising outstanding schools, we saw a new breed of ‘superheads’across the education system.

We need the same in the NHS – so that our best leaders can help turn around failing hospitals.

We also need a single failure regime where the suspension of the Board can be triggered by failures in care as well as failures in finance.

And we will promote a patient-centred culture through the introduction of the Friends and Family Test.

This will ask every NHS hospital inpatient whether they would recommend the care they received to a friend or family member.

It will ask NHS staff whether they would want their own family treated in their own hospital.

Implementing these changes will be a huge challenge.

But in the end we are doing what Labour should have done but failed to do.

The party that claims to speak for the vulnerable betrayed those very same people.

And they betrayed the vast majority of doctors and nurses who want nothing more than to express the innate decency and compassion that made them give their lives to the NHS in the first place.

And once again it falls to us, the Conservatives, to deliver that vision.

And make sure that throughout our NHS no individual is too small, too unimportant, or too irrelevant to matter.

That is our mission – let nothing stand in our way.

Below is the text of the speech made by the Secretary of State for Health, Jeremy Hunt, on 13th March 2013.

In 1953, when the NHS was just five years old, two men named Smith took a flight from LA to New York. They started chatting.

One Mr Smith was the head of American Airlines. He was having a nightmare coping with the explosion in demand for airline travel.

Back then it could take 3 hours to book a single ticket. They were dependent on the amount of work that 8 people huddling around a single rolodex could manage and they had reached their limit. Mr Smith was desperate.

The other Mr Smith worked for IBM.

That chance encounter transformed the industry.

It led to a new computer system that allowed any travel agent anywhere in the country to know which seats were available on any flight, book and issue a ticket all in a matter of minutes.

The implications were massive. Flying went mass-market – and American Airlines became one of the most successful airlines in the world. And we are still using the same system 60 years later – with the internet allowing us all to become our own travel agents.

But think how history would have been different if the man from IBM had been sitting next to a Mr Smith from the NHS.

What they introduced to the airline industry 60 years ago, we still haven’t done for health and social care today. While they innovated, we stagnated. The revolution that has transformed so much of our daily lives is only just starting to touch healthcare.

Today I want to talk about the importance of innovation, of thinking differently and of finally harnessing the power of technology for the improvement of patient care and patient experience.

The NHS today

Very recently, the Francis Report into the appalling abuses of care at Stafford Hospital highlighted one of the biggest challenges facing the NHS. The need not only for high quality treatment, but for genuinely patient centred care.

I am clear that our response to that report must be about getting the culture and values right in the modern NHS as about regulation and systems.

In the end, that boils down to basic human interaction, to the care and compassion that is at the heart of what the NHS stands for. That is at the heart of the reason why so many people – our great doctors and nurses – dedicate themselves to the care of others.

If we are to give them the time and space to deliver on those core NHS values, if we are serious about putting patients in the driving seat, then we need to embrace the time-saving efficiency and productivity that technology and innovation can unleash.

We also need to recognise the improvements in patient safety that technology makes possible. Whether real time information on hospital mortality rates, comparative data on surgery survival rates or the simple availability to a doctor of a patient’s prescribing history before medication is administered – all should make closer the zero-harm NHS that is such a priority in the wake of Mid Staffs.

Let’s be clear though: technology is a means to an end, not an end in itself. But if we ignore what it makes possible, we ignore the biggest single opportunity in front of us to transform the delivery of healthcare away from a medical model into a patient and person-centred approach.

Patient Records

One thing that, more than anything else, will drive innovation is electronic patient records.

Paper records can only be in one place at a time, only seen by one person at a time. So they’re no use to a patient on holiday in Gloucester if his file is in a Godalming GP surgery.

Or to an ambulance driver picking up a frail elderly woman in an emergency who, if he had her notes, could see she was a diabetic with a heart condition who had a fall last month.

They’re no use to a hospital doctor who might not be aware of a patient’s other medication and prescribe drugs incorrectly – potentially lethally – because the notes have got lost.

Unaware of a patient’s full history, complications arise in surgery.

Diagnostic tests are repeated unnecessarily.

And patients find themselves having to repeat their medical history over and over again, sometimes several times on the same day in the same hospital.

But with an electronic record, all sorts of things are possible.

Which is why I have taken what Sir Humphrey would call the ‘brave’ decision to ask the NHS to go paperless by 2018. And to acknowledge explicitly that the last government was right to see the potential of electronic records but tragically wrong in the way it tried to implement them.

We will learn the right lessons – in particular avoiding top down Whitehall driven solutions in favour of locally determined solutions which work to national standards.

Global best practice

Many of the organisations here today offer new ways of using that information to improve care.

Whether it’s doctors and nurses being able to access the right information, giving patients control over their own care, or enabling vast amounts of anonymised data to be used to further research into new drugs and treatments. The potential for fully electronic records is huge and is about to be realised.

In Denmark, people can see all their hospital records online, and this year will be able to see their GP records too.

In America, military veterans, who have their own healthcare system not unlike the NHS, can download their own health records. Something that almost 20,000 veterans do every month.

In Sweden, over 85% of prescriptions are transferred from doctor to pharmacy online.

We have great things happening here in the UK too – like King’s College Hospital on track to become paperless this year, and where nurses use iPod Touches to record and monitor a patient’s vital signs at the bedside.

Or Maudsley Hospital’s MyHealthBox, the first time anwhere mental health patients have been given online access to their hospital and GP records.

Or Newham University Hospital that has reduced missed appointments by 11% through use of Skype for diabetic outpatient appointments.

But, we need to go much further, much faster. And we should not underestimate the size of the prize. With a paperless NHS, we may well be the largest fully online health economy in the world – with massive implications for improved patient safety, genuine patient empowerment and self-management as well as scientific research.

Announcements: Johnson and Johnson

Britain has a global reputation for research. We have world-leading universities and some of the greatest scientific minds. We have well established, high quality R&D, manufacturing and supply chain expertise. And, of course, we have the NHS.

This all makes the UK a natural focus for global investment in innovation and the life sciences.

And with a global healthcare market worth around 6.5 trillion dollars, the potential value to the UK in terms of economic growth and development is enormous.

So I’m delighted to announce one such investment today.

Johnson & Johnson’s Innovation Centre, here in London, will spearhead a multi-mullion pound drive to seek out and develop some of the ‘golden discoveries’ being made as we speak.

They will support and develop promising new breakthroughs in our universities, our SMEs, our research councils and our big research charities.

Johnson & Johnson’s Chief Scientific Officer, Paul Stoffels, said, this “is part of [their] broader innovation strategy to advance human health through collaboration with the world’s leading scientists and entrepreneurs.”

And they’re doing it right here in England, where they have access to the finest health service and the finest people in the world.

Unlike the big investments of the past, this isn’t about vast sums spent on shiny new offices and laboritories, it’s about focussing investment in new ideas, fresh thinking and new products.

Being flexible and moving fast.  Just like many of the small companies here at Expo.

NHS Commissioning Board App Library

For as well as the big giants who push forward the bounds of innovation, we also need the small, disruptive companies. Often close to their customers, often led by people fresh from the coalface of NHS care, outside the traditional structures they bring energy and fresh thinking to age-old problems.

So to help harness what they can offer the NHS Commissioning Board have today launched the Health App Library. Aimed initially at the public, it will play host to new mobile phone apps developed by companies large and small that can help to improve healthcare in myriad ways.

These apps will do everything from helping people to get trusted information on their condition or to find relevant clinical trials, to making it easy for patients to create and manage their own care plans with their doctor using their own medical records.

As the father of a one year old daughter, I am particularly interested in the e-Red Book, allowing parents to keep accurate and up to date records of their child’s early development online.

But you will find many other apps in the Library, all with the knowledge that they are clinically safe.

Innovation, excellence and Strategic Development (IESD) Fund

Finally I can today announce the government is helping small groups – community groups, social enterprises – to play their role in improving care through the Innovation, Excellence and Strategic Development Fund. Today, a further 49 with benefit from grants totalling £5.5 million.

This will cover a wide range of innovations, from tailored online psychological support for people with skin conditions, to phone apps to help people with disabilities gain greater independence, and support for children and young people to access and take control of their own mental health services online or through their phones.

Conclusion

Expo showcases why I am so optimistic about the future of health and social care. Creative people bringing new ideas, new perspectives, new approaches.

It is the opposite of the old top-down, command and control NHS. It shows the future.

A future of an NHS freed from the shackles of top-down bureaucracy where our excellent doctors and nurses can quickly find the solutions that work for them and their patients. Bringing speed and creativity to wards and consulting rooms across the country.

Technology is a big part of this. Not a holy grail or silver bullet. But a way of turning the pyramid upside-down, so the NHS is led by the people it was set up to serve – its patients.

Bill Gates said, “Never before in history has innovation offered promise of so much to so many in so short a time”.

When it comes to taking advantage of that promise of what innovation, let’s put healthcare at the front of the queue. Thank you.

Below is the text of a speech made by the Secretary of State for Health, Jeremy Hunt, to the Policy Exchange on 16th January 2013.

In 1953, when the NHS was just five years old, two men named Smith took a flight from LA to New York.  They started chatting.

One Mr Smith was the head of American Airlines.  He was having a nightmare coping with the explosion in demand for airline travel.

Back then it could take 3 hours to book a single ticket.  They were dependent on the amount of work that 8 people huddling around a single rolodex could manage and they had reached their limit.  Mr Smith was desperate.

The other Mr Smith worked for IBM.

That chance encounter transformed the industry.

It led to a new computer system that allowed any travel agent anywhere in the country to know which seats were available on any flight, book and issue a ticket all in a matter of minutes.

The implications were massive. Flying went mass-market – and American Airlines became one of the most successful airlines in the world. And we are still using the same system 60 years later – with the internet allowing us all to become our own travel agents.

But think how history would have been different if the man from IBM had been sitting next to a Mr Smith from the NHS.

What they introduced to the airline industry 60 years ago, we still haven’t done for health and social care today.  The revolution that has transformed so much of our daily lives has only just started to touch healthcare.

Today I want to talk about why we need to embrace that revolution with enthusiasm – but also the pitfalls if we get it wrong.

The NHS today

Right now, one of the biggest challenges facing the NHS is the Francis Report about the appalling abuses of care at Stafford Hospital, shortly due to land on my desk.

I am clear that our response to that report must be about getting the culture and values right in the modern NHS as about regulation and systems.

Technology is not the answer to this. It can never replace human interaction, nor the care and compassion that must be at the heart of what the NHS stands for.

But today, I want to argue that it does have a role to play if we are to give doctors and nurses the time and space to deliver on those core NHS values.

The clearest example of this is patient records.

Because they are mainly paper-based, they can only be in one place at a time, only seen by one person at a time.

So they’re no use to a patient on holiday in Gloucester if his file is in a GP surgery in Godalming.

Or to a paramedic picking up a frail elderly woman in an emergency who, if he had her notes, could see she was a diabetic with a heart condition who had a fall last month.

They’re no use to a hospital doctor who might not be aware of a patient’s other medication and prescribe drugs incorrectly – potentially lethally – because the notes have got lost.

Unaware of a patient’s full history, complications arise in surgery.

Diagnostic tests are repeated unnecessarily.

And patients find themselves having to repeat their medical history over and over again, sometimes several times on the same day in the same hospital.

International comparisons

Other countries are making great strides.

In Denmark, people can see all their hospital records online, and this year will be able to see their GP records too.

In America, military veterans, who have their own healthcare system not unlike the NHS, can download their own health records.  Something that almost 20,000 veterans do every month.

In Sweden, over 85% of prescriptions are transferred from doctor to pharmacy online.

Here in the UK we too have some interesting pioneers.

King’s College Hospital, for example, is on track to become fully paperless by the end of this year.

The drive comes from the clinicians who demand to have the right information in the right place at the right time.  They’ve introduced electronic prescribing, and nurses use an iPod Touch to record and monitor a patient’s vital signs at the bedside.

Maudsley Hospital’s ‘MyHealthLocker’, gives their patients online access to their hospital and GP records, a world’s first in mental health.  They can also feed back on their care plan, helping them to take control of their own healthcare.

And Newham University Hospital is piloting using Skype for diabetic outpatient appointments that don’t require an examination.

Missed appointments are down by 11%, patients don’t have to travel and the quality of care is improved.

But today I want to argue that we need to go much further, much faster.

So today I am setting a new ambition for the NHS.

I want it to become paperless by 2018. The most modern digital health service in the world.

Patients will be at the heart of this change – which means allowing for those unable or unwilling to engage in technology.

But between the NHS and social care, there must be total commitment to ensuring that interaction is paperless, and that, with a patient’s consent, their full medical history can follow them around the system seamlessly.

Challenges

This will be a profound change with huge impact, impossible to underestimate. And with profound change come profound challenges.

First, unsurprisingly, is money.

If Labour failed to do this with their billions, how can we hope to do it on a much more limited budget?

We shouldn’t forget that local hospitals and local GP practices spend their own money on technology all the time.  We just need a much more ambitious vision as to how to make that money and that investment count.

Every NHS organisation, including all 266 NHS trusts, has a major incentive to do this because the savings are so enormous – £4.4 billion annually according to today’s PWC report – that money, released to spend on better care, can go a long way towards helping them deliver health services sustainably in a time of real financial pressure.

Second, there is the objection that this should not be a priority because we want nurses talking to patients not looking at iPads.

But how many times do we see a nurse station in a ward with nurses unable to catch your eye because their heads are buried in paperwork?  Proper investment in technology means more contact time with patients – which is why the Prime Minister announced a £100m fund to help nurses take advantage of it.

Then there is the objection that patients don’t want technology. It’s true that only 3% of people book GP appointments online.  But 29% say they want to.

Before online banking became available, were customers marching in the streets, demanding that banks put their accounts online?  Of course not.  But that didn’t stop people going online in droves – with 80% of us, including a third of pensioners, now banking online .  Never let it be said that this is only something of interest to younger generations.

Then there is the critical issue of data security, which Fiona Caldicott is reviewing right now. Clearly we need protocols so that people can be comfortable that their data is only being accessed when necessary and with their permission.

But if the banks can make people confident that their money is safe, we must surely be able to develop a system that keeps medical records safe too.

Then there is the importance of the doctor-patient relationship.  There will be many times when only a face-to-face meeting will do.

But allowing repeat prescriptions to be booked online will free up much more time for such meetings, as well as offering a better and more convenient service for patients.

Finally, people say that we’ve been here before.  That Labour tried it and failed. The truth is that Labour had the right idea but the wrong approach.

Labour’s Connecting for Health became the NHS equivalent of ordering an aircraft carrier. A project that became over-centralised, over-specified and ultimately impossible to deliver.

What works – and you can see this everywhere – is local solutions, local decisions and local leadership.

Most systems won’t necessarily need to be replaced, just updated or adapted so they can talk with each other.  A thousand different local solutions linking together using common standards.

If this sounds incredibly complex, it’s actually very  commonplace.  It’s why your Blackberry can talk to my iPhone. It’s why all of those apps on our phones integrate so seamlessly.  It’s why you can use any computer, phone or tablet and log on to the internet to catch up on the latest news or watch a video on YouTube.

Things don’t have to be the same.  They just have to be compatible.

Why do it

Today’s report by PWC confirms what we already know.  That the right sort of technology, used in the right way, can release billions of pounds to be re-invested in better, safer care – and millions of hours of staff time for better patient care.

And it can do something else too.

Over a million people have some form of contact with the NHS every 36 hours and have done so for over 60 years.  This produces mind-boggling amounts of data that, if properly utilised with the right safeguards, can help improve treatments, unlock new cures and transform the face of modern health and social care.

The challenge

The stakes are high.  But already we have made real progress in preparing the NHS for a paperless, digital future.

In November, I announced in the NHS Mandate that by March 2015 everyone who wants it will be able to get online access to their GP record, as well as book appointments with their GP and order repeat prescriptions online.

E-consultations, like those in Newham, will also become much more widely available.

Today I can confirm that the NHS Commissioning Board have agreed that hospitals should be able to share digital data from April 2014, and to adopt paperless referrals from April 2015.  It is currently working on detailed guidance to help local NHS organisations make the leap.

This follows on from other recent steps:

Changing the standard NHS contract to insist that providers comply with defined information standards.

Setting up ‘care.data’, a service to give local commissioners timely and accurate information on the performance of providers.

From this summer, we’ll begin to publish huge amounts of clinical data on a wide range of surgical procedures, everything from vascular surgery to bariatric surgery.  Bringing unprecedented transparency to great swathes of NHS performance.

And to drive all of this, from 2013/14, the NHS number will become a patient’s primary means of identification within the health and care system, enabling all of their records, wherever they are held to combine around the individual person.

Conclusion

So, to conclude, technology is not a holy grail or a silver bullet for all the challenges facing the NHS.  It must always be a means to an end and not an end in itself.

But properly adopted, it has the potential to play a central role in facing up to the core challenge of dealing with an ageing society in which patients insist on a more personalised service.

As Bill Gates said, “Never before in history has innovation offered promise of so much to so many in so short a time”.

Well, health needs to be at the front of the queue in taking advantage of that promise – and I am determined it will be.

Thank you.