Tag: Jeremy Hunt

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 19 May 2016.

Mr Speaker, for the last 3 years there have been repeated attempts to reform the junior doctors contract to support better patient care 7 days a week, culminating in a damaging industrial relations dispute that has lasted over 10 months.

I am pleased to inform the House that after 10 days of intensive discussion under the auspices of ACAS, the dispute was resolved yesterday with a historic agreement between the government, NHS Employers (acting on behalf of the employers of junior doctors) and the BMA that will modernise the contract making it better for both doctors and patients. The new contract meets all the government’s red lines for delivering a 7 day NHS and remains within the existing pay envelope. We will be publishing an equalities analysis of the new terms alongside publishing a revised contract at the end of the month. It will now be put to a ballot of the BMA membership next month with the support of its leader, the Chair of the Junior Doctors’ Committee of the BMA, Johann Malawana.

Mr Speaker, I would like to first of all express my thanks to the BMA for the leadership they have shown in returning to talks, negotiating in good faith and making an agreement possible. I would also like to put on record my thanks to Sir Brendan Barber, the Chairman of ACAS, for his excellent stewardship of the process, and to Sir David Dalton for his wisdom and insight in conducting the discussions on behalf of employers and the government both this time and earlier in the year.

Reforming an outdated contract

This agreement will facilitate the biggest changes to the junior doctors’ contract since 1999. It will allow the government to deliver a 7 day NHS, improve patient safety, support much-needed productivity improvements, as well as strengthening the morale and quality of life of junior doctors with a modern contract fit for a modern health service.

The contract inherited by this government had a number of features badly in need of reform, including:

– low levels of basic pay as a proportion of total income, making doctors rely too heavily on unpredictable unsocial hours supplements to boost their income

– automatic annual pay rises even when people take prolonged periods of leave away from the NHS

– an unfair banding system which triggers payment of premium rates to every team member even if only one person has worked the extra hours

– high premium rates payable for weekend work which make it difficult to roster staff in line with patient need

– risks to patient safety with doctors sometimes being required to work 7 full days or 7 full nights in a row without proper rest periods

Seven day NHS

This government has always been determined that our NHS should offer the safest, highest quality of care possible – which means a consistent standard of care for patients admitted across all 7 days of the week. So the new contract agreed yesterday makes the biggest set of changes to the junior doctors’ contract for 17 years including:

– establishing the principle that any doctor who works less than an average of one weekend day a month (Saturday or Sunday) should receive no additional premium pay compensated by an increase in basic pay of between 10 and 11%

– reducing the marginal cost of employing additional doctors at the weekend by about a third

– supporting all hospitals to meet the 4 clinical standards most important for reducing mortality rates for weekend admissions by establishing a new role for experienced junior doctors as ‘senior-clinical decision makers’ able to make expert assessments of vulnerable patients who may be admitted or staying in hospitals over weekends

– removing the disincentive to roster sufficient numbers of doctors at weekends by replacing an inflexible banding system with a fairer system that values weekend work by paying actual unsocial hours worked with more pay to those who work the most.

A better motivated workforce

The government also recognises that safer care for patients is more likely to be provided by well-motivated doctors who have sufficient rest between shifts and work in a family-friendly system. So the new contract and ACAS agreement will improve the wellbeing of our critical junior doctor workforce by:

– reducing the maximum hours a doctor can be asked to work in any one week from 91 to 72

– reducing the number of nights a doctor can be asked to work consecutively to 4 and reducing the number of long days a doctor can be asked to work to 5

– introducing a new post, a Guardian of Safe Working, in every trust to guard against doctors being asked to work excessive hours

– introducing a new catch up programme for doctors who take maternity leave or time off for other caring responsibilities

– establishing a review by Health Education England to consider how best to allow couples to apply to train in the same area and to

– offer training placements for those with caring responsibilities close to their home by giving pay protection to doctors who switch specialties because of caring responsibilities

– establishing a review to inform a new requirement on trusts to consider caring and other family responsibilities when designing rotas.

Taken together, these changes show both the government’s commitment to safe care for patients and the value we attach to the role of junior doctors. Whilst they do not remove every bugbear or frustration they will significantly improve flexibility and work life balance for doctors, leading we hope to improved retention rates, higher morale and better care for patients.

Reflections on industrial action

But whatever the progress made with today’s landmark changes, it will always be a matter of great regret that it was necessary to go through such disruptive industrial action to get there. We may welcome the destination but no one could have wanted the journey: so today I say to all junior doctors whatever our disagreements about the contract may have been, the government has heard and understood the wider frustrations that you feel about the way you are valued and treated in the NHS.

Our priority will always be the safety of patients but we also recognise that to deliver high quality care we need a well-motivated and happy junior doctor workforce. Putting a new, modern contract in place is not the end of the story in this respect. We will continue to engage constructively with you to try to resolve outstanding issues as we proceed on our journey to tackle head on the challenges the NHS faces and make it the safest, highest quality healthcare system anywhere in the world. Today’s agreement shows we can make common cause on that journey with a contract that is better for patients, better for doctors and better for the NHS and I commend it to the House.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 18 April 2016.

This House has been updated regularly on all developments relating to the junior doctors contract, and there has been no change whatsoever in the Government’s position since my statement to the House in February. I refer Members to my statement in Hansard on 11 February, and to answers to parliamentary questions from my ministerial colleagues on 3 March, which set out the position clearly. Nevertheless, I am happy to reiterate those statements to the hon. Lady.

The Government have been concerned for some time about higher mortality rates at weekends in our hospitals, which is one reason why we pledged a seven-day NHS in our manifesto. We have been discussing how to achieve that through contract reform with the British Medical Association for more than three years without success. In January, I asked Sir David Dalton, the highly respected chief executive of Salford Royal, to lead the negotiating team for the Government as a final attempt to resolve outstanding issues. He had some success, with agreement reached in 90% of areas.

However, despite having agreed in writing in November to negotiate on Saturday pay, and despite many concessions from the Government on this issue, the BMA went back on that agreement to negotiate, leading Sir David to conclude that

“there was no realistic prospect of a negotiated outcome.”

He therefore asked me to end the uncertainty for the service by proceeding with the introduction of a new contract without further delay. That is what I agreed to, and what we will be doing. It will start with those in foundation year 1 from this August, and proceed with a phased implementation for other trainees as their current contracts expire through rotation to other NHS organisations.

Let me be very clear: it has never been the Government’s plan to insist on changes to existing contracts. The plan was only to offer new contracts as people changed employer and progressed through training. This is something that the Secretary of State, with NHS organisations as employers, is entitled to do according even to the BMA’s own legal advice. NHS foundation trusts are technically able to determine pay and conditions for the staff they employ, but the reality within the NHS is that we have a strong tradition of collective bargaining, so in practice trusts opt to use national contracts. Health Education England has made it clear that a single national approach is essential to safeguard the delivery of medical training and that implementation of the national contract will be a key criterion in deciding its financial investment in training posts. As the Secretary of State is entitled to do, I have approved the terms of the national contract.

The Government have a mandate from the electorate to introduce a seven-day NHS, and there will be no retreat from reforms that save lives and improve patient care. Modern contracts for trainee doctors are an essential part of that programme, and it is a matter of great regret that obstructive behaviour from the BMA has made it impossible to achieve that through a negotiated outcome.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at Lancaster House in London on 3 March 2016.

Every year an estimated million patients die in hospitals across the world because of avoidable clinical mistakes.

It is difficult to confirm the exact number because of variability in reporting standards, but if it is of this scale it sits alongside hypertensive heart disease and road deaths as one of the top causes of death in the world today.

In the US they estimate it at up to 100,000 preventable deaths annually and in England the Hogan, Darzi and Black analysis says that 3.6% of hospital deaths have a 50% or more chance of being avoidable – that’s potentially 150 avoidable deaths every week. Holland and New Zealand make similar estimates.

So today is historic.

Distinguished guests, health ministers from across the world, Director General Chan from the World Health Organisation thank you for attending this first ever ministerial-level Global Patient Safety Summit. A special welcome to my friend and colleague the German Health Minister Hermann Grohe with whom I am jointly hosting the summit and who will organise a follow up summit in Berlin in a year’s time. And a warm thank you to the many people who have travelled long distances to be here as we aim to make a decisive step towards improving standards of safety in healthcare.

In 1990 a bright 24-year old medical school graduate started his first job in medicine. He was a pre-registration house officer looking forward to a glowing career in surgery.

In his first month he was attending to a 16-year old boy undergoing palliative chemotherapy. The boy needed two different injections, one intravenously and a second by lumber puncture into the spine.

The intravenous drug was highly toxic – indeed fatal – if administered to the spine. But it arrived on the ward in a nearly identical syringe to the other injection. Both syringes were handed to the young doctor for the lumber puncture procedure and both injected into the patient’s spine.

As soon as the doctor realised what had happened, frantic efforts were made to flush out the toxic drug from the boy’s spine. But it was to no avail and tragically he died a week later.

So what happened next?

You might think the most important priority would be to learn from what went wrong and make sure the mistake was never repeated. But instead the doctor was prosecuted and convicted for manslaughter. He and a colleague were given suspended jail terms.

In this case the convictions were eventually overturned at the Court of Appeal. But the real crime was missed: as the legal process rumbled on, exactly the same error was made in another NHS hospital and another patient died because our system was more interested in blaming than learning.

The blame culture doesn’t just create fear for doctors. It causes heartbreak for patients and their families as I discovered when I met the parents of 3-year old Jonnie Meek.

Jonnie tragically died unexpectedly in hospital in 2014. His parents found their grief at losing Jonnie compounded several times over by the immense difficulty in establishing what actually happened. An independent report found: ‘Two different [hospital] trusts… Both responded in the same closed, unhelpful manner…[Jonnie’s parents] on the outside, unable to find a way in to ask simple questions. [NHS employees] blocked by fear…expectation of blame lead[ing] to defensive behaviours.’

We are now working with Jonnie’s family to seek an order for a second inquest.

But it shouldn’t need an inquest to find out the truth. Instead we need to ask what is blocking the development of the supportive, learning culture we need to make our hospitals as safe as they should be.

Too much avoidable harm and death

In England we have made much progress in improving our safety culture following the Francis Report into the tragedy of what happened at Mid Staffs.

According to the Heath Foundation the proportion of patients being harmed in the NHS dropped by over a third (34%) in the last 3 years. MRSA bloodstream infections have fallen by over half in the last 5 years. We have introduced a new and much tougher peer-led inspection regime which has led to 27 hospitals being put into special measures, 11 of whom have now come out. The law has changed placing on all hospital trusts a statutory duty of candour to patients and their families when things go wrong. The government was elected on a firm commitment to make NHS care safer across all 7 days of the week and we are making good progress.

But today I want to talk about the profound culture change necessary if we are to complete this journey: the change from a blame culture to a learning culture.

A learning culture not a blame culture

In his book Black Box Thinking, Matthew Syed talks about how that same blame culture used to exist in the airline industry.

He tells the tragic story of United Airlines flight 173, where 10 people died in a crash that happened in December 1978. The pilot, Captain Malburn McBroom, was trying to rectify a potentially dangerous problem with the landing gear but failed to notice that the plane was dangerously low on fuel. When he was forced to crash land the plane, he did so with extraordinary skill saving the lives of over 150 passengers. But because of his mistake, he got tied up in a 7-year long court case, came close to suicide, lost his pilot’s licence, and ultimately died a broken man.

But that tragedy had a surprisingly positive ending.

Because it became the moment the airline industry realised that if it was going to reduce airline fatalities, it needed to change its culture. They realised that ‘human factors’, rather than technical or equipment failure had been at the heart of the problem. Anyone could have failed to notice low fuel levels when they were trying to fix the landing gear. Why didn’t other crew members spot the problem and speak out? The issue was not that particular person, but what could have happened to any person in the same situation.

As a result the airlines transformed their training programmes. They mandated reforms that required pilots to attend group sessions with engineers and attendants to discuss communication, teamwork and workload management. Captains were required to encourage feedback, and crew members were required to speak up boldly.

And the result? There were dramatic – and immediate – reductions in the number of airline fatalities. The number of deaths overall halved over 30 years – at the same time as air travel increased nine fold. 10 people died in the United 173 crash, but experts are unanimous that the learning that resulted has saved thousands more.

Healthcare is of course very different to aviation.

When someone dies in an airline accident you know there has been a mistake – whereas with over 1,000 deaths every year in the average hospital it is not always so clear. And while modern airplanes are undoubtedly highly complex, they are nowhere near as complex as the human body.

But the airline industry did change its culture. And so can we.

How? In my speech to the Kings Fund last June I talked of the 3 stages necessary.

Intelligent transparency

The first step is intelligent transparency.

Intelligent transparency leads to action – and that means we need to understand the scale of the problem not just nationally but where we actually work.

So following a request to NHS hospitals by Dr Mike Durkin, NHS National Director of Patient Safety, the NHS in England will this month become the first country in the world to publish estimates by every hospital trust of their own annual number of avoidable deaths. Methodologies vary, so the numbers cannot be compared, but it is a major step forward for every hospital trust to make their own estimate of avoidable mortality and be open about what they find.

What you can compare, however, is the quality of reporting culture. Just how easy is it to speak about things that have gone wrong? Do hospitals listen to doctors raising genuine concerns or do they punish them as we saw happened to Dr Raj Mattu and other whistleblowers? So we yesterday published a table that grades the openness and honesty of reporting cultures in our hospitals. Chief Inspector of Hospitals Sir Mike Richards and NHS Safety Director Mike Durkin have looked at a range of indicators including staff survey measures of how supported frontline staff feel if they raise safety concerns, whether staff feel able to contribute towards improvements at work, and how effectively a trust uses the national reporting and learning system. On the basis of these indicators every trust has been graded as having an outstanding or good reporting culture – or as requiring improvement.

Once we have validated both sets of data, the CQC will include them in a new annual report on the state of hospital quality which will be published from this year.

The world’s largest learning organisation

The second stage in changing culture is to use intelligent transparency to turn the NHS into what I have long wanted it to be: the world’s largest learning organisation.

There is of course a huge amount of learning that goes on every day in our NHS. One study found doctors take 158 clinical decisions every day and we should never diminish their efforts to extract every possible piece of learning from daily work.

The government too, has played its part by introducing the new CQC inspection regime; legislating for a statutory duty of candour; making progress – not always smoothly – towards a 7-day NHS; asking every trust to appoint independent freedom to speak up guardians so clinicians can relay concerns to someone other than their line manager; launching the Sign up to Safety campaign and recently the campaign to halve the number of stillbirths and neonatal deaths.

But if we really are to tackle potentially avoidable deaths, we need culture change from the inside as well as exhortation from the outside. A true learning culture must come from the heart.

And this means a fundamental rethink of our concept of accountability.

Time and time again when I responded on behalf of the government to tragedies at Mid Staffs, Morecambe Bay, Winterbourne View, Southern Health and other places I heard relatives who had suffered cry out in frustration that no one had been ‘held accountable.’

But to blame failures in care on doctors and nurses trying to do their best is to miss the point that bad mistakes can be made by good people. What is often overlooked is proper study of the environment and systems in which mistakes happen and to understand what went wrong and encouragement to spread any lessons learned. Accountability to future patients as well as to the person sitting in front of you.

The rush to blame may look decisive. It may seem like professionals are being held accountable. In fact, the opposite can happen. By pinning the blame on individuals, we sometimes duck the bigger challenge of identifying the problems that often lurk in complex systems and which are often the true cause of avoidable harm.

Organisational leadership is vital if we are to change this – and we can see world class organisations inside and outside healthcare have a very different approach. They have the boldness to probe more deeply, thus learning precious lessons. They see a medication error as an opportunity to make labelling clearer, a mistake in an operating theatre as a chance to improve teamwork and communication, just as airlines did after the crash of United 173.

Which is why we need a new mindset to permeate the entire ethos of the NHS, where blame is never the default option. Justice must never be denied if a professional is malevolent or grossly negligent. But the driving force must be the desire to improve care and reduce harm – fired by an insatiable curiosity to pursue improvement in every sphere of activity. This is what I mean by the world’s largest learning organisation.

And when we give patients an honest account of what happened alongside an apology, what is the impact? Countless academic studies have shown there is less litigation, less money spent on lawyers and more rapid closure, even when there have been the most terrible tragedies.

Resources

Some say that is all very well, but with hospitals in deficit what happens if you can’t afford to implement the lessons you learn about how to improve the standards of care?

Even after the significant rise in the NHS budget announced at the autumn statement, the resources to tackle these deep-rooted issues are finite. But as Sir Mike Richards and many others have pointed out, it is quite wrong to make out there is a choice between safe care or balanced budgets because the evidence shows that hospitals with better care usually have better balance sheets as well.

Of course there are times when safer care requires more resources, but unsafe care is even more expensive – in fact we know from the 2014 Frontier Economics report it costs the NHS up to £2.5 billion a year due to longer hospital stays, repeat visits and expensive litigation.

A compensation culture costs money – £1.4 billion of the NHS budget – but it also costs lives by creating a culture of defensive medicine which means avoidable harm remains stubbornly higher than it should be because we make it so hard for frontline clinicians to speak openly and honestly about how to learn from mistakes.

Next steps

That means a profound change in culture.

The recommendations from Sir Robert Francis’s Freedom to Speak Up review have not yet taken effect and there are still too many stories of whistleblowers being bullied or hounded out of their jobs.

We must go further.

Just as the Carter process announced last month will harness the power of transparency to improve our use of resources, so today I want to harness that same power to bring down the rate of avoidable deaths by turning the NHS into a true learning organisation.

Following the commitment I made to Parliament at the time of the Morecambe Bay investigation, we will from 1 April set up our first ever independent Healthcare Safety Investigation Branch. Modelled on the Air Accident Investigation Branch that has been so successful in the airline industry, it will undertake timely, no-blame investigations.

Harvard Professor Dr. Lucian Leape has said that ‘the single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes’. So just as the Air Accident Investigation Branch gives a legal ‘safe space’ which protects those cooperating with its inquiries, we will bring forward measures to give similar legal protection to those who speak honestly to HSIB investigators so that the principle of a ‘safe space’ is at the heart of what the Healthcare Safety Investigation Branch does.

Affected patients or their families will need to be involved as part of the safe space protection. And while the findings of investigations will be made public, the details will not be disclosable without a court order or an overriding public interest, with courts being required to take note of the impact on safety of any disclosures they order. This legal change will help start a new era of openness in the NHS’s response to tragic mistakes: families will get the full truth faster; doctors will get support and protection to speak out; and the NHS as a whole will become much better at learning when things go wrong. What patients and families who suffer want more than anything is a guarantee that no-one else will have to re-live their agony. This new legal protection will help us promise them ‘never again’.

I have asked the new organisation to consider focusing initially on maternity and neonatal mortality investigations to give us time to examine and understand its effect before rolling it out to other areas of clinical activity. It is intended to make a major contribution to our new ambition to halve still births, neonatal injury and death and maternal death rates where we still rank unfavourably to many other high income countries.

But it will not be limited to maternity. And as we create the legally safe space for learning that has long benefited the airline industry, we will in the words of NHS National Director of Patient Safety Dr Mike Durkin be taking ’the biggest single step in a generation to foster a positive learning culture that will support NHS hospitals to become safer for patients.’

I can also announce some other important steps to help foster a true learning culture.

The GMC and NMC guidance is now clear – where doctors, nurses or midwives admit what has gone wrong and apologise, the professional tribunal should give them credit for that, just as failing to do so is likely to incur a serious sanction. As in the airlines, doctors, nurses and other health professionals need to know that they will get credit for being open and honest and the government is committed to legal reform that would allow professional regulators more flexibility to resolve cases without stressful tribunals, where professionals have admitted their mistake.

NHS Improvement will ask for this to be reflected in all trust disciplinary procedures and ask all trusts to publish a Charter for Openness and Transparency so staff can have clear expectations of how they will be treated if they witness clinical errors.

From April 2018, we will be introducing the system of medical examiners recommended in the Francis Report. This will bring a profound change in our ability to learn from unexpected or avoidable deaths, with every death either investigated by a coroner or scrutinised by a second independent doctor. Grieving relatives will be at the heart of the process and will have the chance to flag any concerns about the quality of care and cause of death with the independent clinician.

NHS England is working with the Royal College of Physicians to develop and roll-out across the NHS a standardised method for reviewing the records of patients who have died in hospital.

The objective of these changes is to make it unnecessary for anyone ever to feel they have to ‘blow the whistle’ on poor care. But as we make this transition, it is vital that we offer whistleblowers protection wherever they are in the NHS so if we discover that there are any gaps in the law protecting whistleblowers, we will act to close them.

Conclusion

Karl Popper said true ignorance is not the absence of knowledge but the refusal to acquire it. So now is the time to use the power of intelligent transparency to make sure that we really do turn our healthcare systems into learning organisations – and offer our patients the the safe high quality they deserve.

Below is the text of the statement made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 9 March 2016.

With permission, Mr Speaker, I would like to update the House on the steps the government is taking to build a safer 7-day NHS. We are proud of the NHS and what it stands for and proud of the record numbers of doctors and nurses working for the NHS under this government. But with that pride in the NHS comes a simple ambition: that our NHS should offer the safest, highest quality care anywhere in the world. Today we are taking some important steps to make that possible.

In December, following problems at Southern Health, I updated the House about the improvements we need to make in reporting and learning from mistakes. NHS professionals deliver excellent care to around 650,000 patients every day, but we are determined to support them to improve still further the quality of the care we offer. So this government has introduced a tough and transparent new inspection regime for hospitals, a new legal duty of candour to patients and families who suffer harm and a major initiative to save lives lost from sepsis. As a result of these measures, according to the Health Foundation, the proportion of people suffering from the major causes of preventable harm has dropped by a third in the last 3 years.

But still we make too many mistakes. Twice a week in the NHS we operate on the wrong part of someone’s body and twice a week we wrongly leave a foreign object in someone’s body. The pioneering work of Helen Hogan, Nick Black and Ara Darzi has estimated that 3.6% of hospital deaths have a 50% or more chance of being avoidable, which equates to over 150 deaths every week.

We should remember that, despite this, our standards of safety still compare well to many other countries. But I want England to lead the world in offering the highest possible standards of safety in healthcare so today I am welcoming to London health ministers and healthcare safety experts from around the world for the first ever ministerial-level summit on patient safety.

I am co-hosting the summit with the German Health Minister, Hermann Grohe, who will host a follow-up summit in Berlin next year. Other guests will include Dr Margaret Chan, Director General of the World Health Organisation, Dr Gary Kaplan, Chief Executive of the renowned Virginia Mason Hospital in Seattle, Professor Don Berwick and Sir Robert Francis QC.

In the end, Mr Speaker, no change is permanent without real and lasting culture change. And that culture change needs to be about 2 things: openness and transparency about where problems exist, and a true learning culture to put them right.

With the new inspection regime for hospitals, GP surgeries and care homes, as well as a raft of new information now published on My NHS, we have made much progress on transparency. But as Sir Robert Francis’s Freedom to Speak Up report told us, it is still too hard for doctors, nurses and other frontline staff to raise concerns in a supportive environment.

Other industries – in particular the airline and nuclear industries – have learned the importance of developing a learning culture and not a blame culture if safety is to be improved. But too often the fear of litigation or professional consequences inhibits the openness and transparency we need if we are to learn from mistakes.

So following the commitment I made to Parliament at the time of the Morecambe Bay investigation, we will from 1 April 2016 set up our first ever independent Healthcare Safety Investigation Branch. Modelled on the Air Accident Investigation Branch that has been so successful in reducing fatalities in the airline industry, it will undertake timely, no-blame investigations.

As with the Air Accident Investigation Branch, I can today announce that we will bring forward measures to give legal protection to those who speak honestly to Healthcare Safety Investigation Branch investigators.

The results of such investigations will be shared with patients and families, who will therefore get to the truth of what happened much more quickly. However, unlike at present they will not normally be able to be used in litigation or disciplinary proceedings, for which the normal processes and rules will apply. The ‘safe space’ they create will therefore reduce the defensive culture patients and families too often find meaning mean the NHS can learn and disseminate any lessons much more quickly so that we avoid repeating any mistakes.

My intention is to use this reform to encourage much more openness in the way the NHS responds to tragic mistakes: families will get the full truth faster; doctors will get support and protection to speak out; and the NHS as a whole will become much better at learning when things go wrong. What patients and families who suffer want more than anything is a guarantee that no-one else will have to re-live their agony. This new legal protection will help us promise them ‘never again’.

Fundamental to this is getting a strong reporting culture in hospitals where mistakes are acknowledged and not swept under the carpet. So today NHS Improvement has also published a Learning from Mistakes ranking of NHS Trusts. This draws on data from the staff survey and safety incident reporting data to show which trusts have the best reporting culture and which ones need to be better at supporting staff who wish to raise concerns. This will be updated every year in a new Care Quality Commission (CQC) State of Hospital Quality report that will also contain trusts’ own annual estimates of their avoidable mortality rates and have a strong focus on learning and improvement.

Furthermore, the General Medical Council and the Nursing and Midwifery Council guidance is now clear – that where doctors, nurses or midwives admit what has gone wrong and apologise, the professional tribunal should give them credit for that, just as failing to do so is likely to incur a serious sanction. The government remains committed to further reform that would allow professional regulators more flexibility to resolve cases without stressful tribunals.

This change in culture must also extend to trust disciplinary procedures. So NHS Improvement will ask for a commitment to openness and learning to be reflected in all trust disciplinary procedures and ask all trusts to publish a Charter for Openness and Transparency so staff can have clear expectations of how they will be treated if they report clinical errors.

Finally, from April 2018, the government will introduce the system of medical examiners recommended in the Francis Report. This will bring a profound change in our ability to learn from unexpected or avoidable deaths, with every death either investigated by a coroner or scrutinised by a second independent doctor. Grieving relatives will be at the heart of the process and will have the chance to flag any concerns about the quality of care and cause of death with an independent clinician, meaning we get to the bottom of any systemic failures in care much more quickly.

Taken together, I want these measures to help the NHS to become the world’s largest learning organisation as part of our determination to offer the safest, highest quality standards of care.

An NHS that learns from mistakes. One of the largest organisations in the world becoming the world’s largest learning organisation – that is how we will offer the safest, highest quality standards of care in the NHS and I commend this statement to the House.

Below is the text of the statement made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 4 November 2015.

This government is completely committed to the values of the NHS – the same values that encourage aspiring doctors to take up a career in medicine.

Junior doctors are the backbone of the NHS, but the current contract has failed to prevent some working unsafe hours, and doesn’t reward them fairly. We know also that they feel unsupported because consultants and diagnostic services are not always available in the evenings and at weekends.

Today a firm offer for a new contract has been published by NHS Employers. The new contract will be fairer for doctors, safer for patients and juniors alike, better for training, and will better support a 7-day NHS.

This offer builds on the cast-iron guarantees that I have previously offered the British Medical Association (BMA) including that we would not remove a single penny from the junior doctors’ pay bill, and we would maintain average earnings for junior doctors. The proposals offer an 11% increase to basic pay, with further increases linked to progressing through training and taking on roles with greater responsibility –instead of being based on time served.

Our ambition for the NHS to be the safest healthcare system in the world is underpinned by reducing, not increasing, the number of hours junior doctors work each week. Juniors will be supported by improved contractual safeguards – the best protection junior doctors have ever had against working long, intense and unsafe hours. For example, no junior will be required to work more than a weekly average of 48 hours without consent and those who opt out of that legal limit in the European Working Time Directive will not be able to work more than a weekly average of 56 hours. The number of hours that can be worked in any single week by any junior will be limited to 72, down from 91; there will be a 13 hour limit on shifts; and there will be no more than 5 consecutive long days or 4 consecutive nights, compared to the current contract which permits 7 consecutive night shifts or up to 12 consecutive day shifts.

Putting patients first is the responsibility of employers and staff. Where doctors are asked to work in conditions that they believe are unsafe, including being asked to work patterns that put patient safety at risk, they will be asked to use reporting mechanisms available to them to raise the issue with the Board of their Trust, and reporting data will now be available for the Care Quality Commission (CQC) to use during inspections. We would expect Trust Boards to look at any such report and decide how to respond to it; and we would expect the CQC, when it carries out an inspection, to look at how the Board has responded to this and other data reporting safety incidents and concerns – a tough new measure to ensure safe working.

In order to better support a 7-day NHS, basic pay will increase by 11% to compensate for an extension in plain time working on Saturdays during the day and on weekday evenings, and there will be an enhanced rates for hours worked at nights, on Saturday evenings and Sunday.

The government has also decided that plain time will be extended only to 7pm on Saturdays – instead of 10pm on Saturdays – and wants to improve training and ensure better clinical supervision from consultants as well.

We will offer new flexible pay premia for those training in hard-to-fill training programmes where there is the most need – such as general practice, emergency medicine and psychiatry – and we will protect the salaries of those who return or switch to training in these programmes.

Junior doctors who take time off for academic research that is part of their NHS training, or which contributes to the wider NHS and improvements in patient care, will get additional pay premia to make sure they don’t lose out.

Today, I have also written to all junior doctors in England confirming that no junior doctor working legal hours will receive a pay cut compared to their current contract during transition. Around three quarters will see an increase in pay and the rest will be protected.

The exception to this is those who currently receive up to a 100% salary boost as compensation for working unsafe hours. Instead, new contractual safeguards will ensure they are not required to work unsafe hours at all.

To see how the offer affects them, junior doctors can now log on to a pay calculator published by NHS Employers where they can calculate projected take home pay.

Our preference throughout has been, and continues to be, to reach agreement through negotiations. We have maintained that, in reforming the contract, we must put patients right at the heart of everything the NHS does every day of the week. A fair, sustainable contract with stronger safeguards, together with the greater availability of consultants at the weekends and evenings, is good for patients and good for junior doctors.

The details published today represent the government’s offer in England, which will be for doctors and dentists in postgraduate training programmes overseen by Health Education England.

Since they withdrew from negotiations in October 2014 – despite agreeing the need for change as far back as 2008 – the BMA have refused to return to the table. In light of today’s announcement we hope that the BMA will now agree to return to negotiations.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 30 November 2015.

With permission Mr Speaker I would like to update the House on the junior doctors strike.

Earlier this month, the union representing doctors, the BMA, balloted for industrial action over contract reform. Because the first strike is tomorrow I wish to update the House on contingency plans being made.

Following last week’s spending review, no one can be in any doubt about this government’s commitment to the NHS, but additional resources have to be matched with even safer services for patients. That is why, on the back of mounting academic evidence that mortality rates are higher at weekends than in the week, we made a manifesto commitment to deliver truly 7-day hospital services for urgent and emergency care.

However, it is important to note that 7-day services are not just about junior doctor contract reform. The Academy of Medical Royal Colleges noted that “the weekend effect is very likely attributable to deficiencies in care processes linked to the absence of skilled and empowered senior staff in a system which is not configured to provide full diagnostic and support services 7 days a week.” So our plans will support the many junior doctors who already work weekends with better consultant cover at weekends, 7-day diagnostics and other support services, and the ability to discharge at weekends into other parts of the NHS and the social care system.

But reforming both the consultants’ and junior doctor contracts is a key part of the mix because the current contracts have the unintended consequence of making it too hard for hospitals to roster urgent and emergency care evenly across 7 days. Our plans are deliberately intended to be good for doctors – they will see more generous rates for weekend work than those offered to police officers, fire officers and pilots. They protect pay for all junior doctors working within their legal, contracted hours, compensating for a reduction in anti-social hours with a basic pay rise averaging 11%. They reduce the maximum hours a doctor can work in any one week from 91 to 72 and stop altogether the practice of asking doctors to work 5 nights in a row. Most of all they will improve the experience of doctors working over the weekend by making it easier for them to deliver the care they would like to be able to deliver to their patients.

Our preference has always been a negotiated solution but, as the house knows, the BMA have refused to enter negotiations since June. However, last week I agreed for officials to meet them under the auspices of the ACAS conciliation service. I am pleased to report to the house that, after working through the weekend, discussions led to a potential agreement early this afternoon between the BMA leadership and the government. This agreement would allow a time-limited period during which negotiations can take place, and during which the BMA agrees to suspend strike action and the government agrees not to proceed unilaterally with implementing a new contract. This agreement is now sitting with the BMA junior doctors’ executive committee, who will decide later today if they are able to support it.

However, it is important for the house to know that right now strikes are still planned to start at 8am, so I will now turn to the contingency planning we have undertaken. The government’s first responsibility is to keep its citizens safe. This particularly applies to those needing care in our hospitals so we are making every effort to minimise any harm or risks caused by the strike.

I have chaired three contingency planning meetings to date and will continue to chair further such meetings for the duration of any strikes. NHS England are currently collating feedback from all trusts but currently we estimate the planned action will mean up to 20,000 patients may have vital operations cancelled, including approximately 1,500 cataracts operations, 900 skin lesion removals, 630 hip and knee operations, 400 spine operations, 250 gall bladder removals and nearly 300 tonsil and grommets operations.

NHS England has also written to all trusts asking for detailed information on the impact of the strikes planned for 8 and 16 December which will involve not just the withdrawal of elective care, but the withdrawal of urgent and emergency care as well. We are giving particular emphasis to the staffing at major trauma centres and are drawing up a list of trusts where we concerns about patient safety. All trusts will have to cancel considerable quantities of elective care in order to free up consultant capacity and beds. So far, the BMA has not been willing to provide assurances they will ask their members to provide urgent and emergency cover in areas where patients may be at risk and will continue to press for such assurance.

It is regrettable that this strike was called even before the BMA had seen the government’s offer, and the whole house will be hoping today that the strike is called off so that talks can resume. But whether or not there is a strike, providing safe services for patients will remain the priority of this government as we work towards our long term ambition to make NHS care the safest and highest quality in the world. I commend this statement to the house.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, in the House of Commons on 11 February 2016.

Mr Speaker, nearly 3 years ago to the day the government first sat down with the British Medical Association (BMA) to negotiate on a new contract for junior doctors. Both sides agreed that the current arrangements, drawn up in 1999, were not fit for purpose and that the system of paying for unsocial hours in particular was unfair.

Under the existing contract doctors can receive the same pay for working quite different amounts of unsocial hours; doctors not working nights can be paid the same as those who do; and if 1 doctor works just 1 hour over the maximum shift length it can trigger a 66% pay rise for all doctors on that rota.

Despite the patent unfairness of the contract, progress in reforming it has been slow, with the BMA walking away from discussions without notice before the general election. Following the election, which the government won with a clear manifesto commitment to a 7-day NHS, the BMA Junior Doctors Committee refused point blank to discuss reforms, instead choosing to ballot for industrial action. Talks did finally start with the ACAS process in November but since then we have had 2 damaging strikes with around 6,000 operations cancelled.

In January I asked Sir David Dalton, Chief Executive of Salford Royal, to lead the negotiating team. Under his outstanding leadership, for which the whole House will be immensely grateful, progress has been made on almost 100 different points of discussion, with agreement secured with the BMA on approximately 90% of them. Sadly, despite this progress and willingness from the government to be flexible on the issue of Saturday pay, Sir David wrote to me yesterday advising that a negotiated solution is not realistically possible.

Along with other senior NHS leaders and supported by NHS Employers, NHS England, NHS Improvement, the NHS Confederation and NHS Providers, he has asked me to end the uncertainty for the service by proceeding with the introduction of a new contract that he and his colleagues consider both safer for patients and fair and reasonable for junior doctors. I have therefore today decided to do that.

Tired doctors risk patient safety, so in the new contract the maximum number of hours that can be worked in 1 week will be reduced from 91 to 72; the maximum number of consecutive nights will be reduced from 7 to 4; the maximum number of consecutive long days will be reduced from 7 to 5; and no doctor will ever be rostered on consecutive weekends. Sir David Dalton believes these changes will bring substantial improvements both to patient safety and doctor wellbeing.

We will also introduce a new Guardian role within every Trust, who will have the authority to impose fines for breaches to agreed working hours based on excess hours worked. These fines will be invested in educational resources and facilities for trainees.

The new contract will give additional pay to those working Saturday evenings from 5pm, nights from 9pm to 7am, and all day on Sunday. Plain time hours will now be extended from 7am to 5pm on Saturdays. However, I said the government was willing to be flexible on Saturday premium pay and we have been: those working 1 in 4 or more Saturdays will receive a pay premium of 30%, that is higher on average than that available to nurses, midwives, paramedics and most other clinical staff. It is also a higher premium than that available to fire officers, police officers or those in many other walks of life.

Nonetheless it does represent a reduction compared to current rates, necessary to ensure hospitals can afford additional weekend rostering. So because we do not want take home pay to go down for junior doctors, after updated modelling I can tell the House these changes will allow an increase in basic salary of not 11% as previously thought but 13.5%. Three-quarters of doctors will see a take home pay rise and no trainee working within contracted hours will have their pay cut.

Mr Speaker, our strong preference was for a negotiated solution. Our door remained open for 3 years, and we demonstrated time and again our willingness to negotiate with the BMA on the concerns that they raised. However, the definition of a negotiation is a discussion where both sides demonstrate flexibility and compromise on their original objectives, and the BMA ultimately proved unwilling to do this.

In such a situation any government must do what is right for both patients and doctors. We have now had 8 independent studies in the last 5 years identifying higher mortality rates at weekends as a key challenge to be addressed. Six of those say staffing levels are a factor that needs to be investigated. Professor Sir Bruce Keogh describes the status quo as ‘an avoidable weekend effect which if addressed could save lives’ and has set out the 10 clinical standards necessary to remedy this. Today we are taking one important step necessary to make this possible.

While I understand that this process has generated considerable dismay among junior doctors, I believe that the new contract we are introducing – shaped by Sir David Dalton, and with over 90% of the measures agreed by the BMA through negotiation – is one that in time can command the confidence of both the workforce and their employers.

I do believe, however, that the process of negotiation has uncovered some wider and more deep-seated issues relating to junior doctors’ morale, wellbeing and quality of life which need to be addressed.

These issues include inflexibility around leave, lack of notice about placements that can be a long way away from home, separation from spouses and families, and sometimes inadequate support from employers, professional bodies and senior clinicians. I have therefore asked Professor Dame Sue Bailey, President of the Academy of Medical Royal Colleges, alongside other senior clinicians to lead a review into measures outside the contract that can be taken to improve the morale of the junior doctor workforce. Further details of this review will be set out soon.

Mr Speaker, no government or health secretary could responsibly ignore the evidence that hospital mortality rates are higher at the weekend, or the overwhelming consensus that the standard of weekend services is too low, with insufficient senior clinical decision-makers. The lessons of Mid Staffs, Morecambe Bay, and Basildon in the last decade is that patients suffer when governments drag their feet on high hospital mortality rates – and this government is determined our NHS should offer the safest, highest quality care in the world.

We have committed an extra £10billion to the NHS this Parliament, but with that extra funding must come reform to deliver safer services across all 7 days. That is not just about changing doctors’ contracts: we will also need better weekend support services such as physiotherapy, pharmacy and diagnostic scans; better 7-day social care services to facilitate weekend discharging; and better primary care access to help tackle avoidable weekend admissions. Today we are taking a decisive step forward to help deliver our manifesto commitment, and I commend this statement to the House.

Below is the text of the speech made by Jeremy Hunt, the then Secretary of State for Culture, at Tate Modern in London on 14 August 2012.

It’s a pleasure to welcome you to Tate Modern. In just 12 years this has become the world’s busiest and most famous contemporary art gallery – perhaps the best single example of our restless determination to develop and improve what our nation offers both in culture and tourism.

And after this year there’s every reason to think this great attraction will be even busier in years to come.

An Olympics triumph which showed the country welcoming the world with professionalism, warmth and even sunshine…

A Jubilee and an Olympics that showed us at ease with a glorious history and a vibrant present – witnessed by a global audience of millions, with the Opening Ceremony alone watched by almost a billion.

A Torch Relay and London 2012 Festival that showcased cultural and tourist treasures in every corner of the country…

Extraordinary shows and exhibitions like Freud, Leonardo, Frankenstein, Richard III and Matilda…

New places to visit from the Turner Contemporary to the Hepworth to the Harry Potter studios…

And old favourites restored like the Cutty Sark…

Whatever the doomsters may say about the economy, we should be proud that our cultural and tourism sectors are investing in the future with optimism, confidence and panache.

When I became Culture Secretary I was very conscious of the criticism that successive governments have undervalued tourism. So, in my first month as a Minister, I gave a speech at the new Olympic sailing venue in Weymouth saying I would address this.

Let’s look at what has been achieved.

GREAT

First of all we have seen the launch of the first ever cross-government campaign to market the UK overseas. Bringing together the Foreign Office, the British Council, UKTI and Visit Britain, the GREAT campaign is our biggest ever investment in marketing the UK, a campaign that has turned heads and really taken the fight for tourist dollars into our key tourist markets.

– We’ve stopped traffic at the Shibuya crossing in Tokyo with a GREAT double decker bus;
– We’ve draped New Delhi taxis in red, white and blue;
– We’ve taken British film to the red carpet of LA during the Oscars;
– We’ve lit up Shanghai with GREAT projections on the Aurora building overlooking the mighty Huangpu river;
– In the US, millions saw Victoria Beckham championing British fashion on a GREAT Britain-branded subway at Grand Central Station, New York;
– On Sugarloaf mountain in Rio, thousands of journalists wrote, spoke, blogged or tweeted about David Beckham and Prince Harry as they promoted Britain;
– And, my favourite, six out of ten Parisians discovered that unlike the Louvre, the British Museum is free thanks to a “Culture is GREAT Britain” poster mounted just outside the Louvre main entrance.

Indeed the highest praise of all came from the country that can often be our sternest critic when the French newspaper La Tribune said that GREAT is the most effective global marketing campaign since the Big Apple campaign for New York.

Back then in Weymouth I pledged £1bn publicity for the UK on the back of the Olympics. Thanks to the GREAT campaign, I am delighted to say we have delivered more than three times that amount of positive PR for Britain in key target markets.

I also said in Weymouth we would back our domestic tourism industry. We all love holidaying abroad – and there’s nothing wrong with that. Indeed the falling cost of overseas holidays has been one of the great social advances of the last half century. But we should not neglect our domestic tourism industry, whether for day trips, weekend breaks or family holidays.

So for the first time ever we have had a £6 million national TV and cinema advertising campaign promoting holidays at home. The ad, featuring Rupert Grint, Julie Walters, Stephen Fry and Michelle Dockery has reached more than 7 out of 10 holiday makers and generated 300,000 extra hotel nights in its first three months alone.

The worm has turned, and no longer will domestic tourism be the poor relation when it comes to big marketing campaigns for the domestic tourism pound. And rightly so – because to suggest we need to choose between either a strong domestic offer or a strong international offer is a false dichotomy. The bigger the domestic market, the more investment we will stimulate in quality accommodation and attractions – and the more international visitors we will attract.

Answering the critics of the Games

So we are taking the fight to our rivals in key markets abroad and determined to win the battle for tourism spend at home.

In doing so, we’re tackling head-on two big myths.

The first is that hosting an Olympic Games is bad for business. In the run up to this year, critics said we’d see huge displacement, with people staying away from the UK in droves because of the crowds and the cost.

The truth is that we’ve seen record-breaking figures for spend and holiday visits from overseas in 2012, even taking into account the blip we’ve seen in the June figures. Visa says that London spend in restaurants is up nearly 20% on a year ago, nightclub spending is up 24%, and spending on theatre and other tickets has doubled.

Far from seeing a bloodbath, Andrew Lloyd Webber has seen sales for his shows increase by 25%. He has generously said that he “has been proved wrong” and “couldn’t be more delighted.”

Quite simply, stories of “ghost town” London are not borne out by the facts:

Retailers in Bond Street, Oxford and Regent Street all reported a surge in sales and footfall during the Super Saturday weekend;
Tube traffic has been at record levels with over four and a half million journeys on some days last week – the highest number for one day in London Underground’s history;

And hotels have been extremely busy – Richard Solomons has talked of 90 per cent occupancy across Intercontinental properties. Many other London hoteliers report they were at least 80% full, and up on the same days last year.

Now I’m pleased to say that hoteliers are looking at new and creative ways to extend the party. Premier Inn, for example, will be celebrating TeamGB’s gold medal haul of 29 by offering 29,000 London rooms at £49 for bookings made until 22nd August.

Of course, we were always going to see changes in visitor patterns during such a big year and there are inevitably some businesses that suffer short term consequences.

But we should never underestimate the long term impact of securing London’s place in as one of the most buzzy and exciting cities on the planet – and the massive upside that offers to all businesses based here.

Nor should we underestimate the power of the Olympic Park to become a new tourist attraction – with the superb landscaping, facilities, transport and views that it offers.

A long term commitment to tourism

Which takes me to the second myth.

Ufi Ibrahim of the BHA said in June that when it comes to tourism the Government is “all talk, no action,” and that we don’t take tourism seriously.

Let me gently remind Ufi that when I arrived in office there was no fully-developed tourism strategy for the Olympics. Getting that right always needed to be the first priority. How could anyone who cares about tourism waste a billion pound opportunity to put ourselves on the map?

And critics are plain wrong to say that this is only about the short term.

Let’s look at the changes that have been made with long term impact that have nothing whatsoever to do with the Olympics.

Firstly, John Penrose and I promised to cut the red tape that was choking tourism.

So in the last two years we’ve curbed regulations on food labelling, on no smoking signs and on arcade entertainment;

– We’ve changed the VAT rules on holiday lets;

– We’re consulting to change live entertainment licensing to help the entertainment industry; and

– We’re giving industry and consumers control of star rating quality schemes.

– We also said we’d improve support for tourism organisations at a local level.

And notwithstanding the difficult financial environment, we’ve now seen a steady expansion of destination management organisations, bringing tourism back to its local roots.

We’re also working with sector skills bodies to increase apprenticeships and training, to create the pipeline of trained staff necessary for future success.

On top of which planning reforms in the localism bill will make it much easier for tourism attractions to invest and expand.

And looking further ahead, transport developments such as HS2 will tackle one of the biggest challenges we face, namely how to get the 50% of international visitors who come to London but never move beyond the capital to discover everything the rest of the country has to offer.

But as a government we can only create a climate that helps investment and expansion. And that means the support of the entire industry. I hope this year has shown what a strong partnership can achieve.

The future

But if we are to truly exploit our potential as the sixth most visited tourism destination, there is much more to do.

Today, the whole country is riding high on a wave of global, Olympic excitement. In Shakespeare’s words: “On such a full sea are we now afloat… We must take the current when it serves, or lose our ventures”.

In such a landmark year, with so much in our favour, isn’t now the time to go further, to make this Olympic year a real turning point for UK tourism? To step up, if you like, from being a creditable finalist to winning the gold medal.

So today I want to invite the tourism industry to embrace some ambitious goals:

To commit as a government and an industry to increasing the number of overseas visitors to the UK from just over 30 million today to 40 million by 2020;

– To make 2012 the turning point for our domestic tourism industry – and make sure the UK is always promoted as actively to its home market as overseas destinations promote theirs in the UK;

– To exploit the extraordinary role that sport has as a magnet for tourism by exploiting the opportunities presented by hosting world cups in rugby league, rugby union and cricket, not to mention the Ryder Cup and the Champions League final, the Commonwealth Games in 2014 and the World Athletics Championships in the Olympic stadium in 2017;

– To build on the incredible success of the London Festival 2012 by binding the cultural and tourism industries much more closely together as we develop Britain’s reputation as the global capital of culture.

– To support this, I am today announcing new initiatives on both the domestic and international tourism front.

Domestic tourism

On the domestic front, I will today commit that the domestic tourism advertising campaign we saw earlier this year will not be our last.

That’s why we will invest a further £2 million in a follow up campaign next year, to be increased further with match-funding, in order to build on the success of the 20.12 per cent ‘Holiday at Home’ campaign.

The Olympic Torch Relay has really helped to ignite domestic interest in UK holidays. In fact, about one in ten expect to visit a destination off the back of seeing the Olympic flame there. But it is still too difficult to book domestic holiday packages on the web.

So Visit England has committed to double the number of domestic package breaks being booked in the years ahead by bringing together website retailers, car rental groups, train companies, airlines and hotel groups.

Cultural tourism

Following this extraordinary year, I also want us to capitalise on the successes we have achieved in developing cultural tourism. Tony Hall and Ruth Mackenzie deserve enormous credit for putting together the London 2012 Festival, which has already been enjoyed by around 10 million people across the country, with more opportunities still to come – surely the biggest and best Cultural Olympiad ever.

How can we build on this? One promising idea is to have a London Biennale – a bi-annual London or UK-wide arts festival to celebrate the best of what we have to offer culturally. I have therefore asked Tony and Ruth to do a report for me on the feasibility of such a festival, how much it would cost and how it should be delivered.

2013- A Focus on China

Finally, how can we keep up the tremendous momentum we have achieved in marketing the UK internationally?

Today I am announcing a continuation of the GREAT campaign next year with an £8 million focus on one of the world’s fastest growing economies, China.

Only around 150,000 Chinese tourists visited our shores last year, a figure that is way down on that of our major competitors such as Germany and France. The numbers are rising, but it is still estimated that France attracts between 25 and 50% more Chinese visitors than the UK.

We simply cannot afford such a comparatively small share of such an important market.

Nobody should underestimate the opportunity China and its cities represent:

By 2025, Shanghai is expected to be the third richest city in the world;

Five other Chinese cities – Shenzhen, Tianjin, Nanjing, Guangzhou and Chengdu – are expected to be among the top 20 globally for GDP growth;

And by 2030, China should have around 1.4 billion middle class consumers – creating a potential market four times bigger than America.

We must get on the front foot. Through this new campaign, I want us to treble the number of Chinese visitors we attract, getting to 500,000 by 2015. This alone will generate more than £0.5 billion additional visitor spend a year and create 14,000 more jobs.

We will be increasing our marketing in China’s major cities, not just in Shanghai and Beijing, but also some of the other major cities where we know there are big gains to be had.

We’ll also be looking at improvements to the visa system and work with airlines and aviation authorities to improve the number of flight connections to China.

Conclusion

2012 already has far too many firsts to be able to list:

– The greatest 45 minutes in our sporting history, thanks to Jess Ennis, Greg Rutherford and Mo Farah;

– A breathtaking London 2012 Festival, our biggest ever summer of culture;

– The creativity and fun of Danny Boyle’s opening ceremony, which amazed and delighted 900 million people around the world;

– Our historic sites – Hampton Court, The Mall, Horseguards – and the new venues on the Olympic Park: all looking their best and projecting the best image of Britain, both heritage and contemporary.

– And then our volunteers – the Games Makers and London Ambassadors and UK-wide Ambassadors – showing the world a friendliness that has never perhaps been associated with Britain before.

But the biggest opportunity is yet to come.

The Olympics should be for Britain what Usain Bolt is for athletics – something that grabs the attention of the whole world and refuses to let it go.

We must use this extraordinary year to turbo-charge our tourism industry. To create jobs and prosperity on the back of a globally-enhanced reputation. And to show that when we talk about Olympic legacy, tourism is an opportunity we seized and ran with all the way to the finishing line.

Below is the text of the speech made by Jeremy Hunt, the then Secretary of State for Culture, on 23 August 2012.

The world’s first truly digital Olympics

The last few weeks have been dominated by the Olympics. Team GB have certainly been faster, higher and stronger. But perhaps less noticed has been the technology behind the Games which has also been faster, higher and stronger. Indeed given the timing of digital switchover, this was for many consumers the first “digital” Games:

– 700 gigabytes per second were delivered from the BBC website when Bradley Wiggins won his gold;

– On the peak day, 2.8 petabytes of data were delivered – equivalent to700,000 DVDs;

– Nearly a million people watched Andy Murray win gold – not on TV but online and over 9 million followed BBC Olympic coverage on their mobiles;

– And over twenty billion views of the official London2012.com website.

Our success in digital broadcasting is fitting given both the global pre-eminence of the BBC and also our aspiration to be Europe’s technology hub. So today I want to take stock of the progress we have.

Economic impact on the UK

The impact of the internet on modern economies is now well-documented by a number of studies. Last year, for example, McKinsey said that whilst the internet only accounted for an average of 3.4% of the GDP of the 13 largest economies it accounted for 21% of GDP growth.

Ericsson and Arthur D. Little say that GDP increases by 1% for every 10% increase in broadband penetration.

And according to Boston Consulting Group the impact on the UK economy is even greater. They say it could increase from being 7% of the UK economy to 13% by 2015 and describe Britain as the e-commerce capital of the world.

Getting the plumbing right for our digital economy is not just an advantage to consumers – it is also essential for our digital and creative industries, all of whom need reliable high speed networks to develop and export their products as they move large digital files around the world.

Think of the industries who now describe themselves as producing digital content: the BBC and the world’s largest independent television production sector; our music industry, globally the second largest exporter; and our animation and video games industries, some of the biggest in Europe.

Get this wrong and we will compromise all of their futures. Get it right and we can be Europe’s technology hub, bringing together the best of Hollywood and Silicon Valley in one country with huge competitive advantage in both content and technology.

Where we started

Because of the scale of this opportunity, I have always prioritised this part of my agenda at DCMS. In my very first speech as a Minister I said that I wanted us to have the “best” superfast broadband network in Europe by 2015. In defining “best” you include factors like price and coverage as well as speed. But over the past two years it has become clear, as Usain Bolt wouldn’t hesitate to say, to be the best you need to be the fastest.

So I am today announcing an ambition to be not just the best, but specifically the fastest broadband of any major European country by 2015. Indeed we may already be there.

Before I elaborate let me explain where we have come from. Just before I came to office:

– we had one of the slowest broadband networks in Europe, coming 21st out of 30 OECD countries;

– we had a target for universal 2 Mbps access – but only half the money necessary to deliver it;

– and we had no objectives for delivering superfast broadband in this parliament, and no money to pay for it.

Progress to date

To me this combination of slow speed and low ambition felt like the technology equivalent of British Rail. So whether rashly or boldly, I decided to commit to not only to universal 2 Mbps access, but also something much more ambitious: to put plans in place for superfast broadband to reach at least 90% of the population by 2015.

Through a rapid settlement of the new BBC licence fee – for which I owe great thanks to Mark Thompson – I was able to secure £600m of additional investment, half of which is available during this spending round. Combined with digital switchover underspend and match-funding from local government the total amount available is now more than £1 billion.

When combined with the additional £150m we are investing in giving our cities some of the fastest speeds in the world, we have been able to make some dramatic progress:

44 out of 46 local authority areas now have broadband plans approved for delivering 90% or greater superfast access. Some have gone even further, with my own county, Surrey, looking to deliver one of the most ambitious programmes of all with near-universal superfast coverage. Procurement for virtually all areas is well under way, with around one moving into formal procurement every week from October. I expect procurement to be completed across the whole country by next July.

In our cities we want even faster speeds. Our £150m urban broadband fund will mean that around 15% of the UK population will have access to speeds of 80-120 Mbps along with universal high speed wi-fi.

Additionally Ofcom has announced that for the 4G auctions one of the licences will require indoor coverage for 98% of the UK population, guaranteeing a wireless high speed alternative to fixed line broadband.

For some time we have had amongst the highest penetration and the lowest prices of anywhere in Europe. But even before this new procurement has taken place we have already started to make made good progress on speed:

– Average speed in the UK has increased by about 50% since May 2010.

– In the last year alone average speed increased from 7.6 Mbps to 9 Mbps, overtaking France and Germany so we now have the fastest broadband of any large European Country.

– Two thirds of the population are now on packages of more than 10 Mbps, higher than anywhere in Europe except Portugal and perhaps surprisingly Bulgaria.

The need for speed

Probably the best characterisation of my broadband policy has been a relentless focus on speed. Let me explain why.

My nightmare is that when it comes to broadband we could make the same mistake as we made with high speed rail. When our high speed rail network opens from London to Birmingham in 2026 it will be 45 years after the French opened theirs, and 62 years after the Japanese opened theirs. Just think how much our economy has been held back by lower productivity for over half a century. We must not make the same short-sighted mistake.

But when it came to sewers, we got it right. In the 1860’s Sir Joseph Bazalgette ignored all the critics when putting in London’s sewers and insisted on making the pipes six times bigger than anticipated demand.

He could never have predicted the advent of high rise buildings – lifts had not been invented then – but he had the humility to plan for the things he could not predict as well as the ones he could.

You don’t need Bazalgette foresight to see that in the modern world, things are speeding up exponentially. Every 60 seconds there are:

– 98,000 tweets
– 370,000 Skype calls
– there are 695,000 Google searches and 695,000 Facebook status updates;
– and 168 million emails sent.

And that’s just today. To download a 4K video, currently used in digital cinemas, would take an average home user two or three days. They don’t need or want to do that today – but will they in the future? Who here would bet against it? The message has to be don’t bet against the internet, yes, but also don’t bet against the need for speed.

Which is why when the Lords Committee criticised me this summer for being preoccupied with speed, I plead guilty. And so should we all. Because we simply will not have a competitive broadband network unless we recognise the massive growth in demand for higher and higher speeds. But where their Lordships are wrong is to say my focus is on any particular speed: today’s superfast is tomorrow’s superslow. Just as the last government was wrong to hang its hat on 2 Mbps speeds, we must never fall into the trap of saying any speed is “enough.”

That is why, although we have loosely defined superfast as greater than 24 Mbps, I have also introduced a programme for ultrafast broadband in our cities that will offer speeds of 80-100 Mbps and more. And we will continue to develop policy to ensure that the highest speeds technology can deliver are available to the largest number of people here in the UK.

Our plans do not stop here either. We are currently considering how to allocate the £300m available for broadband investment from the later years of the license fee. In particular we will look at whether we can tap into to this to allow those able to access superfast broadband to be even greater than our current 90% aspiration.

FTTC vs FTTH

Whilst I am talking about the House of Lords report, let me address a further misunderstanding. They suggest that fibre to the cabinet is the sum of the government’s ambitions. They are wrong. Where fibre to the cabinet is the chosen solution it is most likely to be a temporary stepping stone to fibre to the home – indeed by 2016 fibre to the home will be available on demand to over two thirds of the population.

But the reason we are backing fibre to the cabinet as a potential medium-term solution is simple: the increase in speeds that it allows – 80 Mbps certainly but in certain cases up to 1 gigabit – will comfortably create Europe’s biggest and most profitable high speed broadband market. And in doing so we will create the conditions whereby if fibre to the home is still the best way to get the very highest speeds, private sector companies will invest to provide it.

Let’s look at the alternative: if the state were to build a fibre to the home network now, it would potentially cost more than £25 bn. It would also take the best part of a decade to achieve. We will get there far more cheaply – and far more quickly – by harnessing the entrepreneurialism of private sector broadband providers than by destroying their businesses from a mistaken belief that the state can do better.

Must be mobile

There is one further principle that needs to underline our thinking. Mobile data use is tripling every year and is expected to be 18 times its current levels by 2016. In that time the number of mobile connected devices globally will reach 10 billion – more than the entire population of the world. One survey rather scarily said that 40% of people with smartphones log on before getting out of bed in the morning. I won’t ask for a show of hands but it may not be the best thing for a marriage.

Our working assumption must therefore be that the preferred method of going online will be a mobile device – whether linked to high speed wireless in buildings or networks outside them. But that in order to cope with capacity, we will need to get that mobile signal onto a fibre backbone as soon as possible. So no false choice between mobile or fixed line, between fibre or high speed wireless: all technologies – including satellite – are likely to have a part to play, and our approach must be flexible enough to harness them all.

Next steps

So what next? Clearly the BDUK procurement process is central to our plans. After a frustrating delay, we are confident of getting state aid approval this autumn, after which the procurements will be able to roll out. But to achieve this timetable projects will need to be ready on time and they will need to be able to progress through the procurement process without delay. So I hope all the Local Authority representatives who are here today will be able to respond to that challenge so we are still able to complete the majority of projects by 2015.

We are also committed to helping private sector investors in our digital network by removing barriers to deployment wherever we can. These include:

– plans to relax the rules on overhead lines;
– guidance issued to local councils on streetworks and microtrenching;
– the development of specifications for broadband in new building and an independent review by the Law Commission of the Electronic Communications Code.

In September we will confirm the funding for the Tier 1 cities that have applied for the Urban Broadband Fund and we will announce the successful Tier 2 cities later in the autumn.

In December Ofcom hopes to start the 4G auctions, with deployment taking place as soon as the final digital spectrum becomes available.

One of the biggest successes of this programme has been to work closely with colleagues in local government. This really matters because planning issues remain very critical to the delivery of this programme, and local authorities are also planning authorities. Most have been extremely supportive – but we still have some frustrating examples of inflexible approaches to planning – not least Kensington and Chelsea, who have deprived their residents of superfast broadband investment as a result. But overall the cooperation from local authorities has been terrific and I want to thank those of you present for your tremendous enthusiasm for this programme.

Conclusion

Let me finish by saying this. Two years ago I promised the best superfast broadband in Europe. After two years, we have the lowest cost, most comprehensive and fastest broadband of any major European country. More importantly when it comes to next generation broadband we also have the most ambitious investment plans too.

Can we do it? I am convinced we can. Of course there remain plenty of hurdles: state aid clearance, planning foresight, contract management and delivery, challenges in our more remote areas. But as Shakespeare said “it is not in the stars to hold our destiny but in ourselves.” In other words, it’s up to us.

Let’s also not forget some people also said that we could not host a great Olympics either. They were wrong. We’ve just hosted the greatest Games ever. Time and again our winning athletes told us “never let anybody tell you it can’t be done”. So let’s be inspired by that, let’s aim high and make sure that broadband plays the definitive role in our economic recovery that we know it can.

Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at the Royal Surrey County Hospital on 4 August 2014.

Introduction

I am really pleased to be here at the Royal Surrey this morning – and many thanks to you Nick for hosting us.

I was delighted and honoured to open the Margaret Eaton wing of your ICU in June – and even more delighted to spend time with your brilliant A & E staff before Christmas where for the first time ever I took someone’s blood pressure as part of a frontline shift.

I try to go out somewhere on the NHS frontline most weeks and I can honestly say I have learned more from those visits than I ever do from sitting behind a ministerial desk in Whitehall.

What I know from my visits here is that you deliver superb care and under Nick Moberley’s leadership have the ambition to be the very best in the country. I want to wish you every success in that, and put on record my thanks – both as MP for South West Surrey and Health Secretary – for the dedication and hard work of the brilliant staff who work here.

Progress over the last decade

Every month, more than a million patients start specialist treatment. Keeping up with this demand is crucial: patients tell us all that timely access to treatment is one of the most important things they want from our NHS.

Keeping waiting times low is therefore a key objective for any government. And it is right to acknowledge that the last government made welcome progress in bringing down the number of people waiting a long time for their treatment, progress this government has sustained.

It is also right to pay tribute to the hundreds of thousands of NHS staff who have worked so hard to make that possible over the last 10 years.

Thanks to their efforts, access to NHS healthcare is now amongst the best in the world.

When the target was announced in June 2004, patients could expect to wait more than a year for treatment.

Since then we have seen spectacular improvements for patients: no longer do we read about the scandal of people routinely dying on waiting lists because access to the life-saving treatment they need comes a year too late. No longer are families suffering the pain of watching elderly relatives slowly lose their mobility, becoming trapped and isolated at home because the NHS can’t provide a simple hip operation for 2 or 3 years.

Delivering timely access to treatment has become part of the DNA of the NHS – and that is something we should all welcome.

A tougher context

It is also worth pointing out something everyone in this hospital will be acutely aware of: delivering that objective has been much tougher in the last 4 years than previously.

Until 2010 NHS funding generally rose faster than the demand for its services. We have had to deal with the deficit we inherited, and we have made some very tough choices to protect the health budget. Despite that, since 2010 funding has risen by around 1% a year even though demand for NHS services has risen by 3.6% a year.

Which makes the achievements of the last four years even more astonishing: every year, compared to 2010, 6,000 more people receive knee operations, 9,000 more people receive hip operations, and 10,000 more people have cataract procedures. Overall we are delivering an extraordinary 850,000 more operations year-in year-out.

And this increase in volume has not been at the expense of quality. A couple of months ago the independent Commonwealth Fund said that in the last four years the NHS has risen to become the top-ranked healthcare system across the 11 richest countries in the world – top for quality, top for efficiency, top for access, and top overall.

Targets can be dangerous

But – and there is a ‘but” to this – targets, as we also saw under the last government, can create the wrong behaviour too. What happened at Mid Staffs and many other hospitals was that targets distorted behaviours, changed clinical priorities and led to appalling care, sometimes with tragic outcomes for individual patients.

When the NHS started measuring performance against the 18 week target in 2007, something perverse happened. If faced with a choice between treating a patient who had missed the 18 week target or someone who had not yet reached it, the incentive was to treat the person who had not yet missed the target rather than someone who had – because that would help the performance statistics, whereas dealing with the long waiter would not. So a target intended to do the right thing ended up incentivising precisely the wrong thing.

And that in a nutshell is the problem with targets: unintended consequences.

Under huge political pressure, managers inevitably gamed the system to make their organisation look good – and patients suffered the consequences. Suddenly, real people with real illnesses and real needs find themselves treated like a number or a statistic, there not to be looked after but to be manipulated to show organisational performance in the best light.

So this government has made a determined effort to change that culture. Not by abolishing targets altogether – all organisations need priorities – but by making sure they are implemented more humanely and sensibly.

When we came to office in 2010 there were a shocking 18,500 people who had been waiting not 6 months, not 9 months but over a year for treatment.

I am pleased to say that even though none of those people count towards the standard 18 week target, we have none the less reduced that number to just 500.

But today I want to say that even 500 is too many.

A year is a very long time to wait if you are immobile, in discomfort or in pain. If a single one of those patients is waiting not out of choice, or for proper clinical reasons, but simply because the NHS has not been able to provide the treatment they need for a whole year then that is unacceptable.

So today I want to announce a new ambition for the NHS: I want this number of people waiting more than a year for their operation to be not in the thousands, not in the hundreds, but as close to zero as possible.

There will, of course, be exceptions to this which is why I do not want to fall into the trap of making this “another target”: there will be patients with multiple conditions where one condition needs to be treated first; there may be highly complex treatments which are particularly difficult to source; and sometimes the patient may choose to wait for personal reasons.

Unless there are those good reasons, no-one should have to wait more than a year for treatment.

So from today NHS England will review all 500 cases, and working with CCGs and local hospitals, ensure that any patients who can be treated will be treated as rapidly as possible.

Nor should this just be about people waiting for more than a year.

I want the NHS to put particular focus on anyone who has been waiting more than 18 weeks since being referred for treatment, so have asked NHS England to commission 100,000 additional treatments over the summer including 40,000 additional inpatient admissions.

This focus on long waiters may mean we undershoot the 18 week target for a temporary period, although we will return to meeting it before the end of the year. Indeed as the many NHS target experts will know we could ensure we met the 18 week target every month by focusing those 100,000 additional treatments on shorter rather than longer waiters. But that would be an indefensible betrayal of those who have been waiting the longest and not one I would be prepared to sanction as Health Secretary.

The truth is we need to ensure both that 90% of people get their treatment within 18 weeks – the official target – and that people who are not treated within that period are not neglected. So I have set a timeframe of this calendar year to deliver on both of those objectives.

An NHS about more than targets

Let me conclude with a broader point. Targets matter, but they should never be the only thing that matters. Patient safety, compassionate care, clinical effectiveness and efficiency are also vital.

Robert Francis hit the nail on the head in his report on Mid Staffs when he said “targets were often given priority without considering the impact on the quality of care”.

Even before Mid Staffs, the Healthcare Commission attributed one of the causes of over 30 C diff deaths at Buckinghamshire Healthcare NHS Trust as an over-focusing by the Trust on meeting government targets. Many of you here will have had experience of similar pressures and conflicts in your own daily work.

Which is why last year we introduced a new inspection regime for hospitals that looks at performance more broadly than just targets. We must never go back to the bad old days where targets seemed to matter more than people – so where we do have targets they should implemented sensibly and in line with the clinical needs of patients.

And where there is poor care, it should never be swept under the carpet.

As well as identifying good hospitals such as this one, the new Chief Inspector of Hospitals has recommended a number of hospitals go into special measures – indeed 10% of all NHS hospitals have been put into special measures in the last year alone. But far from leading to despair, the resulting transformation in both quality and financial discipline at those hospitals has been striking.

But it isn’t just at failing or struggling hospitals we have seen improvements. Across the NHS we now have more than 6,300 additional nurses in our wards than in 2010 as we finally put behind us the scandal of short-staffed wards. At the same time we have become the first healthcare system in the world to publish key safety data on a single website for every major hospital in the country.

We have also become one of the first healthcare systems in the world to make a determined national effort to embrace the safety culture of airlines, where there is a much stronger culture of reporting safety concerns and near misses than there is in medicine. That means supporting people on the front line who have concerns about safety or care – and stamping out the bullying and intimidation that is still too common in many hospitals.

These are big changes – changes designed to increase clinical accountability and make sure we always put patients first.

Conclusion

Let me conclude by returning to the new ambition I am announcing for the NHS today.

Let’s continue to make sure we treat the vast majority of patients within 18 weeks of being referred. But let’s also make sure we don’t forget the minority who don’t. So let’s commit that no one – except in exceptional circumstances – should have to wait more than a year.

Targets that help patients get treatment when they need it – not targets followed blindly with no regard for the impact on individuals.

An NHS confident that – in the end – it will continue to meet the huge challenges ahead if it leaves room, amongst many loud, competing pressures, for the quietest but most important voice of all: that of the patient.

Thank you.