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  • Basil Peto – 1912 Speech on the Minimum Wage

    Below is the text of the speech made by Basil Peto in the House of Commons on 15 February 1912.

    I beg to move, as an Amendment to the proposed Amendment, to leave out the words, Your Majesty’s Gracious Speech contains no specific mention of legislation securing a minimum living wage and for preventing a continuance of such unequal division of the fruits of industry by the nationalisation of railways, mines, and other monopolies, and to insert instead thereof the words, Your Majesty’s Ministers are not taking steps to forward the fair and equitable division between capital and labour of the profits of industry by co-partnership which would unite their interests and enormously add to the productive capacity of the country, cheapen the cost of commodities, increase this country’s power of competing in all other markets, and give to wage-earners a human interest in life and work and place them on a moral equality with every other class. I hope the hon. Member for East St. Pancras (Mr. Martin) will excuse me if I do not follow him through the whole of his speech. I would like, however, to say one word with regard to the speech he has made. There is one point in which I find myself in sympathy with him. He drew a comparison between the railway rates charged in this country and those charged in other countries to bring Foreign and Colonial produce to our shores. There I entirely agree with him; there is something which very much wants looking into; but when he says there are these fabulous millions to be saved and enormous reductions in the rates to be obtained simply by nationalisation of the railways, I part company with him. Two hon. Members who addressed the House earlier in the Debate—I think the hon. Member for the Montrose Burghs (Mr. R. Harcourt) and the hon. Member for Walsall (Mr. Cooper)—speaking from opposite sides of the House, said they were in sympathy with what I may term the premises underlying the Amendment before the House, but they did not agree with the remedy the hon. Member for Leicester (Mr. Ramsay MacDonald) and his Friends proposed to apply. I find myself in the same position. Both those hon. Members said they would like to move an Amendment, and the hon. Member for the Montrose Burghs read out the Amendment he would have proposed. I am afraid I do not find myself very much in agreement with him, but I hope when I have the honour of moving the Amendment to the Amendment of the hon. Member for Leicester, of which I have given notice, both those hon. Members will find themselves more in agreement with me than I find myself in agreement with the hon. Member for the Montrose Burghs. I have listened to the speeches which have been made, and before I proceed with my Amendment I should like to say a word or two with regard to one or two of the things those speeches contained. It struck me as rather curious that the hon. Member for Bow and Bromley (Mr. Lansbury) should have used almost the exact phrase with which the Amendment I shall have the honour of proposing terminates. He spoke of the equal value of each human life and the right to a full life. I do not think, however, his argument went to meet that contention. It seemed to me that most of his arguments, and most of the arguments that underlie the whole question of the minimum wage referred to in this Amendment, rather ask for a reasonably full stomach, and nothing more. They do not touch the moral question in any kind of way, or the question of the equality of all people in this country and their equal right to have an equal interest in their life and their life’s work. He also mentioned two or three cases of family budgets where it was perfectly impossible to provide, and where nothing was provided, for milk at all. I am entirely in agreement with the hon. Member when he asked how we can hope to raise an Imperial race when we have children whose parents are so poor that they are unable to provide that which is absolutely necessary for bringing up a healthy human being. All those things touch what I call the premises which underlie this Amendment. They do not deal with the remedy at all, the remedy of the nationalisation of land and of all monopolies.

    I would like to say a word or two with regard to the speech of the hon. Member for Leicester. He said the higher the protection the worse was the condition of labour. Surely a generalisation of that kind comes rather curiously at the present time, when we have had a Report, not of a Tariff Reform Commission, but of a Government Commission, to inquire into the cost of living and labour in the United States of America. It is admitted in that Report that although the cost of living is much higher—it is reported to be something like 50 per cent. higher—than in this country, yet the wages in the most protected country in the world, a country that originated the term of “American Protection” to which one hon. Member referred, are two and a half times as high as in this country. That means that on the average every man there can save as much every week as every man can earn in this country. Yet the hon. Member tells us that the higher the protection the worse the condition of the labour. Then he said it was one of the primary tenets of the Tariff Report party that whenever prices were raised wages were raised. I beg to submit with all respect that the hon. Member was really confusing cause and effect. We never say anything of the kind. What we do say is that under reasonable conditions of employment, and under reasonable conditions of carrying on the trade of the country, such as are common to every other country in the world, wages will rise. It has been said if we had had Tariff Reform in 1906 prices would have been higher than now. I think that is not so. I think the contrary is the case. That leaves out the whole of the other part of the question. The hon. Member did not touch on the question whether, if prices had been higher, the wages would have been higher to meet those prices.

    The hon. Member for North-East Manchester (Mr. Clynes) said that if the wage-earning classes could not get justice by argument and peaceful means they naturally took steps to get advantages by other and forcible means. With regard to that point, in the Amendment which I have on the Paper I suggest an alternative. After all, wages like profit, depend entirely upon what is to be got out of industry. You cannot get out of an egg more than it contains, and a fair division between capital and labour will not involve any complicated methods of conciliation boards nor will it require any resort to force. I should like to say one word with regard to the terms of the Amendment. It suggests a minimum living wage and preventing a continuance of the unequal division of the fruits of industry by the nationalisation of railways, mines, and other monopolies. I should like to know why the term “fruits of industries” is used? Why does not the hon. Member call a spade a spade? Why does he not refer to the profits of industry? After all the fruits of industry are the profits of industry. I wonder whether the hon. Member had in his mind, when referring to the fruits of industry, the idea that the labouring classes in this country were to get something unknown out of the lucky bag without any effort on their part. On this question of the unequal division of profits, I ask how is it going to be met by the nationalisation of the railways and coal mines? The whole underlying basis of the argument for nationalisation is the abolition of profit. The hon. Member for Bow and Bromley said he would like to see profits done away with. He hopes the tramways will, at any rate, become national property. [An. HON. MEMBER: “Municipal property.”] Well, municipal property, and the hon. Member expressed the hope that there would be no occasion to pay anything whatever in connection with them. How, under a system of nationalisation, are you going to arrive at a more equitable division of profits?

    I come next to the question of the minimum wage. What is asked for? Is it the high ideal of the wage-earning classes? It is now over a century since the abolition of slavery, yet we are still in a condition in this country where there are people who do not get adequate food for themselves and their families in return for their labour! I would ask whether under the old conditions of slavery, which this country did so much to abolish, it was not wise policy on the part of the slave owners to give adequate food to those who belonged to them. What do the Labour party ask for as a practical thing? They ask for a minimum wage. Why? In order that there may be enough money to provide a modicum of food for their families. But the hon. Member for Bow and Bromley went on to say that he was in receipt of £400 a year and would like to fix the minimum wage at that figure. I would remind the hon. Member on the basis of figures which I think are more than questionable as to the whole of the national income, it was only the other day pointed out by the Chancellor of the Exchequer that if the whole of the national income, amounting to £1,800,000,000, were divided among the families of this country, it would produce only about £200 per family per year, yet the hon. Member for Bow and Bromley is asking for £400 a year. I do not think he meant that seriously.

    Mr. LANSBURY Oh, yes.

    Mr. PETO Then the hon. Member is trying to get the meat of two eggs out of the shell of one.

    Mr. LANSBURY The hon. Member forgets that there is a multitude of people who are not allowed to work.

    Mr. PETO I am taking the total number of families and dividing among them the estimated national income of £1,800,000,000 a year. Why do hon. Members think it necessary to term coal mines a monopoly and talk about nationalising them? There is a better and much simpler way of dealing with the question. There are plenty of coal mines open for sale, and there is no reason whatever why hon. Members opposite, in direct touch with the great trade unions, if they think the coalowners are earning an unfair amount of profit, should not acquire coal mines for themselves and make the profit for themselves. They would see then exactly how much profit is made with the present wage scales.

    I propose to refer next to the Amendment which I wish to move to the Amendment of the hon. Member for Leicester. I entirely agree with the hon. Member’s Amendment so far as it refers to the considerable increase in the cost of living, and I propose to insert words expressing regret that His Majesty’s Government are not taking steps to forward the principle of a fair and equitable division between capital and labour of the profits of industry by co-partnership in view of the enormous addition that would ensue therefrom to the productive capacity of the country, the consequent cheapening of the cost of commodities, and the increase in the country’s power of competing in all other markets, and give wage-earners a human interest in their life and work, and place them on a moral equality with every other class. That is what I honestly believe, from the bottom of my heart, to be the true solution of this difficulty. If every industry in the country were carried on under this scheme it would mean a livelihood for all. It would enable men to decently support themselves and those dependent on them. If it is carried on for profit now it will have to be carried on for profit always. If we want to do away with this incessant friction between capital and labour we must do something to see that whatever profit is earned over and above what are the fair wages of labour and a fair return for capital is equally divided between those who work with their hands and those who work with their heads in the conduct and management of the business.

    I would indicate to the House what would be the advantages of such a proposal as is contained in my Amendment being generally adopted as a principle of trade in this or in any other country. First of all there would be an increased earning. That is the simplest question of all. The hon. Members opposite ask in their Amendment for the principle of a minimum wage. Instead of a minimum wage I suggest a fair division of profit, and labour would thereby get an increased wage and many other things beside. The next enormous advantage would be that then you would have two natural partners in every industry working for a common purpose, and there would be reconciliation between the interests of capital and labour. I wonder whether the House will think it a far-fetched simile if I describe the present condition of affairs by what would happen supposing anyone in charge of a great engine driving machinery in any works were every morning to put in a dose of sand and grit instead of lubricating oil. Yet that is the present state of affairs in the industry of this country. There is constant friction. I do not wish to specially blame any class for it. But there is constant difficulty, and the cause of friction is that you do not put in lubricating oil to make your machine work smoothly.

    Then there is the question of increased efficiency involving the lower cost of commodities. I do not think that anyone who has ever had anything to do with the productive industries of this country will question—if they think the matter over for a minute or two—the statement that there has been an enormous loss in efficiency. One hon. Member described what had taken place by the gradual diminution of output through one man trying to work down to another man’s level. Whatever industry a man is engaged in you are bound to have a feeling that it is no good doing too much for a fixed wage that cannot possibly be increased by any exertion on the part of the worker. As long as there is unemployment in the country I know from personal experience, particularly in the building trade, there is a very natural feeling on the part of men, especially in winter time, that as there are a great number of people out of work the smaller the individual output the better it will be. In other words, there is very little butter to be spread on the bread, and they therefore spread it as thinly as they can, so that everybody may have a share. I do not say that that is not a generous impulse. But the result of that is a reduction in the output of commodities, and the absence of the incentive to do an honest day’s work is perfectly disastrous both on the cost of production and on the cost of the articles produced.

    Then there is what I think is one of the most important of all the points with regard to this question of co-partnership: there is the interest in life and work. People who are in the fortunate position—I frankly admit it is a fortunate position, of which I have always had the advantage myself—of managing and working with the head and not with the hand, have got an enormous advantage, quite apart from the advantage received over the wage-earner under existing conditions. You have the one great incentive to work, the one great thing that makes the dullest work interesting and that makes life worth living, if it is a life of toil. I asked the House a few minutes ago to look back nearly one hundred years, to the slavery days. I ask them now to carry their minds back the same distance and to consider the conditions under which work was carried on then in this country. You had not these enormous aggregations of workmen and of capital or the enormous and minute subdivisions of trade. You hard then a few men, perhaps working in partnership or employing two or three hands apiece. In the great majority of cases the shipwright, the carpenter or joiner, and the man who made boots, purchased their own raw materials. They were capital and labour combined. They started and they finished their job and they had every satisfaction, both in the result from the moral point of view and the result from the economic point of view, that could be possibly got out of the work. What have we got now? I will only give one illustration. Take the man who built a ship 150 years ago. He had all the pride of the designer and of the man who could carry out every part of the small ship until it was finally launched. That was work which was not dull and of a routine character. Contrast that with the work to-day. One man from morning till night will be heating rivets; another will be holding them in position, and this on every day of the week, and week in and week out, with no interest in the result of the work, but for the wage. I ask the House to consider the enormous growth of trade which would result to this country, or to any country, which first generally adopts this principle. It would result from the increase of trade in the market of every other country which did not adopt this principle. We have had some reference to the question of Tariff Reform, but very few of them. I am an ardent Tariff Reformer, while hon. Members opposite, or most of them, are the reverse. We believe on our side of the House that the present commercial system of this country is a great handicap to our industry and is a drag upon the wage-earners. On the other hand, Members opposite believe that if we adopted the principle of an Imperial commercial policy it would be an enormous detriment to our trade, and perhaps that it would destroy our trade. I made the frank admission, strong Tariff Reformer as I am, that if under Free Trade this country generally adopted in all its industries the principle of co-operation it would so enormously lower the cost of production and increase its productive energy that we should be better off under Free Trade than other countries under the Protective system, who had still this friction going on between capital and labour.

    There is only one more thing I wish to say. It may be said it is idle to propose a sort of pious Amendment in favour of something to which neither this Government nor any Government could give effective force. I am all for dealing with something which I believe is a practical solution of this difficulty, which I believe is the only practical solution, and which I believe inevitably will come whether Governments move in the matter or not. The reason I am confident is that in every single case where a fair co-partnership scheme has been given fair play and a chance by those who are opposed to it, it has succeeded beyond the bounds of ambition and almost beyond the dreams of avarice. The hon. Member for Bow and Bromley (Mr. Lansbury) asked just now under what private employer could we possibly find an increase in wages at 20 per cent. I believe there are hon. Members in this House—I believe there is one hon. Member at any rate who will address the House on this subject—who can assure the hon. Member that not only is a 20 per cent. increase in wages possible under co-operation or co-partnership, but something infinitely better than that, something which means an increase far above 20 per cent. and which turns every wage-earner into a capitalist and compels every capitalist to be a wage-earner as well. It may be asked, What can any Government do? I say there are two things they can do. The Government have one enormous power in their hands—the power of taxation. I say it is perfectly possible, provided that any Government were convinced that it is in the interests of the country to do all in their power to forward this great principle of true partnership, for them to temper the wind to the shorn lamb, and they can say, where a fair and equitable system of profit-sharing is adopted, that they will make their Income Tax and all other direct taxes fall more lightly on those concerned. There is even a more direct way in which the Government can help. The Government are probably the largest employers of labour in this country, and just as they have it in their power to say that no firm shall be able to compete for a Government contract that does not pay a fair wage, so they can say they will only give the contracts for all public and national work to those firms who have adopted the great principle which is the only solution of the friction between capital and labour. I feel most strongly about this. I do not say anything about feeling great responsibility in addressing the House. I should feel that at any time, but I should feel a still greater responsibility if, either by not voting or by returning a direct negative, to the proposal of the hon. Member for Leicester, I tacitly and silently admitted that the remedy which he proposes is in any sense a true remedy, and could in any way assist the cause which I believe he has at heart, when I know there is another principle which has been all too little adopted in this country the general adoption of which will solve once and for all all questions of labour disputes.

  • Patricia Hewitt – 1997 Maiden Speech to the House of Commons

    patriciahewitt

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Patricia Hewitt – 2006 Speech to Unison Health Care Conference

    patriciahewitt

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

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

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

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

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

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

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

    The best year ever for patients

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

    We can all remember what it used to be like.

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

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

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

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

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

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

    Financial problems

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Engaging front-line staff

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

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

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

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

    The need for change

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

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

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

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

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

    All part of the changes taking place in the NHS.

    But there are other changes that are more controversial.

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

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

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

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

    That’s not privatisation, that’s progress.

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

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

    But there are others who would abandon those principles.

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

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

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

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

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

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

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

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

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

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

  • Patricia Hewitt – 2006 Speech at Royal College of Nursing

    patriciahewitt

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Record improvements

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

    And I want to congratulate the RCN.

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

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

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

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

    Working together

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

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

    We worked together to extend nurse prescribing.

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

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

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

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

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

    The founding values of the NHS.

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

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

    But there are others who would abandon those principles.

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

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

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

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

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

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

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

    And that is a prize worth fighting for.

  • Patricia Hewitt – 2006 Speech at HR in the NHS Conference

    patriciahewitt

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

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

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

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

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

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

    The facts speak for themselves.

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

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

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

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

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

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

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

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

    Financial problems

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    But not everybody believes in these principles.

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

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

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

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

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

    But look at the prize.

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

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

    And you are the experts.

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

    Thank you.

  • Patricia Hewitt – 2006 Speech to NHS Confederation

    patriciahewitt

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

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

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

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

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

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

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

    And you’ve done it.

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

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

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

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

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

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

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

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

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

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

    Ian said yesterday that the centre wasn’t listening.

    That has got to change.

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

    From “top down” to “bottom up”

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

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

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

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

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

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

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

    The four parts of the reform programme work together.

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

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

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

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

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

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

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

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

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

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

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

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

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

    Meeting future challenges

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

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

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

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

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

    Conclusion

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

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

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

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

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

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

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

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

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

  • John Hutton – 2005 Speech at NHSFT Forum

    johnhutton

    Below is the text of the speech made by John Hutton, the then Minister of State for Health on 11 January 2005.

    Good afternoon.

    I’m delighted to take advantage this opportunity to say a few words to you today because it is very important we have an open and effective dialogue over the future of NHS Foundation Trusts. But first I’d like to say 1 or 2 words about what it is we’re trying to do – because NHS Foundation Trusts are very much a means to an end.

    Establishing NHS Foundation Trusts was all about re-invigorating the delivery of NHS services by introducing new freedoms and new rewards for good performance. As far as the Department and Government are concerned we remain absolutely committed to these objectives and they will continue to guide our thinking about the next steps in the process of establishing new waves of NHS Foundation Trusts.

    For the vast majority of the people who live in our country, the NHS remains central to our national identity and national sense of purpose. It stands for a set of values and principles our society continues to hold dear. Our task in Government is, and remains, to ensure the NHS delivers its services in a way that will allow support for these core values to be maintained and strengthened. That is what NHS Foundation Trusts are all about. They are designed to sustain not to supplant these essential principles of equity and universality.

    If we are going to succeed in doing this we cannot afford to stand still, because the challenges the NHS faces today are different from those of fifty, twenty or even ten years ago. Our national expectations, both as consumers and taxpayers are higher today then they’ve ever been before. Rightly so. We know how important good health is to the quality of our lives and those of our families. We expect a more personal service. We want our healthcare to be provided at a time and place that suits us best. And we want more choice over what sort of service we can use.

    That sort of healthcare service has of course always been available to those who could afford it. For most of our fellow citizens however, it has sadly always been out of reach because this wasn’t the service that the NHS provided. This is what has to change. Making this change is I think the biggest challenge facing the NHS today. People want the NHS to succeed in rising to this challenge, because we know it is the fairest and most efficient way to organise and deliver the highest quality healthcare to the largest number of people.

    NHS principles stand head and shoulders above private insurance or voucher based alternatives in terms of equity of access. Every piece of research, both national and international, confirms this. The task facing all of us today is how to convert the principle of equity of access that rightly underpin the NHS into a modern delivery mechanism that guarantees patients the kind of service they have come to associate exclusively with the private sector. To succeed in this historic challenge we need two things. Investment and reform.

    We need significant and sustained investment so that we can make good decades of under funding which has left the NHS short of the necessary capacity and the infrastructure to meet the needs of the people we seek to serve.

    The extra investment is already making a very big difference to the NHS. Waiting times are falling quickly in every part of the country. The quality of the care we provide is improving too. Fewer people with cancer and heart disease are dying from their illnesses. New treatments and drugs are being made available more quickly. More doctors and nurses than ever before are helping us to realise these improvements in the standards of care that we provide. We cannot claim that every single problem facing the NHS has been solved in the last seven years. That’s palpably not the case. But we are now heading firmly in the right direction.

    But one thing is clear. Although essential, this investment on its own would never have been enough to complete this process of transition from the old NHS to the new. That’s why the way we deliver our services needs to change as well.

    We have set out the changes we believe are necessary in order to help the NHS become the service we all want it to be. Led by greater choice for NHS patients, resourced through payment by results and supported through the largest investment in new information technology underway in any healthcare system anywhere in the world, the NHS stands on the threshold of the most radical reforms since it was created over fifty years ago.

    NHS Foundation Trusts and the work of MONITOR are at the forefront of this programme of change. That is why the Government remains absolutely committed to the principles that underpin NHS Foundation Trust status and to making these reforms a success.

    To make these reforms work in the acute sector, we need greater operational and financial freedom for providers, less bureaucracy and red tape, stronger local accountability, and greater rewards and incentives to raise the standards of patient care. In all of these key areas, NHS Foundation Trusts are quite literally leading the way. All of you can point to real improvements and benefits to your patients that Foundation status has helped deliver. All of you have helped the NHS rise to the challenges it faces today. Less than a year into these reforms, I believe the progress you have made has been truly impressive.

    It is clearly right however that we should look carefully at how we take forward this policy over the next few years. Firstly, we have to learn from the experience of the first wave. In particular, we need to reflect carefully on the support the Department provides applicants for NHS Foundation Trust status to see what more we can do to help Trusts prepare for the new financial regime under which they will operate.

    Secondly, we all need to consider very carefully the experience of the first wave of NHS Foundation Trusts in operating the new Payment by Results system in order to make sure the wider NHS can benefit from the new incentive and reward systems. I think this is particularly true in the area of emergency care and outpatient activity.

    Thirdly, we need to be mindful of the need to keep bureaucracy and red-tape to an absolute minimum so that hospitals can focus on the job at hand – treating patients and raising standards of care. This must be a shared priority for all of us. I was particularly glad last week that we were able to announce that NHS Foundation Trusts no longer need to inform the Department of Health every time there is a false fire alarm. I’m sure there is more that we can do on this front.

    Fourthly, we need to maintain a strong focus on making the new governance arrangements work as they were intended by strengthening the new links that exist between hospitals and their local communities. I think we’ve got to ensure that this new form of public ownership adds real value to the NHS – strengthening the concepts of local accountability and public engagement.

    And finally we will need to consider the report of the Healthcare Commission into how the new freedoms for NHS Foundation Trusts are working in practice.

    So there is a full agenda in front of us. For our part, we are fully committed to working with individual NHS Foundation Trusts, with the FT Network, with MONITOR and the wider NHS to make a success of these reforms and a success of NHS Foundation Trust status. That is why we remain open to new ideas and suggestions from all of you about how foundation status can lead to a more dynamic, flexible, entrepreneurial and higher quality NHS.

    I want to finish with this observation. At the beginning of this reform process two years ago, what mattered most was what Ministers said about NHS Foundation Trusts. Now what matters most is what you do with the new freedoms that you have – how you use them to improve the quality and convenience of the care you provide to your patients.

    Thank you.Good afternoon.

  • John Hutton -2004 Speech on Practice Based Commissioning

    johnhutton

    Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 7 December 2004.

    Can I first of all thank the HSJ for giving me the opportunity of saying a few words at this very important gathering.

    This is a decisive moment for the future of primary care in the NHS. Last year we saw agreement on the new contracts for GPs and the first tranche of new investment to go in alongside it. Next year we will see the introduction of the new practice based commissioning arrangements. Both of these changes have the potential to fundamentally change the quality, capability and capacity of primary care services. We need to take full advantage of these opportunities if we are to maximise the benefits of both. We need to do this for one very obvious reason.

    The NHS was built on the foundations of primary care and primary care remains central to its future. Nearly all of our patients begin and end their treatment in a GPs surgery. Primary care continues to enjoy the highest satisfaction rates of any part of the National Health Service. It has a proud record in public health and health promotion. And despite all of its detractors, NHS primary care is still the envy of every other developed health care system and a model admired right across the world. If primary care is the cornerstone of the NHS then it is clear that the ambitions we have for the NHS can never be fully realised unless primary care has the tools to do its job properly.

    But I believe we have every reason to be positive and optimistic about what lies ahead for both primary care and the NHS.

    There are more GPs and nurses working in primary care than at any time in the history of the NHS. More doctors than ever before want to work in general practice. As a result, people can see their GPs more quickly and there are more services available to patients. Many GP surgeries have been improved and modernised – creating a better environment in which both to work and to treat patients. And there is a steady increase in resources going in to primary care. Helping to build up capacity and capability even further.

    So we’ve come a long way. But clearly not everything is perfect. Not every part of primary care in our country has seen all of these improvements. The pressures are still there and they are experienced every day by hundreds of dedicated staff and thousands of increasingly frustrated patients. So it is not my argument today that every problem in primary care has been solved. We all know that isn’t true. Nor am I saying that primary care cannot improve further still, because we all know that it can. My argument today is that primary care has an extraordinary opportunity to build for the future. To play a leading role in shaping our definition of healthcare. To make Britain a healthier place to live for me the most important thing is the health of the poorest of all.

    If we are going to take advantage of these opportunities there needs to be further significant investment and change in primary care. Not change for changes sake. But reform with a very clear purpose. To strengthen primary care and to improve the service it provides helping, in the process, the NHS to become the service we all want it to be.

    Advances in technology and in our understanding of illness and disease together with an expanded workforce and greater resources will allow us to provide more services to a higher quality. So in the future more surgery, testing and diagnostics will be performed in primary care settings.

    GPs with a special interest will take on new roles that have, until now, always been the exclusive preserve of hospital consultants – particularly in the area of chronic long term illness. Nurses and other health care professionals working in primary care will similarly see their responsibilities expand as they enter into new partnerships with GPs to deliver GMS and PMS.

    New contractual frameworks will, for the first time, allow both for improvements in the quality of services to be properly rewarded for the first time as well as encourage new providers to enter primary care and help deliver a wider range of NHS services. Expanding choice as well as accessibility for patients.

    The introduction of new information technology applications in primary care through the National Programme I hope too will herald further improvements to the quality, safety and convenience of the service we provide to the public.

    All of these changes are designed to improve the service available to patients in primary care and are going to be backed up higher investment in primary care – up by a third over the next few years. And who better to lead this process of change than our family doctors and our primary care staff who have always been at the forefront of innovation in the NHS.

    That is why I believe the engagement and involvement of front line professionals themselves is going to be essential to the success of these reforms.

    Thousands of doctors and nurses are currently engaged in designing new ways of working and are hoping therefore to reshape the boundaries between primary and secondary care.

    I want this to be the norm everywhere in England. I want GPs and their practice staff to be properly enabled and encouraged to fashion services around the needs of patients. Where we do look critically at all of the care pathways patients follow to ensure we offer the best possible configuration of expertise and resource.

    To make this happen, I don’t think we need another re-organisation. But we will require a new balance of responsibilities in primary care, with new powers for general practices to work creatively with their local NHS partners in taking the key decisions that affect the delivery of frontline services.

    We set out in July our plans for practice led commissioning. Next week we will publish the final guidance. There won’t be any major changes. From next April, every practice will have the right to hold a practice level commissioning budget. From elective care to prescribing, from chronic care to diagnostic screening, practices will be better able I think to help determine the future shape of the NHS.

    There will be no new targets. No one will be forced to do anything they don’t want or choose to do. Instead, we will set out what practices are entitled to receive as a budget and how any disputes about the budget can be easily resolved. We will set out the ground rules about how any savings can be re-deployed into developing better services. And we will highlight many of the local success stories from around the country where practice led commissioning is already making a major contribution to the work of our NHS.

    Within this framework, people will be free to determine their own pace of travel. They will be free to develop their own local preferences. They will be free to do it their own way. Because here there is no one size fits all model and therefore we will not be imposing one.

    So this will be a bottom-up process. Led by GPs and their practice staff and working alongside PCTs and NHS Trusts to deliver the best possible services that we can provide. We want to see local innovation resulting in flexible high quality services for patients. And, if innovation leads to money being freed up, which I believe it will, then it will be ploughed back into patient care to further improve the services that patients receive.

    We have always been clear about the need to fully involve GPs and practice staff in local decision making in the NHS. In our very first White Paper on the NHS in 1998, we made clear that we wanted to:

    “Extend to all patients the benefits, but not the disadvantages of GP fundholding”

    That is what practice based commissioning is all about. It is not a return to the fundholding arrangements of the past.

    Unlike fundholding, there will be no extra resources going to those practices who take up PBC. There will be a level playing field for all practices whether they want to take advantage of PBC or not. No patient will be unfairly disadvantaged if their practice decides not to take up these new opportunities to have more say over how local services are designed. That wasn’t true under the policy of fundholding.

    Secondly, PBC, unlike fundholding, will not usher in a huge expansion in bureaucracy as PCTs will still retain legal responsible for the contracting process.

    And finally, there will be no return to the situation under fundholding where it frequently came down to which hospital could provide a service at the lowest possible price. The single national tariff will prevent this from arising. PBC will instead focus on quality and efficiency. This will put the interests of patients first. As it should be.

    So we remain clear that it was right to end fundholding because it unfairly discriminated against the patients in those practices who chose not to take it up and because it spawned a giant bureaucracy. So we won’t be repeating these mistakes with PBC.

    But clearly in return for the significant new freedoms that PBC will bring I do believe that it is fair and reasonable for PCTs to expect that primary care services will operate to the appropriate level of customer service and convenience. For example, patients should be able to take advantage of electronic booking systems that connect GP surgeries to hospital admission systems. And patients should also be guaranteed prompt and fast access to GPs and their practice staff.

    There will also be effective safeguards to ensure value for money and the proper use of public funds. Practices will have the responsibility of balancing their budget over three years and PCTs will have the right to intervene if public money is being used inappropriately. In balancing rights and responsibilities, we want to encourage PCTs and practices to work in a mature partnership to ensure the best outcomes for their patients.

    We are not promoting Practice Based Commissioning at the expense of commissioning at a locality level by groups of practices. For the correct size for commissioning care varies for different services.

    And we should aim high. I hope that all practices will be involved in Practice Based Commissioning by 2008. Within that context, people can decide their own pace of change. We will actively support those practices and PCTs who want to take advantage of the possibilities that practice led commissioning provides. Next year, we will be offering support to the NHS in the form of further technical guidance and IT support, which I think will be essential. This will give practices the tools they need in order to take the fullest advantage of these new opportunities. The rest will be down to you. You will write the next chapter in the history of NHS primary care. That is how it should be, because there is no one better placed to do that than Britain’s family doctors.

    The ultimate test of any new policy must be what benefits it brings for patients. I believe Practice Based Commissioning will be particularly advantageous for people with long-term conditions, allowing their doctors to commission integrated care that ensures holistic treatment of a condition. Diversity of provision and more use of primary care should also reduce waiting times. In North Bradford PCT, which has been using Practice Based Commissioning for 4 years, waiting times are well below six months. And Practice Based Commissioning will give GPs and their patients greater choice in how services are provided and should lead to more varied and more local services. For instance, East Devon PCT has used Practice Based Commissioning to reduce reliance on secondary care. Patients that would have gone to the Royal Devon & Exeter Hospital for Ear Nose and Throat complaints are now being treated in a primary care setting by practitioners with special interests.

    These are a just a few examples of the benefits that Practice Based Commissioning offers. It will be for those who work in the NHS to explore the full potential.

    Practice Based Commissioning is part of a journey to improve the NHS and make it the service we all want it to be. Focused absolutely on the needs of patients. On managing referrals into secondary care efficiently and effectively. On providing services in the most appropriate setting possible and as close to the patient as we can. That journey is not over yet. We still have a great deal to do. But even our most sternest critics would, I think, be prepared to acknowledge that there are now real and tangible signs of progress right across the country. Shorter waiting times. Reduced mortality from cancer and coronary heart disease. Newer hospitals and better GP premises. Faster access to the latest drugs, treatments and equipment that can help us improve our ability to diagnose and cure our patients. This is down to the hard work of people like you in the NHS.

    So I want to conclude my remarks by expressing my own appreciation for your commitment to the NHS and for the values it stands for. Those values have never been more relevant to our society than they are today.

    Our challenge is simple. It is to make these values meet the aspirations of the British people for the best possible healthcare that money can buy. Work with us to meet those aspirations. Help us to make the NHS the service we know it can be.

  • John Hutton – 2004 Speech on Alternative Provider Medical Services

    johnhutton

    Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 23 November 2004.

    Can I first of all thank the NHS Confederation for asking me to say a few words this morning at this very timely event. It’s important we have the opportunity to talk about the future of primary care, to shape and mould it. It’s been the cornerstone of the NHS for fifty years. And will continue to remain so for the next fifty years. The boundaries between primary and secondary care going to shift. We are going to see new and different services being provided in primary care settings and this is all to the good.

    Primary care must never be seen simply as a set of organisational structures. Like the NHS itself, it is instead a set of values that reflect a particular concept of care. It can be delivered by different types of providers – some in the public sector, some in the private sector. What matters is the quality of care being provided rather than who is commissioned to provide it. It is the sense of care being designed around the needs of the individual in settings that are convenient and accessible that really matters most to patients. Those characteristics should be the hallmarks of modern Primary Care services. I think it is in this sense that APMS can play an important and distinctive role in this in the future.

    So we are on a journey. Services are going to change. The boundary between primary and secondary care is going to shift. And not before time.

    If we are going to take advantage of these opportunities there needs to be further significant investment and change in primary care. Not change for changes sake because we don’t want to do that. But reform with a very clear purpose. To strengthen primary care and to improve the service it provides helping, in the process, the NHS to become the service we all want it to be.

    Advances in technology and in our understanding of illness and disease together with an expanded workforce and greater resources will allow us to provide more services to a higher quality. So in the future more surgery, testing and diagnostics will be performed in primary care settings. GPs will have more direct access to diagnostics. Health professionals like physiotherapists will be taking more direct referrals from GPs and more self referrals from patients. We should be looking to use LIFT schemes to help build up a new infrastructure in primary care capable of accommodating this shift from hospital to community based models. Bringing our services closer to where people live and work.

    GPs with a special interest will take on new roles that have, until now, always been the exclusive preserve of hospital consultants – particularly in the area of chronic long term illness. Nurses and other health care professionals working in primary care will similarly see their responsibilities expand as they enter into new partnerships with GPs to deliver GMS and PMS.

    If this process of change is going to be managed properly we need to get the basics right.

    Firstly, we need to get additional resources into primary care and they need to get to the right part of the system. It is for these reasons that investment in primary care is set to rise by a third over the next two years with more to come in future years. It is for PCTs to use these resources effectively. The best way to do this is to fully involve primary care professionals in the decision making process.

    Secondly, we will need a range of flexible contracting mechanisms so that we can tailor local services to meet the needs of local people. The new primary care contracts – GMS and PMS – will help us to focus on quality and convenience. But I do think it is absolutely right that PCTs should have other routes available to them in order to ensure that local needs are being properly met. That is why APMS is so important.

    APMS allows PCTs to contract with commercial, voluntary and mutual providers, with GMS and PMS practices, and with NHS Trusts, including Foundation Trusts for primary medical services. APMS can be used for essential, additional, enhanced and Out of Hours services. Overall, because APMS embodies minimal – although important – statutory requirements, it gives PCTs considerable discretion to develop different ways of improving primary care capacity and shaping service delivery. Possible examples include:

    – Improving access in areas with GP recruitment and retention difficulties

    – Providing services where GMS and PMS practices opt-out

    – Commissioning services for particular populations

    – Developing greenfield or brownfield sites

    – Provision of out-of-hours services

    For our part in the Department, we have deliberately kept the requirements for APMS contracts to a minimum so that it will remain a flexible instrument that can be adapted to meet local circumstances. It will stay that way. It is not to be strangled by red-tape at birth.

    APMS will, I hope, be seen as a powerful tool to level change and improvements in primary care services. Our job at the centre is to support PCTs, who are working to secure these ends: helping the NHS become the service we all want it to be.

  • John Hutton – 2004 Speech at the Nurse of the Year Awards

    johnhutton

    Below is the text of the speech made by John Hutton, the Minister of State for Health, on 2 November 2004.

    It’s a tremendous honour to have been asked to present this year’s Nursing Standard Awards. I’m absolutely delighted to be here this evening.

    For over 150 years, nursing has been a profession with high standards, a clear ethos and a strong sense of public service. It’s not surprising therefore that nurses are amongst the most respected of all of our caring professions. Respected just as much for the care you provide to the sick and to the injured as for your compassion and humanity, often in the face of personal tragedy and distress. There will be very few people in this room tonight, in our country, whose lives haven’t been touched by the comfort and reassurance that nurses provide, every hour of the day, every day of the year.

    It is an extraordinary job that you do.

    And the role of nursing is central to the delivery of high quality care to patients. So our national health service must always look to strengthen this role and help make nursing an attractive and rewarding career. As part of this process we need to highlight the achievement and contribution that nurses make to the work of the NHS and to work with the profession in planning for the future – for what lies ahead of the profession. Because it’s the future of nursing as a profession, not what might have happened to it in the past, that is probably at the forefront of all of our minds this evening.

    And I do believe that the future for the profession is a hugely bright one. Of course we haven’t solved every problem. There are still too few nurses working in the NHS and the pressure this generates is experienced every day by nurses and patients up and down the country – we all know this. And we do need to do more to break through the artificial demarcations that still limit the contributions that nurses can make. In our hospitals and in primary care too. I accept that.

    But neither is it true that no progress has been made in any of these areas. There are more nurses than ever before working in the NHS – both full time and part time and we are able to do more in ensuring access to decent childcare support.

    We are succeeding in attracting more of those who have left the profession to come back to nursing.

    There are more nurses in training than ever before.

    We have hundreds of nurse consultants running their own clinics and treating their own patients. Not enough, but a good start.

    Thousands of nurses are now able to prescribe drugs – a task which in the past, had always been the exclusive preserve of doctors.

    And nurses are delivering care in over 50 NHS walk in Centres and in NHS Direct.

    And in primary care, nurses are now employing doctors. We have come a very long way indeed. But there is more still to do.

    But I believe, and I hope people in this room do too, that if we are going to lay the foundations for a successful future for the profession we have to get the basics right.

    Agenda for Change, negotiated by all of the NHS trade unions and supported by the RCN is a huge step forward for nursing. No more artificial barriers to how far a nurse can progress. Nurse consultants earning the equivalent of senior doctors. Parity between nurses and teachers in terms of career salaries. And a proper acceptance that if a nurse takes on new roles and responsibilities then he or she will be properly rewarded for doing so. We will continue to work closely with the RCN on making Agenda for Change the beginning of a new deal for nurses. For Agenda for Change to succeed partnership at every level is going to be essential. The RCN had asked for more resources to help meet the backfill costs of staff representatives who are helping to implement Agenda for Change. Last month, I was pleased to do just that – an extra £30 million to help Trusts meet these additional costs. So I am grateful to the RCN for the leadership it is showing.

    But it’s not just nurses who will benefit from these reforms. Patients will benefit too. Agenda for Change will help us recruit more nurses into the profession. It will help us to retain them for longer as well, and so improving the continuity of care to patients. Helping the NHS to become the service we all want it to be.

    We need to do more I accept to reduce the drop out rate from nurse training courses and also to improve the career prospects for nurse educators in college. Attrition rates of 15% are simply not good enough. We need to reward those colleges that do more to keep attrition rates as low as possible. And we need to look carefully at whether we are providing the right financial support to student nurses because ensuring that nursing remains a popular career choice for young people is absolutely essential for the future success of the profession as a whole.

    In all of these areas we want to work constructively with the profession. We want to make more progress in all of those areas where we know there is still more work to be done. And we would like to do this, as I said, in a partnership with nurses themselves so that the advances we are able to make are sustainable and that we focus on the right priorities. And we will always listen with respect to the profession because no one understands better than nurses themselves what isn’t right and what isn’t working.

    So you can help us to get it right.

    But tonight we are also focusing on what we know is already right about nursing.

    We are here to celebrate the achievements of some truly outstanding nurses. Nurses from all over the country whose professionalism and service to others has been rightly identified as being of the highest possible professional standard.

    You have done an absolutely brilliant job. I want to congratulate each of you for winning these very special awards tonight. The decision to make these awards has been made by other nurses. I don’t think there can be any higher praise than that.

    We can now move on to the award ceremony itself. Thank you for listening. And thank you once again for everything you do for the NHS and its patients.