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Tag: Speeches

  • John Hutton – 2004 Speech to NHS Alliance Conference

    johnhutton

    Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 20 October 2004.

    I’d like to start by thanking the NHS Alliance for giving me this opportunity to say a few words at your annual conference this morning. The NHS Alliance continues to play a very important role in the national debate over the future of the NHS. We share common ground over the values the NHS should continue to espouse. And we agree that the NHS can never afford to stand still – to rest on its laurels. We all know there is more we need to do if the NHS is to become the service we all want it to be. So the dialogue between us should continue because the process of change has not come to an end. For our part, we want the debate on the long-term direction of travel for the NHS to be informed by the views and opinions of those working on the frontline. That is why we value your contribution and your opinions.

    And the future of primary care remains central to the future of the NHS.

    Nearly all of our patients begin and end their treatment in a GPs surgery. The relationships we all forge with our GPs and other healthcare professionals working in the community form a re-assuring presence in the lives of each and everyone of us. Primary care has a proud record in public health and health promotion. And despite what people say, NHS primary care is still the envy of every other developed health care system and a model respected right across the world.

    All of this adds up to an outstanding record of achievement for primary care in the NHS over the last fifty years. But we all know that primary care can do more provided the resources are in the right place and that we encourage primary care professionals to have more say over the shape and design of local services. Because 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 providing 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. These can and should be the hallmarks of modern Primary Care services

    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.

    These changes will represent a significant challenge to the NHS as a whole and to Primary Care Trusts in particular. Every member of staff needs to be fully engaged in this process of change because they will all be affected by them. So the nature and purpose of these changes will need to be spelt out clearly in every part of the service. Patients and the public will need to be involved too. And our resources will need to be put to the best possible use. So I am not going to minimise the scale or the importance of the work that lies ahead of us. But I believe we have every reason to be positive and optimistic about the future of primary care in our country because we have a solid platform on which to build.

    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 the benefits of these improvements. The pressures are still there and they are experienced every day by hundreds of dedicated staff and thousands of frustrated patients. Not everyone working in primary care feels that their views are heard and listened to.

    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 all of our people and for those in the poorest health most 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 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 will be able to use LIFT schemes to help build up a new infrastructure in primary care capable of accommodating this shift from hospital to community based care. 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.

    New contractual frameworks will, for the first time, allow both for improvements in the quality of services to be properly rewarded 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.

    Developments in out of hours arrangements following the introduction of the new primary care contracts give PCTs the opportunity to design improved unscheduled care services that are more integrated with other parts of the NHS. Helping to manage demand more efficiently and raise both the quality of the care as well as the choices available to 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. And here too, PCTs have a critical role to play in introducing the new electronic booking systems and building up the national care records service. Because without the successful introduction of the National Programme, the NHS will never become the service we all want it to be.

    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 with more to come. 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 helping therefore to reshape the boundaries between primary and secondary care. We see the fruits of this hard work all over the country where many practices have been working with local PCTs and acute sector providers to make sure our services are as efficient and effective as they possibly can be.

    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, and I want to make this clear. Because this is not about organisational change. But it 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 sharing in the key decisions that affect the delivery of frontline services.

    Now as I’m sure all of you know, earlier this month we published guidance to the NHS on practice based commissioning. 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.

    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.

    There will be no new national targets. People can decide their own pace of change. They can chose to share their commissioning budgets with other practices. But it will be a level financial playing field for everyone. And the national tariff will guarantee that practice level commissioning does not become a bargain basement competition between those who can provide the lowest price for treating patients, because it is quality that must always come first.

    I said a few moments ago that I believed the future of primary care was a very positive one. A rising share of the NHS budget coupled with a greater influence over the future shape of the NHS will allow primary care to play a leading role in improving the quality of the care we provide to our patients.

    The journey is not over yet. We still have a great deal to do. But there are 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. A great deal of this is down to the work you are doing. 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 all want it to be.

    Thank you.

  • John Hutton- 2004 Speech on Promoting Opportunities

    johnhutton

    Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 11 October 2004.

    I am very very pleased to be here this morning.

    I want to start first of all by thanking all of you for the work you do in helping the NHS and social care improve the service we provide to the public. I also want to thank you too for your commitment to helping the NHS become a better employer by ensuring our staff are treated fairly and also reflect the communities we are here to serve.

    As you all know, Positively Diverse began here in Bradford. Over 200 NHS Organisations across England are part of this important new network. It was designed first and foremost to help the NHS become that better employer by recognising the talents and skills of all of its staff. To help us break down barriers that had so often held people back in the past. And to help us meet our legal as well as moral obligations as the largest public sector organisation in Britain to give more people than ever before the opportunity to be part of the greatest army for good in our country and that is the NHS.

    The Government is committed to supporting NHS Employers to become better employers. We have this responsibility because, I think, of the position the NHS occupies in the life of our country. Because for me and everyone else here the NHS represents a set of values. Fairness. Equality. Compassion. Respect for the individual. Decent values that reflect the powerful instinct of the our people for fairness and tolerance. If we are to properly discharge our responsibilities as the main provider of healthcare services in Britain today, we have to embed these values in the way we behave as an employer. Because we recognise that to improve the care we provide our patients we do need to improve the way we look after our staff. This means we will need to confront discrimination and prejudice within our own organisation. Because it is there. It does exist. And we have to tackle it.

    I think now we are making significant progress. Over 600 NHS organisations have already been awarded the Improving Working Lives Standard.

    All of these 600 organisations are committed to offering flexible, modern employment practices that recognise the need to balance responsibilities at home with our responsibilities at the workplace. Our job is to help staff balance both of these responsibilities. Not to find reasons why things can never be done differently. But to find ways to make change happen.

    We all recognise that to get the best from all our staff we need working patterns that fit the way people live their lives today and they are changing. We have to support staff to better manage their work life balance. Take child care for example. There are over 230 childcare co-ordinators in post and 150 on-site nurseries that have received funding, of which 140 have been opened offering 6,000 new subsidised places. That’s a start.

    Modern working practices are reaping rewards for NHS Employers. Not only are staff able to work more flexibly. We need to do more to make sure they are supported in the workplace with good training and development programmes and continual professional development. And I think have to – perceptions of us as an empolyer are changing.

    The NHS, the world’s third largest employer is now the 5th in the Times top 100 graduate list, a jump of 22 places over the past 2 years. I think we’ve made that leap because the NHS is now offering better career prospects, together with improved salaries and conditions of work.

    It is not my argument today however that every problem has been solved. It hasn’t. And neither is it my claim today that we can’t do more. Because we all know that we can. But it is my argument today that we are making progress in the right direction. That’s not just my view. I think that I can say it’s the view of NHS staff themselves.

    The first ever national survey of NHS staff was conducted during October and November of last year. The overall results have been very encouraging. For example, the survey showed that 73% of respondents were satisfied with their jobs, enjoyed their jobs, with 91% having received training and development opportunities in the previous 12 months. This figure is much higher than a survey by the Department of Trade and Industry (DTI) of employees in the private sector. There were also good results in team working and a general satisfaction with the help that we are now able to provide in achieving a work-life balance.

    These results highlight what many of us already know: that NHS staff are committed, caring and well trained; The survey also indicated that the NHS is getting better at reporting and recording accidents and violence and has considerably improved its compliance with statutory obligations to provide staff with a safe and healthy working environment for staff over the last six years

    NHS Employers are also committed to enabling staff to work differently, making the best use of their skills.

    The Skills Escalator will provide new opportunities for staff to develop new roles and responsibilities and then to be paid fairly for the work they do. A persons job title will be less important than their own individual contribution to the success of their enterpise. Treating people fairly. Breaking through some of the glass ceilings that have held people back for so long in our NHS.

    As I said earlier, the fundamental value of the NHS is equity of access to its services. Everybody, irrespective of their gender, age, disability, race, colour, nationality, ethnicity, religion or sexuality should have equal access to services that are, as far as possible, sensitive and responsive to their own individual needs. The Health Service is committed to ensuring that its workforce is able to respond fully to the needs of all its patients. I know local authorities share this aspiration as well in relation to SC. For this reason, it is important that staff working across the NHS and social care reflect the diverse communities they serve.

    As well as Positively Diverse we have a number of national equality & diversity projects that are helping to develop a more reflective workforce.

    The Positive Action project is aiming to identify and map positive action intiatives and schemes that exist within the NHS and then share the good practice that emerges.

    We have started the first ever national leadership development programme for managers form black and minoroty ethnic communities. Better career development and succession planning by the Leadership Centre I think will help us track the talent of BME staff and help them reach the most senior positions in our organisation.

    The Equality & Diversity in the Medical Workforce Project aims to gain a better understanding of what the current barriers are for equalities target groups within the medical profession and to assess the effectiveness of different approaches to tackling this. Some of you might have seen a consultation document ‘Sharing the challenge, sharing the benefits’ we issued recently. The consulation period closed on the 17 September and a joint action plan will be produced to respond to the conclusions. Similar work is underway in relation to nursing.

    So the pursuit of equality and diversity must always be central to the work of both the Department of Health, social care and the NHS itself. Because we are in the equality business. Nigel Crisp has issued a personal challenge to NHS leaders – both managers as well as clinicians – to give greater prominence to race equality as part of our culture to improve health. He has set up an independent panel to review progress and provide the opportunity to bring external scrutiny to our work, offering support to every part of the organisation in promoting equality across all of our activities.

    A commitment to equality runs through this vision of a reformed health and social care system too. Because only by building equality into every aspect of our work can we hope to create a truly patient centred and responsive service that provides fair access to services for every section of our community.

    For our part in Government, we are fully committed to working with you to improve the working lives of NHS staff and those working in social care. To confront prejudice and intolerance wherever it exists. To protecting our staff from harassment and violence. And to extending new opportunities to develop worthwhile and rewarding careers in the public sector, where what matters is what you can contribute, not where you come from or where you were born. Work with us to realise these ambitions. And in the process, help us make the NHS and social care the service we all want it to be.

  • John Hutton – 2004 Speech to the National Association of Primary Care conference

    johnhutton

    Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 6 October 2004.

    First of all, I’d like to thank the NAPC for hosting this very important event today and for giving me the opportunity to say a few words. I am also very grateful for the way in which the NAPC has engaged positively with Government in keeping primary care at the centre of the debate about the future of the NHS. I think you’ve succeeded in doing that.

    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.

    All of this adds up to an outstanding record of achievement for primary care in the NHS over the last fifty years. But the question to answer today is what about the future?

    I believe we have every reason to be positive and optimistic about what lies ahead.

    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 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 all of our people and for those in the poorest health most 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. We see the fruits of this hard work here in West Yorkshire where practices have been working with local PCTs and acute sector providers to make sure our services are as efficient and effective as they possibly can be.

    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. 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.

    Today we are publishing our guidance on practice led commissioning to 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 are setting out what practices are entitled to receive as a budget and how any disputes about the budget can be easily resolved. We are setting out the ground rules about how any savings can be re-deployed into developing better services. And we are highlighting 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.

    So in launching this guidance today I want to emphasise that this is the beginning not the end of this process. We will actively support those practices and PCTs who want to take advantage of the possibilities that practice led commissioning provides. Early in the New 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.

    I know that the NAPC will continue to champion this cause. The Department of Health for its part will put its weight behind these reforms. I hope together we can make sure they succeed and in the process help the NHS become the service we all want it to be.

  • David Cameron – 2016 Statement Following Cabinet Meeting on EU Council

    davidcameron

    Below is the text of the statement made by David Cameron, the Prime Minister, at Downing Street in London on 20 February 2016.

    Last night in Brussels I set out Britain’s new settlement with the European Union.

    This morning I have just chaired a meeting of the Cabinet in which I updated them on the special status we have secured for Britain.

    And the Cabinet agreed that the government’s position will be to recommend that Britain remains in a reformed European Union.

    Now I want to speak directly to the British people to explain why.

    We are approaching one of the biggest decisions this country will face in our lifetimes.

    Whether to remain in a reformed European Union – or to leave.

    This choice goes to the heart of the kind of country we want to be. And the future that we want for our children.

    This is about how we trade with neighbouring countries to create jobs, prosperity and financial security for our families.

    And it is about how we co-operate to keep our people safe and our country strong. I know there will be many passionate arguments over the months ahead.

    And individual Cabinet Ministers will have the freedom to campaign in a personal capacity as they wish.

    But my responsibility as Prime Minister is to speak plainly about what I believe is right for our country. I do not love Brussels. I love Britain.

    I am the first to say that there are still many ways in which Europe needs to improve – and that the task of reforming Europe does not end with yesterday’s agreement.

    And I will never say that our country couldn’t survive outside Europe.

    We are Great Britain – we can achieve great things.

    That is not the question in this referendum.

    The question is will we be safer, stronger and better off working together in a reformed Europe or out on our own. I believe we will be safer in a reformed Europe, because we can work with our European partners to fight cross border crime and terrorism.

    I believe Britain will be stronger in a reformed Europe because we can play a leading role in one of the world’s largest organisations from within, helping to make the big decisions on trade and security that determine our future.

    And I believe we will be better off in a reformed Europe because British businesses will have full access to the free trade single market, bringing jobs, investment and lower prices.

    Let me be clear. Leaving Europe would threaten our economic and our national security.

    Those who want to leave Europe cannot tell you if British businesses would be able to access Europe’s free trade single market or if working people’s jobs are safe or how much prices would rise.

    All they are offering is risk at a time of uncertainty – a leap in the dark.

    Our plan for Europe gives us the best of both worlds.

    It underlines our special status through which families across Britain get all the benefits of being in the EU, including more jobs, lower prices and greater security.

    But our special status also means we are out of the parts of Europe that don’t work for us.

    So we will never join the Euro, we will never be part of Eurozone bailouts, never be part of the passport-free no borders area, or a European Army or an EU super-state.

    Three years ago I committed to the British people that I would renegotiate our position in the European Union and hold an in-out referendum.

    Now I am delivering that commitment.

    You will decide.

    And whatever your decision, I will do my best to deliver it.

    On Monday I will commence the process set out under our Referendum Act.

    And I will go to parliament and propose that the British people decide our future in Europe through an in-out referendum on Thursday 23rd June.

    The choice is in your hands.

    But my recommendation is clear.

    I believe that Britain will be safer, stronger and better off in a reformed European Union.

  • David Cameron – 2016 Statement Following European Council

    davidcameron

    Below is the text of the statement made by David Cameron, the Prime Minister, following the meeting of the European Council to discuss giving the UK special status in the EU.

    Within the last hour I have negotiated a deal to give the UK special status in the European Union.

    I will fly back to London tonight and update the Cabinet at 10am tomorrow morning.

    This deal has delivered on the commitments I made at the beginning of this renegotiation process.

    Britain will be permanently out of ever closer union – never part of a European superstate.

    There will be tough new restrictions on access to our welfare system for EU migrants – no more something for nothing.

    Britain will never join the Euro. And we have secured vital protections for our economy and full say over the rules of the free trade single market while remaining outside of the Euro.

    I believe it is enough for me to recommend that the United Kingdom remain in the European Union – having the best of both worlds.

    We will be in the parts of Europe that work for us, influencing the decisions that affect us in the driving seat of the world’s biggest market and with the ability to take action to keep people safe.

    And we will be out of the parts of Europe that don’t work for us.

    Out of the open borders. Out of the bailouts. Out of the Euro. And out of all those schemes in which Britain wants no part.

    Let me set out the details of exactly what we have agreed and why.

    I began this negotiation to address the concerns of the British people.

    Today all 28 member states have signed up to concrete reforms in each of the 4 areas I set out.

    British jobs and British business all depend on being able to trade with Europe on a level playing field.

    Financial protection

    So our first aim in these negotiations was to get new protections for countries like ours which are in the single market but not in the euro.

    Let me take you through what we have secured.

    We have permanently protected the pound and our right to keep it. For the first time, the EU has explicitly acknowledged it has more than one currency.

    Responsibility for supervising the financial stability of the UK remains in the hands of the Bank of England, so we continue to keep our taxpayers and our savers safe.

    We have ensured that British taxpayers will never be made to bail out countries in the Eurozone.

    We have ensured that the UK’s economic interests are protected. We have made sure that the Eurozone cannot act as a bloc to undermine the integrity of the free trade single market.

    And we have guaranteed British business will never face any discrimination for being outside the Eurozone.

    For example, our financial services firms can never be forced to relocate inside the Eurozone if they want to trade in euros, just because they are based in the UK.

    And not only are these rules set out in a legally-binding agreement, we have also agreed that should the UK, or another non-Euro member state, fear these rules are being broken they can activate an emergency safeguard, unilaterally, to ensure they are enforced.

    Let me be clear, because there has been a big debate about this.

    Britain will have the power to pull this lever on our own.

    European competitiveness

    Our second aim in these negotiations was to make Europe more competitive, so we create jobs and make British families more financially secure.

    We have secured a declaration outlining a number of commitments in this area.

    For the first time, the European Union will now say competitiveness is – and I quote – “an essential objective of the union.”

    This is important because it goes to the very heart of what Europe should be about.

    It means Europe will complete the single market in services.

    This will make it easier for service-based companies including IT firms to trade in Europe.

    Nowhere will this be more of an opportunity than in the UK where thousands of service companies make up two thirds of our economy.

    It could add up to 2 per cent to our economy each year.

    That’s a real improvement.

    The European Union will also complete the single market in capital.

    This will mean UK start-ups will be able to access more sources of finance for their businesses and it will also present new opportunities for the UK financial services industry.

    Europe will now also complete the single market in energy.

    This will allow more suppliers into the UK energy market, lowering bills and increasing investment across the continent.

    That’s a real improvement too.

    In addition, we have secured commitments from Europe to complete trade and investment agreements with the fastest growing and most dynamic economies around the world including the USA, Japan and China as well as our Commonwealth allies India, New Zealand and Australia.

    These deals could add billions of pounds and thousands of jobs to our economy every year.

    And because I know one of the biggest frustrations with Europe, especially for small businesses, is the red tape and bureaucracy we have also got Europe to introduce targets to cut the total burden of EU regulation on business.

    That means that, from now on, the cost of EU red tape will be going down, not up.

    Migration

    Our third aim in these negotiations was to reduce the very high level of migration from within the EU by preventing the abuse of free movement and preventing our welfare system acting as a magnet for people to come to our country.

    In this respect, we have secured the following:

    New powers against criminals from other countries – including powers to stop them coming here in the first place, and powers to deport them if they are already here.

    Longer re-entry bans for fraudsters and people who collude in sham marriages.

    And an end to the ridiculous situation where EU nationals can avoid British immigration rules when bringing their families from outside the EU.

    We have also secured a breakthrough agreement for Britain to reduce the unnatural draw that our benefits system exerts across Europe.

    We have already made sure that EU migrants cannot claim the new unemployment benefit, Universal Credit, while looking for work.

    And those coming from the EU who haven’t found work within 6 months can now be required to leave.

    Today we have established a new emergency brake so that EU migrants will have to wait 4 years until they have full access to our benefits.

    This finally puts an end to the idea that people can come to our country and get something for nothing.

    The European Commission has said unambiguously that Britain already qualifies to use this mechanism.

    And it won’t be some short-term fix. Once activated this brake will be in place for a full 7 years.

    We have also agreed that EU migrants working in Britain can no longer send child benefit home at UK rates.

    The changes will apply first to new claimants.

    And, after intense negotiations, we have ensured that they also will apply to existing claimants, from the start of 2020.

    I came here to end the practice of sending child benefit overseas at UK rates.

    Both for current and future claimants.

    And I’ve got them both.

    Powers for UK Parliament

    Our fourth aim in these negotiations was to protect our country from further European political integration and increase powers for our national Parliament.

    Ever since we joined, Europe has been on the path to something called Ever Closer Union.

    It means a political union.

    We’ve never liked it. We’ve never wanted it.

    And today we have permanently carved Britain out of it, so that we can never be forced into political integration with the rest of Europe.

    The text of the legally binding agreement sets out in full the UK’s position.

    It says that the treaties will be changed to make clear – and I quote: “…the Treaty references to ever closer union do not apply to the United Kingdom.”

    Let me put this as simply as I can: Britain will never be part of a European superstate.

    We have also put power back in the hands of Westminster and other national parliaments.

    A new red card will mean that the UK Parliament can work with others to block unwanted legislation from Brussels.

    And at long last we have an agreement that, wherever possible, powers should be returned to member states and and we have a new mechanism to make this a reality.

    Every year the EU now has to go through the powers they exercise and work out which are no longer needed and should be returned to nation states.

    In recent years we have also seen attempts to bypass our opt-out on justice and home affairs by bringing forward legislation under a different label.

    For example, attempts to interfere with the way the UK authorities handle fraud but under the guise of legislation on the EU budget.

    With today’s new agreement we have made sure this can never happen again.

    Likewise, we have established once and for all in international law that Britain’s national security is the sole responsibility of the British Government – so, for instance, we will never be part of a European Army.

    These are significant reforms.

    Further reforms

    But I have always said that if we needed to go further to put Britain’s sovereignty beyond any doubt, then we would.

    So in addition to these changes, I will shortly be bringing forward further proposals that we can take as country, unilaterally, to strengthen the sovereignty of Britain’s great institutions.

    The reforms that we have secured today have been agreed by all 28 leaders.

    And I thank them for their patience, for their good will, for their assistance, for all the work that we’ve done, not just in the last 48 hours, but in all the months since the election last year.

    The changes will be legally binding in international law, and will be deposited at the UN.

    They cannot be unpicked without the unanimous agreement of every EU country – and that includes Britain.

    So when I said I wanted reforms that are legally binding and irreversible – that is what I’ve got.

    And the council was also clear that the treaties will be changed in 2 vital respects.

    To incorporate the new principles for managing the relationship between countries inside and outside the Eurozone and to carve the UK out of ever closer union.

    I believe the changes we have secured as a country fulfil the objectives I set out in our manifesto at the last election.

    And I think they do create a more flexible Europe more of a “live and let live” arrangement that recognises one size does not fit all.

    But of course, there is still more to do.

    I am the first to say that there are still many ways in which this organisation needs to improve.

    The task of reforming Europe does not end with today’s agreement.

    Far from it. This is a milestone on a journey, not the end point.

    And let’s be clear, there’s absolutely nothing in this agreement that stops further reform taking place.

    For as long as we stay in the European Union, Britain will be in there driving forward the single market bearing down on regulation, championing the cause of free trade and helping to ensure that the Europe remains open to the world and robust for instance in the face of Russian aggression.

    Referendum

    But with this new agreement I believe the time has come for me to fulfil the promise I made when I stood for a second term as Prime Minister.

    So tomorrow I will present this agreement to Cabinet.

    And on Monday I will make a statement to Parliament and commence the process set out under our EU Referendum Act, to hold a referendum on Britain’s membership of the European Union.

    The British people must now decide whether to stay in this reformed European Union or to leave.

    This will be a once-in-a-generation moment to shape the destiny of our country.

    There will be many passionate arguments made over the months ahead.

    And this will not be a debate along party-political lines.

    There will be people in my party – and in other parties – arguing on both sides.

    And that is entirely right. This is an historic moment for Britain. And people must be free to reach their own conclusion.

    And in the end this will not be a decision for politicians.

    It will be a decision for the British people.

    And we will all need to look at the facts and to ask searching questions of what either choice would really mean.

    Simply being in Europe doesn’t solve our economic problems – far from it.

    I have always been clear about that – just as I have always opposed Britain joining the Euro.

    But turning our back on the EU is no solution at all.

    And we should be suspicious of those who claim that leaving Europe is an automatic fast-track to a land of milk and honey.

    We will all need to step back and consider carefully what is best for Britain, and best for our future.

    Whatever the British public decide I will make work to the best of my abilities.

    But let me tell you what I believe.

    I do not love Brussels. I love Britain.

    And my job – the job of the British Prime Minister – is doing all in my power to protect Britain’s interests.

    So when it comes to Europe, mine is a hard-headed assessment of what is in our national interest.

    We should never forget why this organisation came into being.

    Seventy years ago our countries were fighting each other. Today we are talking.

    And we should never take that cardinal achievement – peace and stability on the continent – for granted.

    Even today our world is an uncertain place with threats to our security and existence coming from multiple quarters. This is a time to stick together; a time for strength in numbers.

    Like many, I have had my doubts about the European Union as an organisation. I still do.

    But just because an organisation is frustrating it does not mean that you should necessarily walk out of it, and certainly not without thinking very carefully through the consequences.

    The question that matters for me as Prime Minister is what is best for my country.

    How, as a country, are we stronger, safer and better off?

    This is something I have given a huge amount of thought.

    Future of Britain’s relation with Europe

    And now we have this new agreement, I do believe the answers lie inside a reformed European Union.

    Let me explain why.

    First, Britain will be stronger remaining in a reformed Europe than we would be out on our own because we can play a leading role in one of the world’s largest organisations from within, helping us determine our future.

    Yes there are frustrations and no, we don’t always get our way.

    But time and again British leadership at the top table gets things done whether it’s imposing sanctions on Russia and Iran, or tackling people smuggling in the Mediterranean.

    Because the truth is this.

    Throughout our history, our strength as a nation has come from looking beyond our shores and reaching out to the world.

    And today the EU, like NATO and the UN, is a vital tool Britain can use to boost our nation’s power in the world and multiply our ability to advance Britain’s interests, to protect our people, sell our goods and services, generate jobs and a rising our people’s standard of living.

    Britain has always raised her eyes to the horizon and today we are energetically seeking new markets in India and China – from south-east Asia to Latin America – in the finest go-getting traditions of our nation.

    But that is not a substitute for doing the same right next door to us – on the continent of Europe.

    We can, and should, have the best of both worlds.

    That is one reason why our closest friends outside Europe – from Australia to New Zealand, the US to Canada – want us to stay in the EU. We should listen to them.

    People who want us to leave would take us out of this position of influence and they can’t tell you what that would mean for Britain’s ability to advance our interests.

    Second, I profoundly believe the British people will be safer remaining in a reformed Europe than we would be out on our own.

    Let me tell you why.

    We will always depend on NATO as the bedrock of our nation’s defence.

    But today we face a myriad of threats to our security, from terrorism to organised crime, from human trafficking to cyber attacks.

    We defeat these threats by working together, by the closest possible co-operation between countries, especially with our closest neighbours in Europe.

    Let me give you one example from the way we share information.

    When terrorists tried to bomb London for the second time in 2005 one of the culprits fled to mainland Europe.

    Because of the European Arrest Warrant we could bring him back in a few weeks.

    Previously that could have taken years.

    So when I say we are safer, I really mean it.

    By contrast, those who want to leave can’t tell you whether and how this co-operation would continue or how long it would take to attempt to replicate these arrangements with each European country one by one.

    Third, Britain will be better off remaining in a reformed Europe than we would be out on our own because British businesses will have full access to the free trade single market of 500 million people.

    This brings jobs, investment, lower prices and financial security to our country.

    Those who want to leave can’t tell you if we would still have access to this free trade single market, or on what terms.

    They can’t tell you how long it would take to get a new agreement with 27 countries.

    That could mean years of uncertainty for our economy – for our children’s future.

    And let’s be clear: if we were to leave, it’s not in Europe’s interests to give us all the benefits of membership without any of the responsibilities.

    Look at Norway and Switzerland.

    Neither have as much as access to the single market. And neither have any say over its rules.

    And yet they both still have to pay into the EU budget.

    And they both have to accept migration from within the EU.

    Of course, as I have said, the EU isn’t perfect.

    There is a need for further and continuing reform.

    But the UK is best placed to do that from the inside.

    Our plan for Europe gives us the best of both worlds.

    It underlines our special status through which we will be in the parts of Europe that work for us keeping full access to the EU’s free-trade ‘single market’, which makes us better off and the Europe-wide co-operation on crime and terrorism that makes us more secure.

    But we will be out of the parts of Europe that don’t work for us.

    We will never join the Euro.

    And we will never be part of Eurozone bailouts, the passport-free area, the European Army or an EU super-state.

    As I have said, I’m not saying that Britain couldn’t survive outside Europe.

    But after nearly 6 long years of difficult decisions and hard work by the British people, our economy has turned a corner.

    In an uncertain world, is this really the time to add a new huge risk to our national and economic security?

    I do not believe that is right for Britain.

    I believe we are stronger, safer and better off inside this reformed European Union.

    And that is why I will be campaigning with all my heart and soul to persuade the British people to remain in the reformed European Union that we have secured today.

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

    rosiewinterton

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

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

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

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

    – provided medical treatment

    – prescribed medicine

    – trained apprentices

    – performed surgery

    – and served as man-midwives

    Is that familiar or what?!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Rosie Winterton – 2004 Speech to the PSNC Conference

    rosiewinterton

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

    My sincere thanks to Barry for his warm welcome.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Developments in last 12 months

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    – In helping patients with asthma or mental health problems

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

    – In treating patients with minor ailments

    – In supporting better use of medicines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    – guidance on the new framework and control of entry reforms

    – a series of 5 roadshows for PCTs in December

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

    – a help-line to deal with questions and queries

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

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

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

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

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

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

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

    I wish you a very successful and rewarding day.

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

    rosiewinterton

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

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

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

    Principles

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

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

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

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

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

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

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

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

    Developments in last 12 months

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

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

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

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

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

    New contractual framework for community pharmacy

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

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

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

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

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

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

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

    rosiewinterton

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

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

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

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

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

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

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

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

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

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

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

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

    So where are we, five years on?

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

    Already we have :

    Over 253 assertive outreach teams

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

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

    – 174 Crisis resolution teams

    – Improvements mental health care for people in prison is improving

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    – support the delivery of health promotion

    – promote early intervention so we can prevent more serious

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

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

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

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

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

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

    The Mental Health Bill

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

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

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

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

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

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

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

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

    Nurse prescribing

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

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

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

    BME programme

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

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

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

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

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

    – 80 Community Engagement Projects

    – a target to develop 500 Community Development Workers by 2006

    – A diversity package for services

    – A census of service users so changes can be monitored

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

    – Work to look at pathways to care and suicide prevention

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

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

    Conclusion

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

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

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

  • Rosie Winterton – 2004 Speech to NHS Chairs Conference

    rosiewinterton

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

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

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

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

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

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

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

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

    That trend has been reversed.

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

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

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

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

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

    • over 19,000 more doctors;

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

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

    Well, there are now:

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

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

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

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

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

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

    Well, everyone except the press it would seem!

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

    It wouldn’t make any difference anyway.

    But what I will say is this:

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

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

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

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

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

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

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

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

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

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

    The improvements have been hard won.

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

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

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

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

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

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

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

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

    Not just some.

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

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

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

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

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

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

    We have different strengths and perspectives.

    But we are all bound by the same values.

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

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

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

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

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

    The time to construct a shared agenda and shared leadership.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Thank you.

    Thank you for what you have done.

    Thank you for what you will do.

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

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

    Thanks for listening.