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Tag: Speeches

  • Baroness Verma – 2016 Speech on Education for Children with Disabilities in Kenya

    baronessverma

    Below is the text of the speech made by Baroness Verma, the Parliamentary Under-Secretary for International Development, at 1 Parliament Street, Westminster, London on 9 February 2016.

    Thank you very much. It really gives me great pleasure to be here. I really want to start by thanking the All Party Parliamentary Group on Education for All. I also have to thank you, Mark [Mark Williams MP – Chair of the APPG for Global Education for All], for this really insightful introduction because it is really about going there [to Kenya] and having a look at what is working on the ground. It really gives us a sense of how what we are doing in the UK impacts positively the lives of people on the ground.

    I am also delighted to sit next to my colleagues from the House of Lords – Lord Low and other colleagues I have known for many years, so I am really pleased. And of course as I look across the room, I see many faces that are very familiar and I am pleased that civil society partners are always with us and working hard. These are the partnerships which do develop a real thinking and allow us to make sure that what we are delivering on the ground actually does work. And also, the challenges you rightly bring to us. We do need the challenges so that we can do much better in delivering the services from DFID.

    Last year was a really crucial year for everybody who is committed to disability inclusion. As you know, people with disabilities in the past have been unable to benefit from much of the programmes we had globally on tackling poverty. For all of us, seeing disability mentioned in the global development agenda for the first time was an extraordinary moment and no Global Goal, I am so glad, will be considered met unless it is achieved for everyone. And that should really mean everyone. This for me was a major step forward for insuring that those currently left behind, including people with disabilities, are equally benefiting from international development. I would like to use this opportunity to thank all of you in the room who have worked so hard in the last years to make this possible.

    At DFID we have pushed for disability to be at the heart of all our programmes and everyone who has worked with DFID has hopefully been a testimony to that. We have learned a lot since the launch of the first Disability Framework in 2014 and the revised Framework of 2015 confirms our vision that people with disabilities need to be put at the heart of our work, which includes our commitment to secure education for everyone.

    Education is one of the most crucial instruments a country can make in its people and the country’s future. It is a critical driver in reducing poverty and the importance of making education inclusive of children with disabilities cannot be overstated. It does not only play a central role in fostering development, but also breaks the stigma and discrimination and allows people with disabilities to gain agency over their own lives. Leaving no one behind is not only essential for sustainable development and eradicating poverty, but – and I hope we all agree – for the freedom, dignity, tolerance and respect that all human beings should see as a right. These are fundamental to our all humanity. That is why we are committed to ensuring that all children, including those with disabilities, are able to complete a full cycle of education.

    In the last three years, we have invested nearly £35 million in education in Kenya to improve early learning, enhance transparency and drive up enrolment and retention so that Kenya’s poorest and most marginalised children, including those with disabilities, are reached. In 2014 we made the commitment that all DFID-funded educational related construction is fully accessible. In Kenya, this meant that by August 15th, 24 new and renovated classrooms, 12 dormitories and 24 latrine blocks directly funded by DFID were fully accessible for people with disabilities.

    I think the basics of having latrines for children with disabilities can sometimes be overlooked. I recently visited another country where I saw latrines developed and when I asked, “What about for those children with disabilities?” they looked at me and said, “We don’t have any children with disability”. I think this is the stigma and taboo we really need to challenge hard. Our Girls Education Programme has undergone an analysis of how well our projects are targeting girls with disabilities. My Department has provided £7 million to fund disability-funded girls’ education programmes in Kenya, Uganda and Sierra Leone. In Kenya, our partner Leonard Cheshire Disability is working with policy makers, research institutions, teachers and community members to address the key barriers faced by disabled girls in accessing schools.

    On a global level, we are working closely with the Global Partnership for Education to ensure that their approach of children with disabilities is inclusive. Our influencing efforts made disability a priority for the June 2015 replenishment of the Global Partnership and it was a great success to see that twelve countries, including Kenya, pledged at this event that they would do more for children with disabilities.

    However, we do know that despite these successes, so much more has to be done. And reports like the one you are launching today are crucial reminders that there is still a very long way to go. The study confirms that too many children with disabilities are out of school – 1 out of 6 in Kenya. In light of this, I would like to thank the All Parliamentary Group for Education, the Commonwealth Parliamentary Association, the Global Campaign for Education UK, RESULTS UK and Leonard Cheshire Disability for supporting this very important report. One thing which has been clear is that none of this will be easy and it will require a concerted action by governments, citizens, civil society and by business. I am convinced that we are moving in the right direction with the work we have done so far. We at DFID are doing more than we have ever before on disability inclusion and together with the organisations in this room today and beyond, we can really do much to contribute to a better future for people with disabilities all over the world. That is a way of making sure that we speak to the pledges we made to leaving no one behind.

    Thank you very much.

  • Justine Greening – 2016 Speech on Social Mobility

    justinegreening

    Below is the text of the speech made by Justine Greening, the Secretary of State for International Development, in London on 16 February 2016.

    Introduction

    Good afternoon.

    It’s a real pleasure for me to have the opportunity to speak to you today under the auspices of the Centre for Social Justice.

    This is an organisation dedicated to putting social justice at the heart of British politics and policy.

    And it’s great to be speaking here at 2nd Chance, which does fantastic work giving unemployed young adults a future, by helping them move into sustained employment.

    Now you might be wondering why, as Secretary of State at the Department for International Development (DFID), I’m here today talking to you about social mobility.

    Well partly it’s because international development and social mobility are both issues very close to my heart.

    But it’s also because improving social mobility is a generational challenge.

    And tackling generational challenges is really what DFID has been all about:

    – Ending extreme poverty,

    – Ending Female Genital Mutilation,

    – Eradicating polio and malaria.

    If these are the generational challenges for our world, then I believe social mobility is the generational challenge for our country.

    DFID is all about creating a levelled-up world, and I think it can equally help point the way to how we can get a levelled-up Britain.

    I know from personal experience just how much social mobility matters. It has underpinned my personal and my political life.

    Today is a long way from the local comprehensive school I went to in Rotherham.

    And climbing the ladder has been exhilarating but at times a real challenge. It involved going to university – a step in the dark.

    When I asked my parents for advice on where to go, what to study, it was new to them too. As no one in my family had done it before.

    At the time, I remember that it felt like a risk, because I was putting off when I would start earning money in a job.

    I didn’t know what kind of job I was aiming for, so I wasn’t 100% sure what I should study.

    When I look back, my horizons were quite limited.

    I didn’t consider doing law as a degree, because I’d never met a lawyer.

    And instead, I chose to study something that had already had a big impact on my family.

    Economics. Which at the time was all around me in Rotherham and South Yorkshire.

    I grew up against the backdrop of the steel industry strikes and miners’ strike.

    In fact, my first ever economics lesson was the day my dad was made redundant from British Steel.

    That year he was unemployed was the toughest year of my childhood.

    But I knuckled down at school and college. And I got on with climbing my own ladder.

    As I got on through university and got on with my career, sometimes you had a feeling almost of ‘vertigo’, from gradually getting further and further away from where I started.

    Things didn’t always go well. I’ve had to be very resilient at times.

    And the bottom line is that my own experience of climbing the ladder is that it is often extremely hard.

    I’m not alone in my experience.

    The question I ask is: is it easier climbing the ladder now?

    Well, if you look across the piece, there is progress on social mobility. But it’s a mixed picture, depending on how you define progress.

    So in Britain over the past 50 years, as in other developed countries, we have seen so-called “absolute” social mobility take place. It’s a sort of “quantity” measure.

    This is, put simply: have there been more opportunities for people? The answer to that is yes. There have been more opportunities for more people.

    Fundamentally, the research by people like Goldthorpe suggests it’s been a story of economic restructuring, as jobs became less manual and more office-based, and economic growth.

    With more jobs, many young people have had the opportunity “headroom” to get on.

    It’s why keeping our economy on track, creating jobs with our long term economic plan, is so vital.

    But what if we look at social mobility in a more qualitative way?

    Relative social mobility is when we strip out what’s happened over time in the economy. Look at an underlying picture.

    And when you strip out those economic structural and cyclical effects, then, as in so many countries around the world, it’s a different picture.

    Because where you relatively start still over-whelmingly predicts where you relatively finish. Even today.

    So not accepting that lack of relative social mobility and then changing it, that is our generational challenge.

    And this government is rising to that challenge.

    UK social mobility: the goal

    On his first day back in Downing Street after the General Election, the Prime Minister set out how he wants to make Britain “a place where a good life is in reach for everyone who is willing to work and do the right thing.”

    And, we have already got on with delivering on that ambition:

    – More students from disadvantaged backgrounds in English universities

    – More apprenticeships

    – Lower youth unemployment

    – Lowest levels of young people not in education, training or employment since records began.

    As a nation our social mobility strategy has a lot of good elements already in place.

    And I want to set out what I believe lessons from DFID can contribute to get that structural shift our country needs in relative social mobility.

    And it’s worth briefly setting out the case of why we do need social mobility.

    In my department, we talk about development being not just the right thing to do, but the smart thing to do.

    I believe that dramatically improving social mobility is both the right thing to do and the smart thing to do for Britain.

    There is both a moral and an economic case for more social mobility in Britain.

    It’s better for individuals – as I know from my own experience. When people believe they can get higher, they aim higher. And when they aim higher, they’re likely to go further.

    It’s better for communities. When people believe we all have an equal shot, it makes for more cohesive, stable communities.

    It’s right for society. The wider the pool of people from which we draw our Parliament, our courts, our boardrooms, our newsrooms, the stronger the basis for trust in accountability, in how Britain runs day-to-day.

    But it’s more than that.

    Improved social mobility, making more of our country’s human capital, is one of the biggest structural levers we can pull in the UK economy.

    Work for the Sutton Trust has assessed that improved social mobility could boost our economy by up to £140bn a year by 2050, that’s an extra 4% of GDP.

    It means that only when people can reach their potential, will our economy reach its potential.

    Lessons from DFID

    So, to take a first lesson from our work on DFID.

    On improving prospects for girls in developing countries.

    That has taught us that alongside day to day work, there are “critical moments.”

    For example girls reaching adolescence may be under pressure to marry, have children and drop out, instead of staying in school.

    Yet if they stay in school they’ll marry later, have fewer, healthier children, and if they can work they’ll reinvest most of what they earn back into their family and community.

    So focusing on supporting these girls through those moments is especially important to their lives down the line.

    For young people in the UK those “critical moments” might be different, but recognising them and helping manage through them is vital.

    Another lesson comes from our projects tackling FGM. Getting that work done, and making that generational change on FGM, means taking a comprehensive, holistic, approach.

    One that works at a range of levels – all at the same time and for long enough, for change to take root from the top right the way through to the grass roots.

    If you look at the work we have done combating FGM, it has seen:

    – National Laws changed

    – National and local political leadership

    – Grass roots projects working with communities and individuals

    – Community leaders and religious leaders giving the same messages on ending FGM

    – Civil society voices backing up and amplifying the message, often doing the work on the ground.

    And all tailored at the local level for communities. Take Ethiopia, for example, where tackling FGM at the local level means dealing with challenges like the fact that over 80 different languages.

    So the lesson is the power of an approach that is comprehensive but locally tailored, and locally led.

    Another lesson I’d point to from FGM and across the board, that I can’t emphasise enough, is the huge role civil society plays in success, and the momentum that civil society brings.

    Make Poverty History was a hugely influential movement that had a big impact.

    And the ability of our NGOs to work collaboratively as one team has proved immensely powerful in generating political consensus.

    And in getting culture, tradition, attitudes changed on the ground.

    The fight against ebola is just one example. It was civil society work that helped people understand in communities how they could stay safe.

    And civil society advocacy has helped take what was wrongly a niche issue like FGM to being much more mainstream.

    Looking at all that, I don’t think we will have the sort of step-change on social mobility we need here in the UK, without that kind of coordinated advocacy and campaigning from civil society.

    You’ve got to be out there, beating the drum, holding all our feet to the fire as well as doing the amazing projects you do.

    Time and time again, our work in DFID tells us, it’s about finding momentum and keeping it, because otherwise the power of inertia and status quo drags you back.

    In international development we have International Women’s Day coming up on 8 March, we’ve just marked International Day of Zero Tolerance for FGM (6 February).

    What are the days and moments for social mobility we can come together on?

    Another lesson from DFID: meeting that challenge, sustaining that momentum, and staying the course, is about not chopping and changing our approach every few years.

    We’ve been working to eradicate polio for at least 25 years, and working towards a malaria-free world for at least 15 years.

    Generational challenges require generational policy.

    If we are to shift the dial on social mobility in Britain, we need a longer term approach. Not interventions that are changed with every incoming government.

    That means achieving a cross party consensus, built around an evidence-based strategy, working on the 80% we can agree on rather simply arguing about the 20% of this agenda we don’t agree.

    And here is another lesson from development work: the central role of evidence, of data and analysis in what we do.

    DFID works in complex places, in tough places, with a lot of risk, sometimes danger, and tracking effectiveness is critical.

    So in DFID we are data and measurement geeks – and proud of it. That approach to evidence is also key to social mobility strategy in the UK.

    It’s happening – take the Sutton Trust-run Education Endowment Foundation, take the work of the Social Mobility and Child Poverty Commission.

    But we need more. And what we’ve got needs pulling together and sharing much more systematically.

    The other side of the evidence coin is ‘scale’ and scaling up what works.

    At the end of January, the Social Mobility and Child Poverty Commission published its Social Mobility Index.

    Most strikingly, while we are in a city, London, that really topped the tables – this city is a social mobility hotspot – whilst other cities, including relatively affluent places like Oxford, Cambridge and Worcester, are social mobility coldspots.

    We need to dig into why we are finding such big differences on the ground, what has worked in London – can it work in other places? How might it need to be tailored?

    If every city could replicate London, that would be a prize worth having.

    Call to action

    For our part, this Government is stepping up to the challenge on social mobility.

    We have a Prime Minister who is leading from the front, who has put giving the opportunity for every child in Britain to go as far as their talents will take them at the heart of this government’s work over the next five years.

    In the last month alone the PM has announced the new campaign for mentors for children.

    We have BIS working with universities on going further to bring in those from disadvantaged and BME backgrounds, and the Cabinet Office setting out how we will tackle inequality in the public sector.

    We have our forthcoming Life Chances strategy.

    And so, step by step we are doing what we can in Government.

    But Westminster and Whitehall are only part of the solution on social mobility. This is so much more than just about government.

    All of us have a role to play. We can and should all ask ourselves, what more can we do?

    Employees – ask your boss what more your company can do.

    Employers, business need to see that apprenticeships is a start, but what else?

    Are they really getting beyond the usual recruits? Are you promoting outside of the usual networks?

    My then employer Smithkline put me through an MBA at the London business school. It’s not that normal though.

    How can Britain’s corporate world do a better job of more consistently pulling in and then pulling through talented young people who start as rough diamonds?

    Professions – there’s been lots of progress, but there’s much more work to do.

    My profession of accountancy has done lots but there’s much more work to do.

    Conclusion

    I started by talking about my own journey.

    But what galvanised me as a young person wasn’t being angry about a less than perfect start. I’m actually very proud to have been born and brought up in Rotherham.

    I remember how I felt. It was a mix of challenge, of excitement, of optimism, of aspiration, of being in an amazing country, with an amazing history, having a sense of wider world out there too, which I wanted to be part of.

    It was great parents, encouraging teachers, adamant swimming coaches, who taught me about single-minded persistence to reach your goals.

    And I believe that our young people will get themselves and our country a very long way.

    But we need to make that ladder of opportunity one that’s easier to climb now and in the future, than it was for those of us climbing it in the past.

    It’s about setting Britain fair to help our young people successfully navigate those critical moments, having them channel their energy into achieving goals rather than overcoming barriers.

    Improving social mobility is a lot more than individuals reaching their potential.

    It’s about our community, our society, our economy, our politics.

    A social contract between all of us with everyone else. To me it underpins everything. And it’s complex.

    That’s also why delivering a more socially mobile Britain is hard, because it’s about changing Britain’s DNA if we’re going to be successful.

    But we’re truly making a start now and we have a huge amount to be proud of.

    Britain is a recognised world-leader in international development.

    And I believe, in time, we can be a world leader on social mobility too.

  • Matt Hancock – 2016 Speech on Cyber Security

    Matt Hancock
    Matt Hancock

    Below is the text of the speech made by Matt Hancock, the Minister for the Cabinet Office and Paymaster General, in Israel on 16 February 2016.

    Thank you for being here today and for the warm welcome we have received.

    I’d like to begin by thanking Herzog, Fox and Neeman for hosting us today, and the Israeli National Cyber Bureau and UK Israel Tech Hub for organising the workshop.

    I am full of admiration for what can only be described as the modern transformation of Israel.

    David Ben Gurion wanted to see the Negev bloom. And the flourishing cyber ecosystem in Beer Sheva must be a fulfilment of his dreams.

    You have transformed an arid desert into a Silicon Valley and brought Israeli companies, academia, public authorities, venture capitalists, and multinationals together to produce a fertile breeding ground of ideas and enterprise.

    And it is not just Beer Sheva. Israel’s cyber ecosystem is thriving in Jerusalem, Tel Aviv, Haifa, Nazareth and beyond.

    It is an amazing and brilliant fact that Israel has the highest density of cyber and digital start-ups per capita in the world. We are very jealous of this fact. So I thought I’d do something about it, and come and learn from this start-up nation; from the Israeli spirit of innovation and mission.

    I am delighted to lead a fantastic group of businesses representing the best of British industry and academia.

    I hope we find businesses on both sides with an opportunity to showcase their products, discover areas of mutual interest and identify opportunities for partnership. And I hope to see concrete outcomes flowing from the discussions. We want to boost our trade, encourage even more Israeli investment in the UK and oppose those calling for boycotts.

    The problem

    So what is the challenge we face? New technologies, including digital technologies, give the world and its citizens opportunities like never before. This connection has helped more people escape poverty around the world, at a pace never seen. Yet this new opportunity brings new threats.

    We are here today as cyber security is increasingly important. To our citizens, to our businesses, to our infrastructure, and to government itself. In the UK, our mission to create better digital public services for citizens is wholly dependent on the ability to protect our networks, our users and our data.

    As the minister responsible for both digital government and cyber security in the UK government, it is my duty to drive progress on both of these interdependent issues.

    Part of that means supporting the cyber security sector, helping companies innovate and learn from the best. And that is the theme of the workshop today. Part means better protection of government itself, and I’ll touch on that later.

    As you will know, this is increasingly difficult because the volume and complexity of cyber attacks is increasing, both in scale and complexity.

    Cybercrime, espionage, or attacks on critical infrastructure, from both state and non-state actors are increasing. The average cost of the most severe online security breaches for bigger companies now starts at almost £1.5 million. The number of significant attacks has doubled in the UK in the last year alone.

    What we are doing

    And cyber security is a shared responsibility. It requires the engagement of the whole of society. When it comes to protecting our critical national infrastructure, the importance of partnership between government and industry is particularly important.

    You lead the world in making this partnership effective, and I want to learn how. You lead in the world in bringing government expertise and private enterprise together and we want to know how. In the UK we are establishing a National Cyber Centre to provide business and the government with a single point of contact and source of advice on how to manage cyber security risk.

    The new Centre will make it easier for government and industry to share information on cyber threats to better protect the UK. And it will give us a new platform to handle incidents in real time, ensuring a faster and more effective response to major attacks. It will be critical in joining the secret and public-facing worlds together.

    In the first instance this is to protect UK Crucial National Infrastructure (CNI). In the UK, where much of our CNI is owned and operated by the private sector, companies are responsible for ensuring privately-operated CNI is cyber secure.

    New proposals

    We need to get the design right. And we want to do more. In November we announced that the UK government will invest £1.9 billion over the next 5 years in cyber security. This means we’re nearly doubling our current investment to make the UK one of the safest places to do business online.

    More widely, we are strengthening law enforcement capabilities to ensure that cyber criminals can’t escape justice.

    We are boosting skills, sponsoring students and rolling out a major programme for the talented teenagers, involving after-school sessions with expert mentors, challenging projects, and summer schools. A number of academic initiatives in the UK are based on Israeli models of identifying and nurturing young cyber talent.

    But cyber isn’t just about government alone.

    The UK’s cyber security sector already contributes over £17 billion to the economy. Our ambition is for the UK to develop an innovative and truly world-class cyber security sector that will protect our national security.

    We want to create a cyber ecosystem in which cyber start-ups proliferate, get the investment and support they need to win business around the world, to provide a pipeline of innovation that channels ideas between the private sector, government and academia.

    We will establish cyber innovation centres to support early-stage companies to commercialise their products. I look to the Israeli model as an exemplary precedent.

    And we are setting up a £165 million cyber and defence fund to invest in the next generation of cyber-security companies.

    To get this right, international collaboration is crucial.

    As a fellow member of the D5, which brings together the 5 leading digital governments in the world, we have been working closely with you to help reform government technology.

    British/Israeli collaboration in technology and innovation has facilitated a multitude of business partnerships in areas such as fintech, cleantech, digital health and more.

    I want to see this partnership strengthened. So I can announce today that we have launched a new academic engagement between the UK and Israel in the emerging area of cyber-physical security – an area vital to the safety and security of our economies and our infrastructure.

    Israeli experts will engage in joint research with UK academics in cyber-security. We will launch a competition to find the best ideas and people to work together to develop research focussed on what is another new frontier: protecting our cyber physical systems: like protecting industrial control systems, the internet of things and driverless cars.

    I can also announce that our leading cyber security bodies, CERT-UK and CERT-IL will strengthen their engagement and provide greater situational awareness through sharing incident information, malware analysis, methodologies, policies and best practice.

    It is my hope and intention that we can build on what we have done in the past by identifying and developing opportunities for collaboration amongst our two nations.

    For perhaps no two countries know more, in times both historic and present, of the need to fight for our security, to keep our people safe and free. While very real physical battles persist, the new frontier in that fight is the cyber war.

    Together, we must ensure that cyberspace is resilient to malicious attacks, and remains open and free for the innovation and progress that is the embodiment of the human spirit. Our task is no less than that.

    So, together, let us make it happen.

    Thank you very much.

  • Theresa May – 2016 Speech on Tackling Terrorism

    theresamay

    Below is the text of the speech made by Theresa May, the Home Secretary, at the Center for Strategic and International Studies, in Washington DC on 16 February 2016.

    I am delighted to be able to be in Washington and speaking at the Center for Strategic and International Studies. For more than half a century this think tank has been at the forefront of international research and analysis, helping decision makers navigate our volatile and unstable world.

    In the five years since the start of the conflict in Syria, millions of people have lost their livelihoods, their loved ones, the country they call home. Syria’s neighbours have provided sanctuary to the vast majority of those who have fled the country. But when more than a million people, from Syria and elsewhere, sought to travel to Europe last year the debate changed.

    The problems of failed and fragile states, not just in Syria, but across the Middle East and Africa, are no longer confined to those regions. Not only has this created one of the greatest humanitarian challenges in decades, it has also sparked a political crisis within the European Union. It has forced countries to re-examine their approach to migration and border security. And it has made the threat from terrorism more complex than ever before.

    According to last year’s Fragile States Index a terrorist or insurgency campaign was being waged in nine out of the top ten failing states. These power vacuums provide a conducive environment for terrorists, organised criminals and insurgent groups. Groups that do not play by international norms or humanitarian laws.

    They are able to exploit the lack of effective governance in these countries, unchallenged by corrupt and weak law enforcement agencies. And they are able to manipulate populations resentful of widespread abuse of human rights, promising an alternative to the dysfunction and injustice they already suffer in their daily lives.

    Exacerbating this changing picture are the same technologies that we all use, exploited by terrorists and organised criminals. Today there is no need for face-to-face, or even direct contact: a cyber-criminal sitting in Moldova can attack the online bank account of a pensioner in Minneapolis, while a terrorist sympathiser in Raleigh, North Carolina can communicate with Daesh in Raqqa.

    In the UK, we’ve seen a 15-year-old boy, inspired by terrorists in Syria, jailed for encouraging violent extremists in Australia to commit a terrorist attack on Anzac Day.

    This then is the new reality: a web of global threats that feed off the instability of conflicts overseas, that exploit modern technology, and which – sadly – are all too often supported by misguided individuals at home.

    A constantly changing threat

    Last week a sickening video was released online by the terrorist group Daesh. That video featured a small child who in full view of an audience was seemingly made to kill others.

    You may not have heard about this video. Just as you may not have heard about similar videos with gruesome content often targeted at western leaders including our Prime Minister and your President. But there will be some people from across America who will have watched this video, and been captivated by the twisted message.

    Daesh is an organisation that revels in its own depravity. It has killed hostages in the most horrific way possible. It has murdered hundreds of thousands of men, women and children – the vast majority of them the same practicing Muslims it purports to represent.

    The threat from terrorism is not new. When I first sat down at my desk, as Home Secretary, nearly six years ago, the main threat was from Al Qaeda. Today, Al Qaeda’s senior leadership may have been weakened, but that threat has not gone away.

    Its affiliates in Yemen and in North West Africa remain a serious concern. Al Shabaab in Somalia recently claimed an attack on a plane flying out of Mogadishu airport, while Boko Haram in Nigeria continue to wage a brutal insurgency against the Government.

    But the hard truth is Daesh is operating in a way that we have never seen before. At the start of the conflict in Syria and Iraq, some likened this to the Spanish civil war, or fighters that went to Bosnia and Afghanistan. But the reality is we have never seen this number, demographic, or range of ages travelling to take part in a conflict. Nor have we seen this scale of territorial ambition before.

    From the UK we believe that around 800 people of interest to the security and intelligence agencies have gone to Syria and Iraq, including women and families. Independent organisations estimate that up to 11,000 foreign fighters have travelled to Syria from the Middle East. To this we can add the thousands from Africa, Asia, Australia, Europe, Russia and the former Soviet Union.

    In 2014, in its bid to establish a global Islamic Caliphate, Daesh in Syria and Iraq directed, inspired or enabled around 20 attacks in other countries worldwide. In 2015, there were almost 60 such attacks – from Paris to Sydney– as well as over 200 attacks carried out by Daesh branches including those in Libya and Egypt.

    There have been 16 attacks in Europe over the past two years, the majority inspired or directed by Daesh. A number of the terrorists that carried out the attacks in Paris last November received training in Syria. And in Sousse in Tunisia, a young man murdered 38 people at a beach resort, 30 of whom were British holidaymakers. It was an evil and senseless attack, and the largest loss of British life from a terrorist attack since the London bombings in 2005.

    The domestic response

    In the UK, over the past 18 months, the police and the security and intelligence agencies have disrupted seven terrorist plots to attack the UK – all either linked to or inspired by Daesh and its propaganda.

    The number of people arrested for terrorism-related offences has increased by over a third in the last year – a total of 315.

    And as the threat has continued to morph and adapt, the strength of our security at home has prompted terrorists to seek out new methodologies, new evasive methods and new spaces in which to carry out their crimes.

    And we must, in turn, adapt our response.

    In the UK, we recently announced that we will make new funding available to our security and intelligence agencies to provide for an additional 1,900 officers – at MI5, MI6 and GCHQ – to better respond to the threat we face from international terrorism, cyber-attacks and other global risks.

    To ensure they have the powers they need to do their jobs in a digital age, we are committed to introducing legislation that both protects the security of our nation and the public’s private lives.

    Our draft Investigatory Powers Bill brings together all of the powers already available to law enforcement and the security and intelligence agencies to obtain communications and data about communications; it introduces a double-lock on the way these powers are authorized – using Secretary of State approval, backed up by the decision of a judge; and it ensures these powers are fit for the digital age.

    The Government has now received three Parliamentary committee reports on the draft legislation. We are carefully considering their recommendations. However, I want to make one thing clear on a subject that resonates on both sides of the Atlantic.

    The British Government believes encryption plays a valuable role in today’s society. It helps keep people’s personal data and intellectual property safe from theft by cyber criminals. It helps our economy grow and prosper.

    But as President Obama has said, we cannot be in a situation where technology is also used by terrorists and criminals to escape justice. The government has a responsibility to protect national security and ensure public safety. Communications service providers have a responsibility to their customers to ensure their privacy. Together we can find a way that achieves both.

    But the Investigatory Powers Bill is not the only new legislation we have introduced to keep our citizens safe.

    We have introduced a power to temporarily seize passports of those suspected of travelling to engage in terrorism overseas. And we have extended our ability to refuse airlines the authority to carry people to the UK who pose a risk.

    This legislation is designed to underpin the delivery of CONTEST, our world leading counter-terrorism strategy. Pursuing terrorists, protecting people and infrastructure and preparing in case of an attack are three pillars of that strategy.

    But crucially, it contains a fourth pillar – aimed at preventing people from becoming radicalised in the first place. Because unless we address the circumstances in which radicalisation and terrorism thrives, we will always be fighting a rearguard action against it.

    To do this we work with sectors and institutions where people are at risk of radicalisation or where there are opportunities to intervene. We work in prisons, with educational institutions, in communities and online. We support community based initiatives up and down the country that aim to challenge terrorist propaganda and communicate an effective counter-narrative. We work with internet companies to remove terrorist propaganda online. And we have established a programme, Channel, designed to protect and divert vulnerable people who we know are at risk of becoming radicalised.

    This work can be controversial, but it’s too important to ignore – and it is vital not only for our national security, but in safeguarding vulnerable people from harm.

    Since Channel was rolled out nationally in April 2012, there have been more than 4,000 referrals to the programme. Of those referrals, hundreds have been provided support, by trained intervention providers, to help lead them away from radicalisation.

    However, we want to go further than preventing people from becoming terrorists and focus on a broader approach to counter-extremism – both violent and non-violent.

    Because where non-violent extremism goes unchallenged, the values that bind our society together fragment. Women’s rights are eroded, intolerance and bigotry become normalised, minorities are targeted and communities become separated from the mainstream. So while by no means all extremism leads to violence, it creates an environment in which those who seek to divide us can flourish.

    The fight at home and abroad

    As I have said, our approach needs to continually adapt. That is why the British Government is currently reviewing CONTEST – to ensure the highest priorities are given the right resources, that government departments and agencies have a unified approach, and that we ensure we are making an impact on our counter terrorism priorities overseas.

    Because this is a fight that cannot just be won at home.

    So we must go well beyond traditional counter-terrorism policy. We can no longer afford to see our counter terrorism work at home and our counter terrorism work overseas as two separate entities.

    In the UK we are forming a new joint unit for International Counter-Terrorism, which brings together existing expertise in the Home Office and the Foreign and Commonwealth Office.

    This new joint unit will drive our counter-terrorism agenda abroad, our work with partners such as the Five Eyes, as well as influencing and supporting our work with multilateral organisations such as the EU and the UN.

    Because it is no good arresting a person in your own country, if they cannot be brought to justice in theirs … it is no good ensuring world class aviation security at home, if people are not properly screened at airports abroad… and it is no good sharing intelligence with another country, if they cannot act on it effectively… and it is no good fighting terrorism in and from Syria, if we can’t help stabilise that country and its neighbours.

    What needs to change

    I am in Washington to attend the Five Country Ministerial with my counterparts in the US, Canada, Australia and New Zealand. Together, we will expand upon the successful cooperation between our countries on issues of national security which we have built over the past decades.

    Faced with the growing threat I have described, we must act with more urgency and with greater joint resolve than we have before.

    We must be more open to sharing intelligence with our partners, and more proactive in offering our expertise to help others.

    We must counter the twisted narrative peddled by Daesh and show it for what it is – a perversion of Islam built on fear and lies. And we must organise our own efforts more effectively if we are to bring order to those failed states most beset by disorder and disarray.

    So at this week’s Five Country Ministerial I will be calling for action on three key fronts, action I believe to be essential if we are to defeat extremism and keep our people safe from terrorism.

    Building capacity where it is needed most

    We need to work with vulnerable states to improve their ability to respond to the threat from terrorism. This includes providing advice on crisis management to helping them combat the extremist narrative, from improving their investigative capacity to strengthening aviation security.

    For example, following the downing of the Russian Metrojet plane last year, we have been working with the Egyptians on improving security at the airport at Sharm Al Sheikh.

    In Pakistan and Nigeria, we have well-established programmes to strengthen investigatory and prosecutorial frameworks for dealing with terrorism, underpinned by clear human rights principles. That includes zero tolerance for torture and mistreatment. Not only because that reflects our principles, but because we must reduce opportunities for extremists to feed grievance narratives.

    We would like to do more in fragile states, and draw on the expertise of our partners. Because we need to be working together with these countries to prevent atrocities happening – not just reacting in response to them.

    Stopping the message of hate from spreading
    We also need to do more to stop the message of hate from spreading, and prevent people from becoming radicalised.

    I have already mentioned that in the UK we are working with civil society groups who seek to challenge extremist messages and provide credible alternatives.

    And I am pleased that last week the UN endorsed the UN Secretary General’s Preventing Violent Extremism Plan, encouraging a whole system approach to counter-terrorism. This is a welcome step and the UK stands ready to support other countries with this work.

    Together, with other European Union member states, we continue to build capabilities at the European Internet Referrals Unit at Europol to secure the removal of terrorist propaganda from the internet. The Unit has expanded its language capabilities which now includes Arabic, Russian, German, Dutch, and French. But we need other like-minded groups to come on board and reduce the scope for terrorist groups to spew their hate online.

    I would like to see the United States, Canada, New Zealand and Australia – Britain’s Five Eyes Partners – taking the same approach in working with communications service providers to tackle this propaganda. We need other like-minded groups to come on board from all corners of the world to reduce the scope for terrorist groups to spew their hate online and to undermine their twisted narratives.

    Working together, creating lasting impact

    Finally, and most importantly, we need to bring much greater order and joint resolve to the disparate work taking place internationally, and a comprehensive and coherent response to the common threat.

    It is great to see the potential of capacity building initiatives in many countries – whether that’s sharing intelligence between European agencies, training law enforcement in Tunisia, or counter violent extremism projects with civil society groups in Kenya. These measures can have real impact.

    But governments and organisations often undertake similar things in the same place with too little join up. Likeminded nations too often work in parallel rather than in partnership. And we need a much better understanding of what really works.

    Bodies such as the Global Counter Terrorism Forum and the Radicalisation Awareness Network regularly convene policymakers, practitioners and experts from governments, multilateral organizations and NGOs, to discuss their approaches and share best practice. But we must now focus on practical delivery and translate this expertise into action.

    There has been some useful progress in the past year.

    In December last year the UN held the first meeting of Security Council finance ministers in its 70-year history. Together with our allies we agreed on new measures to update the UN counter-terrorism sanctions regime to focus on Daesh in order to deny it the access to the resources they need and to identify and exploit the vulnerabilities in their financial network.

    In the EU, after many years of negotiations, we reached agreement on the sharing of passenger name records on flights to, from and within Europe, a crucial step in supporting our fight against terrorism. Further measures to raise the deactivation standards for firearms across Europe were agreed at the same meeting.

    But across the board there is scope for more action: better information sharing between countries, more active use of passenger data to identify persons of interest, more thorough exchange of terrorist finance information, as well as work to improve protective security and crisis response. For the EU to deliver on the security of its members, it must be a forum for taking action and garnering a collective response.

    And then, there is the opportunity we have together, as Five Eyes countries, to garner collective action. We enjoy the deepest, longest lasting security relationship in the world. The innovation of the Five Eyes Ministerial in 2013 provides us with a forum not just to share collective lessons on security and counter terrorism, but to take collective action.

    Conclusion

    So this evening I have spelt out three of the most important priorities in our efforts: building the capacity of those governments that need support to counter terrorism; preventing the pernicious spread of extremism and ensuring that we, collectively, match international cooperation with coordinated international action that has real, lasting impact on the ground.

    Because I am clear that defeating terrorism requires a global response, and we will not succeed by acting in isolation.

    This is the challenge of our generation. Extremism is spreading, threatening and taking lives, not just in our countries but in other lands. It thrives in the disorder created by fragile and failing states. It is contributing to, and in some cases exploiting, mass migration. It is turning the benefits of modern technology to its twisted ends.

    If we are to deal with this threat effectively, we can no longer look simply for domestic solutions. There must be international cooperation, a common approach, free flows of intelligence and information, and the closing of technological gaps which the extremists exploit.

    Together, we can defeat terrorism. We can stop the spread of extremism. We can save lives not only from terrible attacks, but from the damage and destruction which is wrought.

    It is a challenge for our generation, and it is a challenge that we must win.

    Thank you.

  • Hugo Swire – 2016 Speech in Wellington

    hugoswire

    Below is the text of the speech made by Hugo Swire, the Minister of State at the Foreign and Commonwealth Office, in Victoria University, Wellington, New Zealand on 19 February 2016.

    I am delighted to be here in New Zealand and I am particularly pleased to have this chance to talk to you today about the UK economy and the opportunities that exist for future collaboration between the UK and New Zealand.

    Before doing so, I would like to pay tribute to the success of the New Zealand economy. At a time when the rest of the world was beset by the Global Financial Crisis, we watched as the New Zealand economy flourished. We were impressed and jealous in equal measure!

    Five years ago, in 2011, the British economy was facing huge challenges.

    We were struggling to recover from the financial crash that threatened our economy, and the recession that followed on its heels.

    There was talk of a double dip recession.

    Our unemployment rate hit a peak of 8.5%. Real wages were falling.

    But under the leadership of David Cameron there was a clear long term economic plan for us to follow. We would tackle the crisis in our public finances.

    We would cut business taxes and boost enterprise.

    We would take the difficult long term steps to ensure a lasting private sector recovery rather than pump up the public sector balance sheet still further and risk catastrophe.

    Our British people and British business understood that there was no easy shortcut to the work Britain had to do. Everyone kept their nerve.

    And the results have been there for all to see.

    Britain has been one of the fastest growing advanced economies in the world these past few years.

    Unemployment has fallen to almost 5%.

    And now we’ve got the highest employment rate in our history.

    Real wages are growing.

    The deficit as a share of GDP is down to nearly a third of what it was.

    On the back of this, business investment is forecast to grow at 7.4% this year – the fastest growth since before the crisis.

    That shows the high level of confidence that exists in the UK economy.

    Now I know that that optimism is sometimes tempered, both here and in the UK, by concern about global economic trends – whether it be China’s slowdown, low dairy prices or falling oil prices.

    But my message today is one of confidence: we can meet these challenges and overcome them.

    There’s a lot of transition taking place – some that is difficult and turbulent, yes; but some that is fundamentally positive too.

    We know that China’s economy is in transition, with growth driven increasingly by consumption, services and domestic demand.

    We know that global oil markets are in transition, with new suppliers like Iran and new sources like shale.

    We know that interest rates in the US are in transition.

    And we know there are big forces at work as the demographics of many Western nations change, altering the balance between investment and savings.

    In New Zealand – of all places – I hesitate to use the shifting tectonic plates metaphor. But there is no doubt that huge changes are taking place in the global economy.

    And the question for all of us here is: do we just talk about this transition – or do we take the action, and show the political will, to adjust to it and make it as smooth as possible?

    We need to see every shoulder at the wheel. Every country acting as one in search of growth.

    We need China to keep reforming. To deliver on the ambition set out at the Fifth Plenum to allow markets to play a greater role.

    We need countries like Russia and Brazil to make greater efforts to diversify, away from state owned companies and to increase investment, particularly in infrastructure.

    We need a global commitment to tackle the corruption which stunts global growth. This is why the UK is hosting an Anti-Corruption Summit later this year. We aim to put fighting corruption at the heart of our international institutions. We want to make the rules and practices which govern global commerce even more resilient to threats from corruption.

    And in Europe, we don’t want yet another action plan for completing the single market, or yet more calls for free trade deals. We want to see those plans put into effect, which is why the UK has been the strongest and loudest advocate for the proposed EU-New Zealand Free Trade Agreement.

    As we face these challenges side by side, I am confident that New Zealand and the UK will remain close trading partners. The UK is New Zealand’s 6th largest trading partner. We are the 6th largest destination for New Zealand exports and the 7th largest source of imports for New Zealand in the year ending September 2015.

    Now is a great time to join us and invest in Britain. This is not yet more empty rhetoric. As a government we are investing in hard infrastructure

    In Victorian times we led the world in rail infrastructure.

    The first inter-city railway in the world was British, the fastest steam locomotive in history was British.

    But then we fell back. We are now addressing that, with innovative projects like Crossrail – a smart railway for 21st century London.

    We’re also backing the largest road investment programme since the 1970s, building new nuclear power and investing in renewable energy.

    We are committed to creating a competitive economy. We know that competition doesn’t always happen if you leave it to the market alone.

    That’s why in November we published a new plan to break up monopolies and back new entrants into certain sectors.

    We need action to let competition flourish, back the new company that doesn’t always have a seat at the top table and put the customers first.

    We are the top destination in Europe for Foreign Direct Investment and the leading FinTech hub in Europe.

    These are encouraging signs. Because a digital economy is a productive one

    And we will continue to build stronger and deeper links with the rest of the world.

    We don’t deliver sustained growth by becoming insular and isolated.

    We’ll protect ourselves by reaching out to the world and broadening our links.

    By looking to each and every trading opportunity. Particularly with close partners such as New Zealand.

    And let me just say a few more words about a trading relationship close to the hearts of both our countries – China.

    We want China to rebalance.

    As recent events have shown, China is bound to experience bumps along the road to a reformed economy. But we’re in it for the long haul.

    We are going to support China on its path to prosperity, along which it has already made such impressive strikes.

    Some say that stock market volatility in China means we are wrong to strengthen our economic ties.

    But those critics fail to look beyond that day’s headlines.

    China is an economic colossus, it is the second biggest economy on the planet. It’s a huge part of our world’s future.

    Any economy of that size you would want to trade with, whether it is growing at 7%, 6% or 5%.

    At a 7% growth rate, China will add an economy equivalent to the size of Germany’s to world output by the end of this decade.

    So we, the British government, are committed to strengthening our links across the world.

    A country can only thrive as an outward looking nation that wants to trade with the world if it has a pro-business government.

    Under David Cameron’s leadership, I am proud to be part of a government working to achieve that, and in doing so making Britain the best place for New Zealand companies to establish an international presence.

    For five years we’ve unashamedly backed business, large and small.

    We’ve reformed R&D tax relief – making it more generous.

    We’ve dealt with the punitive 50% income tax rate because it was destroying enterprise.

    But the biggest business tax reform introduced was made to corporation tax.

    In 2010 it stood at 28%, and Britain suffered as a result. In Budget after Budget we have cut the rate, from 28% to 20%. The lowest in the G20. Today, the United Kingdom is recognised as a low tax destination for business.

    Overall the business tax cuts we’ve announced since 2010 will be worth nearly £100 billion to business this decade.

    That is £100 billion of support for business. In return we expect businesses to pay their fair share of taxes.

    You won’t be surprised to discover that there aren’t many votes in cutting taxes for business.

    But supporting business in the UK is the right thing to do. Support of this magnitude encourages business to invest, to expand and to compete.

    It encourages businesses to build for the future.

    To innovate to solve problems, and to respond positively to open and fair competition.

    Never has Britain been more open for business, in every sense. The welcome mat is out for more New Zealand businesses, partners, investors and consumers to follow the lead of companies like Rex Bionics, Tri-Max and Orion Health. I look forward to welcoming you to the UK.

  • Eric Lubbock – 1962 Maiden Speech in the House of Commons

    lordavebury

    Below is the text of the speech made by Eric Lubbock (later Lord Avebury) in the House of Commons on 27 March 1962.

    I understand, Mr. Deputy-Speaker, that there are two conventions which are generally followed by hon. Members in making their maiden speeches. The first of these is that they should make some general references to their constituency. In view of the fact that a great many things have been written in the national Press about my constituency which hon. Members may have had an opportunity of reading, I think that I need not deal with that subject. Indeed, several hon. Members have paid visits to my constituency within the last few weeks. Some of them came away with some curious ideas.
    The right hon. Gentleman the Leader of the House, from his researches, concludes that there are—and I think that I have the figure correct—22,846 people out of an adult population of 55,000 who do not possess features. I happen to be an example of them, but I have, as you can see, Mr. Deputy-Speaker, a perfectly good nose and ears and I have, not only in the literal sense but also in the metaphorical sense, teeth—as the right hon. Gentleman may discover.

    The second convention which is generally followed by maiden speakers is that they should say nothing controversial. But we are speaking about nurses’ pay, which is a subject on which I feel very strongly—as, indeed, do many of my constituents—and, therefore, if it is necessary to transgress this rule slightly I am sure that hon. Members will understand.

    There is another factor, which is that I have already been attacked from the Treasury Bench before I had an opportunity of speaking and when I did not have an opportunity to reply. But this is a thing which I welcome. I hope that it will happen on many future occasions, because it proves conclusively to me that I have been saying the right things.

    In speaking about nurses’ pay, I would like to refer to a reply given on 12th March by the Parliamentary Secretary to the Ministry of Health to the hon. Member for Stoke-on-Trent, Central (Dr. Stross). The hon. Lady told him that it was mistaken to compare the salaries and conditions of nurses with those of ancillaries. It may be mistaken, but that is what I intend to begin by doing today.

    A male ward orderly in the London area receives £10 0s. 8d. basic pay for a 42-hour week, which was the figure the hon. Lady gave. He also gets 100 per cent. extra for Sundays; 25 per cent. extra for nights; 50 per cent. extra for Saturday afternoons; 100 per cent. extra for Bank Holidays, and, of course, if he works on a Bank Holiday, he has another day off in lieu as well. He also gets overtime for all hours over 42.

    A State enrolled nurse at the top of the scale receives £11 13s. 3d. for a basic week which is two hours longer, and does not receive one penny extra, no matter if he or she works round the clock. Two pay slips have been shown to me by a constituent, and they have been sent to the Parliamentary Secretary. I hope that she will have seen them by now. They were sent to her by a nurse in Orpington Hospital. One of them was the pay slip of the nurse. He received the maximum figure of £11 13s. 3d.—and he is a man with twenty-five years’ service in the profession. Also sent to the hon. Lady was the pay slip of a ward orderly who had been in the hospital five weeks, who worked for two hours less and who received £13.

    The hon. Lady also said that we should not compare these two because the nurses receive better conditions of service—among other things, better holidays. I can prove that that statement is false, because they work a greater number of hours in the course of the year than do the ancillaries. The nurse, indeed, has five weeks holiday. But if my arithmetic is correct, he or she is working 47 weeks at 44 hours a week. Multiply these, and the total is 2,068 hours. The ward orderly works 50 weeks of 42 hours, but he gets five Bank Holidays, each of eight hours, so that his total comes to 2,060 hours. In fact, there is hardly any difference, in spite of the fact that, on the face of it, nurses get longer holidays.

    In one respect, indeed, there should be no comparison between trained nurses and ward orderlies. The ward orderly has no responsibility whatever, whereas the trained nurse has the greatest responsibility which any person can possibly undertake—that of protecting human life.

    The consequences of this situation are much more grave than the Minister would lead us to suppose. I must talk about my own constituency in this because, obviously, I know more about it than I do about other parts of the country. But I think that the situation which we have in Orpington is a microcosm of the whole country, and many of the aspects of our situation are repeated in other places, as the hon. Member for Abertillery (Mr. L Williams) has already said.

    We have trained nurses who are leaving the service in Orpington and are going to industry—to Morphy Richards, or to Tip Top Bakeries, or whatever we have in Orpington—and there are nearly as many trained nurses in Orpington’s factories as there are in Orpington Hospital. This is because we have presumed on the spirit and devotion of the nurses for far too long. But if we want to look at this not from the point of view of equity, but from the point of view of how public money is spent, then the present policy is entirely wrong because public money is being spent on training these people. They take several years to acquire their skills and then leave to work at a factory bench.

    The hon. Member for St. Pancras, North (Mr. K. Robinson) said that 30 per cent. of those who enrol in the nursing profession fail to complete the course, but the Guardian of 12th October last gave the figure of 40 per cent., and in the same article said that 50 per cent. of the nurses who had completed their training had left for other work.

    The students are already doing a shorter week, and they spend less time in the wards nowadays than they used to because there are more lectures in the course. Therefore, it becomes all the more important that those who enrol remain in the profession, because the ward sisters have less time to give attention to the students in the wards, because there is a more rapid turnover of patients, and because there is a shortage of ward sisters. It is extremely important for those who enrol in the profession to complete the course and stay with it.

    What inducements are there? I have already quoted the figure of the maximum which a State enrolled nurse can attain. Also of interest is that a staff nurse’s maximum is £656 and a ward sister’s £840. This maximum of a State enrolled nurse of £578 per annum is after two years’ training and six years of qualified service.

    When one considers that this is £1 a week less, roughly, than a shorthand typist gets right at the beginning of her professional career, one can see how ridiculous these salary scales are. The Minister has been unwarrantably complacent about the staffing situation in hospitals. He sees the situation as being adequately covered in the nation as a whole. I can tell him that, in Orpington Hospital, there are 58 vacancies in its establishment of 168 trained people. In the country as a whole, there are 25,000 such vacancies.

    This is borne out by looking through the pages of journals such as the Nursing Mirror. I was looking through its issue for 23rd March, and I counted 56 pages of situations vacant. Someone asked the Parliamentary Secretary the other day how much money was being spent on advertising vacancies in the National Health Service. I therefore did a little sum and I found that the Nursing Mirror was receiving £150,000 a year in advertising revenue for nursing situations vacant—and this is not the only journal in which these vacancies are advertised.

    I have spoken of shortages of staff and the danger particularly as it refers to Orpington Hospital, which has three night sisters on duty for 23 wards, in which there are between 500 and 530 patients. As a result of this situation, first-year students are in charge of the wards after only nine months’ training and in other cases, nursing auxiliaries are in charge of the wards.

    That is not a situation about which the hospital authorities can do anything. They would like to be able to get the extra trained staff to which their establishment entitles them, but there are 74 part-time and 30 full-time auxiliaries working in the hospital and it would be impossible to function without them. They are not trained, however, to recognise an acute condition when it occurs. Moreover, even if they recognise it, they have to summon help in a crisis, because, obviously, they are not themselves allowed to give treatment. This constitutes a danger to human life.

    The danger is increased by the expansion of the geriatric side of the general hospitals. To ease overcrowding in the mental hospitals—this is an arrangement which dates back some years—a great many senile dementia cases were diverted to the general hospitals which took geriatrics and were rechristened cerebral arteriosclerosis cases. In Orpington Hospital, there are 350 geriatric patients in a total of 510, many of whom are totally incapable and require constant skilled attention. It may well be imagined that in these circumstances superhuman efforts are necessary to cope with any emergency.

    During the summer, accident cases are brought in nearly every weekend and this happens frequently even in the winter and spring. Nurses have to be recalled to duty in their time off and from their beds. I should like to quote an instance of this which happened on Sunday, 11th March. A particularly serious motor accident occurred at Badger’s Mount and the casualties were brought into Orpington Hospital. The theatre sister had already done two spells of duty that Sunday, from 7.45 a.m. to 1.15 p.m. and from 4.30 to 8.15 p.m. She was summoned back to the hospital, where she attended from 10 p.m. until 7 a.m. next day, having assisted at two major operations.

    That is not the end of the story. Monday is a busy day in Orpington Hospital and it was not possible to allow that sister to go home. She then had to do another spell of duty from 9 a.m. until 1.15 p.m., at the end of which time she had been on duty on and off for 22½ hours without sleep. How many professions or occupations are there in which people would not only stand for this kind of treatment, but would do so without asking for a penny extra?

    The 2½ per cent. which has been offered to those in nursing is an outrageous insult and is presuming on the noble ideals of service of the profession. The Minister knows of the reluctance of these people to take positive action by striking in defence of their legitimate rights. Perhaps he thinks, like the Minister of Aviation, that striking terror into the hearts of a potential enemy is a mission which should be fulfilled at the expense of those sections of the community who are least able to protest.

  • Alan Milburn – 2002 Speech to the Royal College of Nursing Congress

    Below is the text of the speech made by Alan Milburn, the then Secretary of State of Health, on on 24 April 2002.

    It is a pleasure to be here today – especially on a day when you are focussing on the needs of student nurses. It is right today that as we plan for the future generation of nurses we can plan with confidence the future of the NHS.

    It is two years since I was last at your Congress. Since then, quite a lot has changed, for the RCN and for the NHS. You have a new General Secretary. Beverley is a powerful advocate for nurses and for patients. I am grateful for the role she plays and I believe you have every reason to be proud of the leadership she shows.

    I said two years ago I shared an ambition with you: to get more members for the RCN because I wanted to see more nurses in the NHS. Two years later, there are 16,000 more members of the RCN because there are 20,000 more nurses in the NHS.

    After years when nurse numbers fell and when training numbers fell too, nurse numbers in the NHS are now rising and are set to go on rising for many years to come.

    There are of course huge problems still in the NHS. Decades of under-investment still take their daily toll on frontline services and frontline staff. Nurses work under huge pressure. I know that because I hear it and see it wherever I go. I know too the pressures and frustrations brought by staff shortages or by equipment failures or by lack of IT support.

    I know the pressures are real – and today I want to set out how we can address them together. In the last few years we’ve made a start. Waiting times are still too long – but they are falling. Cancer equipment is still too old – but it is improving. Hospital buildings are still in disrepair- but the biggest programme of new building is underway. Staff shortages are still there for all to see – but the NHS Plan target for 20,000 more nurses has been delivered – and delivered two years early.

    The NHS Plan we prepared and published with your help is a programme for ten years not for two. The truth is we are at first base in what will be a long haul to improve services for patients. But step-by-step we are making progress. And we can now build on the foundations that you have helped to lay.

    Whether you work in the health service or the independent sector, in mental health or in the community, whether you are a student or a sister, a matron or a midwife, up and down the country nurses at every level are making a difference for patients every hour of every day.

    It is tough out there and the problems that are real have to be tackled. But we also have to have some balance, particularly in the media debate on the NHS.

    Nothing makes me more angry than when stories in some of the papers give the impression that no patient ever gets good treatment. Or when the false charge is made that nurses treat patients worse than dogs. Or that the NHS is full of bad nurses, or bad doctors, when it is in fact full of good people doing their best for patients.

    In a service treating millions of people every week, there will always be cases where things go wrong but, thanks to your efforts, for most patients most of the time things go right. Most staff do a good job. And I’ve got a simple maxim: if you are on the side of the people who use the NHS you’ve got to be on the side of the people who work in the NHS.

    So today I want to set out what the future holds for the health service – for staff and for patients. And because nursing values are health service values, I will set out the leading role I want nurses to play in changing the health service – and changing it for good.

    Today we can look to the future with confidence. Last week’s Budget gives the NHS the best chance it has ever had – perhaps the last chance it will have – to transform health care in our country. For decades we have lagged behind the rest in Europe. Now we have the chance to be up with the best.

    Funding for the NHS – already growing faster than in any other major European country – is now set to grow by over £40 billion. It is the biggest increase in NHS resources the country has ever seen. Where there used to be funding for just one year there will now be funding for sustained increases for the next five.

    And the same is true of social care. For too long nurses know social services have been the poor relation of health services. Health and social care are two sides of the same coin. They both rely on each other. Older people rely on both. So I can confirm today that funding for social care, which just five years ago was rising by less than 1% above inflation a year, is now set to rise by 6% a year for the next three years.

    The Budget is a profound moment of choice for our country. It puts behind us the decades of pretence that Britain could get world class health care on the cheap. That was our nation’s impossible dream.

    But it was just that: a dream. If we want world class health care it has got to be paid for. And I believe the best and fairest way of providing health care for country is a tax-funded, well-funded NHS.

    The NHS is an insurance policy that comes with no ifs and no buts, no small print, no get-out clauses. It is based on the scale of your need not the size of your wallet. So we should support the NHS with our heads as well as our hearts.

    Some say that what we did in the Budget is a gamble. Well maybe it is. But I believe it is now right to ask the British people to pay a little more for the health service so that we can get a lot more for patients.

    And when the British people are being asked to put more in, they have every right to expect more out.

    So the Government has an ‘acid test’ for health investment. It is this: the extra investment has to secure an expansion in capacity or an increase in productivity or an improvement in performance.

    Against this ‘acid test’ we expect to be judged. Against this test the NHS can expect to be judged.

    Raising the money required discipline – sorting out the public finances, putting the economy on an even keel. Spending the money requires discipline, too.

    There will be many pressures from many quarters for many good causes. But we will not be forgiven – and the NHS will not be forgiven – if having raised the resources we fail to use them to get the results that both nurses and patients want to see. Shorter waiting times. Higher clinical standards. Better health outcomes.

    So we will focus the extra resources where they will count most for patients. Expanded capacity means more nurses and doctors, scientists and therapists, more beds and buildings.

    We need more investment in more modern hospitals and health centres, better equipment and, of course, IT systems that might just actually work.

    Investment will help to reduce the waiting times for treatment and investment needs to be focussed not just on treatment but in prevention.

    Our job in government is to provide opportunities for all and not just some in our society. So improvements in cancer, heart disease, mental health and care of the elderly will remain our key priorities.

    Investment here will help to improve health outcomes and tackle the health inequalities that are such a scar on the face of our nation.

    So investment will be focussed not just in hospital services but in primary and community services too. To create the modern health service we need we have to shift the balance of services in the NHS. The problems of hospitals can not be solved solely in hospitals.

    Tackling waiting in the A&E and in the outpatients department of course requires more staff and new equipment. But it requires better help and more support in the community, in primary care and in social services.

    Social services will be able to extend by a third the number of older people with access to rehabilitation. There will be extra resources to stabilise the care home market and to buy more care home beds. And we can now set ourselves the objective, not just of giving older people a choice of care in a care home but of increasing the number of people who can be cared for in their own home.

    The point is this. Everywhere I go, virtually every nurse I speak to says: things can not just go on as they are. And you’re right.

    The new money cannot be just for more of the same. It has to buy a different sort of health service. It has to meet the ‘acid test’ of expanded capacity, increased productivity and improved performance.

    That’s why the reforms we implement are as important as the resources we invest. Only if we now have the courage to match reforms with resources will we get the best results for patients.

    So as we expand capacity for patients we must expand choices for patients. So that for the first time in fifty years NHS patients are able to make an informed choice about where they are treated and when they are treated.

    So that we pay hospitals by results – with more resources for treating more patients, more quickly and to higher standards.

    So that social services are paid by results too – for ending the misery of bed blocking, using their extra resources to expand community support to the elderly patient in need.

    So that the services that are struggling – rather than being left to sink or swim, as they were under the old internal market – are helped and supported and yes, where necessary are taken over by management with a track record of success.

    So that we get the public, private and voluntary sectors working for a common cause – improved services for NHS patients.

    None of these changes can happen through Government action alone. We can secure the resources. We can help set the standards. We can hold the system to account. But in the end I do not treat a single patient. You do that. So I need your help, not for political reasons (still less for party political ones). But because nurses make the difference for patients.

    Nurses above all others are the frontline in the NHS. Alongside your colleagues in medicine and the other professions, you are uniquely placed to help translate the extra resources into results for patients.

    Make no mistake about it there is a bruising battle ahead. The cynics and the critics say that to choose the NHS is the wrong choice for Britain. That the health service is not working and that it can never work.

    The Government is on test – of course we are. And we are happy to be judged against the improvements we have promised. But there is a bigger test than the political one. It is whether the NHS itself can deliver. The public want to know that if they put more resources in we can get more results out. That the NHS can meet this ‘acid test’.

    I am one hundred per cent confident that the NHS will deliver. Why? Because I know NHS staff are one hundred per cent committed to delivering improvements for patients.

    And it is nurses who are leading this process of reform. Reform is happening out there because you are making it happen.

    Nurses who are now running clinics, triaging patients, discharging patients, prescribing medicines, running walk-in centres. Nurses the first point of call already for 10 million patients through NHS Direct. Nursing doing jobs previously only done by doctors. And now, through PMS, for the first time, nurses in charge of doctors.

    And this meets our ‘acid test’: liberating the talents of nurses helps to expand the overall capacity of the NHS, increases the productivity of the NHS and improves the performance of the NHS.

    Liberating the talents of nurses quite simply means better care for patients. And in the last few years, nurses have carried the torch for change.

    We share between us – the profession and the government – a common aim: to get the best from nurses so that we can get the best for patients. Now we look to strengthen our partnership so that we can go further still. To make sure that we liberate the potential not just of some nurses but of every nurse.

    There are five further steps I believe we should now take to realise our shared ambition:

    First, to get the best from every nurse we need to get more nurses working in the NHS.

    A start has been made. And I want to thank you for the help you have given us so far in our recruitment campaign. Since 1997, over 11,000 nurses who left the NHS have been encouraged to return. 2,000 more are on their way back. In total the number of nurses working in the health service has risen by 31,000. That is good progress. But there is more to do.

    So I can confirm today that we plan over these next five years to increase again the total number of nurses working in the NHS by a further 35,000.

    Applications for nurse diploma courses have doubled. Nursing degrees are now the second most popular university course in the country. And I can confirm that these increases in training mean by 2008 there will be 60% more nurses qualifying each year than there are today.

    And we will continue to bring back nurses who have left the NHS and to recruit some nurses from abroad. And I can give this assurance today, where we do we will not actively recruit from developing countries. Those countries need their nurses more than we do.

    Like many of you I have been appalled by reports of nurses being dishonestly recruited abroad, for a fee, by private agencies, coming to this country and then finding themselves exploited.

    So I can announce today that to tackle this exploitation we will establish a national helpline for these overseas nurses so we can get them out of dead-end jobs, match their skills to NHS jobs, make them an NHS employee and end their exploitation.

    But getting more nurses into the NHS is just one part of the story. We may have turned the corner on nurse recruitment but what we cannot have is nurses coming in through the front door only to find more nurses leaving by the back door. The emphasis now has to shift to retaining nurses as well as recruiting them.

    So second, as the RCN constantly reminds us, we can only expand the number of nurses in the NHS if we improve the working lives of nurses already in the NHS. A start has been made but much, much more needs to be done.

    The NHS won’t get better treatment for patients unless it offers better treatment for staff. And the truth is some NHS employers are better at it than others. You can see that in vacancy rates where in one trust the nurse vacancy rate is 8% whilst in the next door trust it is less than half of one per cent.

    Nurses often have two jobs – one at home and one at work. The NHS has got to do more to help nurses balance their family and their working lives. Some employers are already doing that offering more flexible hours and better childcare. But some are not.

    When I met with a group of nurse returners earlier this year their message to me was that improving working lives should be a priority for every chief executive in every trust in every part of the country.

    So today I can confirm that in future the star ratings system for NHS employers will include an assessment of how well the staff are treated and how well they are involved.

    Beverly, you asked on Monday for a guarantee that every NHS employee would have access to a child care co-ordinator.

    Now, I can’t promise you’ll always get everything you ask for – you know that – but I can promise that by April next year every nurse will get the child care help you called for.

    And today I can go further still to extend nurses’ access to practical childcare support. As you know we plan to invest an extra £100 million in childcare for NHS staff. So far, the intention has been for this to be targeted only at qualified nurses. Today I can announce that it is our intention, within two years, to make subsidised childcare available not only to qualified nurses but to student nurses as well.

    This is investment in nursing. In the future of nursing. In the future of the NHS. And to those who say that there is a choice between investing in staff or investing in services, I say in the NHS unless we invest in staff we will not get better services for patients.

    Third, then that brings me to the question of pay.

    Every nurse deserves fair pay.

    In the past nurses pay was staged. Now it is being paid in full.

    Three years ago we increased the starting pay of newly qualified nurses by 12%.

    Two years ago staff nurses had increases of almost 8%.

    Last year ward sisters and charge nurses got over 5%.

    Since 1997, nurse pay has risen faster than average earnings.

    And nurses deserve a fair deal over the years to come.

    Investment in pay, just like every other area of future NHS spending has to pass our ‘acid test’ – it must contribute to expansion in NHS capacity, it must bring about increases in NHS productivity and it must deliver improved NHS performance.

    As the Chancellor said in his Budget Statement last week, “sustained commitment to better public services demands responsibility in setting public sector pay.”

    As you know, we have been negotiating a new pay system for nurses and for other staff. The Agenda for Change discussions have been long and hard.

    I am grateful both for your participation and for your patience. I know there have been concerns about our commitment to Agenda for Change.

    So I can confirm today, that we are fully committed to Agenda For Change; we want now to move to conclude the negotiations; and providing we can reach agreement we will start to implement Agenda For Change by the end of this year.

    But let me just say this: this will not be a something for nothing arrangement. Agenda for Change is all about paying people according to what they do. The more they do the more they can get. As nurses take on new roles and responsibilities they have a right to expect a fair reward. In return the NHS has a responsibility to gain improvements in flexibility and productivity. This must be a something for something arrangement.

    It will take time and effort to fully implement the new pay system but, providing we can reach agreement, we can deliver a better deal for Britain’s nurses.

    Fourthly, we know that if we are to get improvements in flexibility and productivity, the NHS has to change traditional working practices to help more nurses smash through the glass ceiling that has held them back for too long. There simply have to be better career prospects for all NHS nurses.

    There are already 700 nurse consultants, 2000 modern matrons. They are showing that nurses can break through that glass ceiling. If it can be done in some parts of the health service it can be done in all parts of the health service.

    So you have a job to do to challenge the structures in your own NHS organisations. To argue for better use of nursing skills. To say that it is good for doctors and good for patients to unlock the talents of nurses. And I want to help, if I can.

    So I can announce a major expansion in an area of clinical practice that matters both to nurses and to patients – and I know it matters to the RCN. Today there are 23,000 nurses who are able to prescribe drugs to patients. Within two years we expect there to be more than 30,000 independent nurse prescribers but we need to go further and we need to go faster.

    I can tell you today I have asked the Chief Nursing Officer to draw up proposals to extend the range of drugs and medicines these nurses are able to independently prescribe.

    I can also announce today that it is now our intention to ensure that every nurse who wants to, and is trained to, is able to prescribe appropriate drugs and medicines to patients.

    Last week we issued a consultation document on supplementary prescribing. We await your response with interest.

    We now propose that supplementary prescribing should have no formulary, no restricted list of drugs, no restriction on the location or the type of practitioner other than that they are registered and qualified and safe to prescribe. Prescribing will be limited only by the individual patient’s clinical plan. I expect the first supplementary nurse prescribers to be in training by the end of this year.

    And I can also say today that we will embed these reforms for the long term. So I have asked the CNO to work with the Nursing and Midwifery Council and Higher Education to review and reform nurse pre-registration training so that in future nurse prescribing can be enshrined in the training of every single newly qualified nurse.

    Let us be clear: these proposals represent a fundamental change in traditional working practices in the NHS. What once was the sole preserve of the doctor will now become a shared responsibility between nurses and doctors together. It will be good for nurses, good for doctors and above all else it will be good for patients.

    So those who say nurses can not lead or should not lead should think again. Nurses are leading, others can lead and in the future many more will lead.

    Fifth, then, to get more nurses leading requires better training. Nurses should not have to struggle alone against the odds to make the reforms the NHS needs. Every nurse who wants to lead change should be supported to do so.

    When I last spoke at your Congress two years ago, I announced then the largest ever investment in leadership development for nurses. Since then over 20,000 nurses have completed leadership programmes such as the LEO or the RCN’s own clinical leadership programme.

    By October this year over 30,000 will have done so. The nurses I have spoken to say these training opportunities have given them the skills and the confidence to change services for patients. Indeed one ward sister I spoke to last time I was visiting Harrogate told me how she was so inspired by what she had learned that she has now become a course tutor to pass on the benefits she had received to other nurses.

    Today I want to build on that nurse’s experience – and I want to extend opportunities to many more nurses. I can announce that over the next two years, the current leadership programmes will be extended to 50,000 D&E grade nurses.

    The RCN clinical leaders programme will also be extended to a further 100 trusts including primary care trusts.

    In addition I have asked the NHS Leadership Centre to provide e-learning programmes to tens of thousands more nurses, opening up new opportunities, particularly for nurses with family commitments. And I can announce today that I have asked the Chief Executive of the new NHS University to make nurse training an early priority in its work programme.

    These five changes – more nurses, better working lives, fairer pay, improved career prospects, enhanced training opportunities – big changes – all amount to one thing: more power for nurses to improve services for patients.

    As Beverley rightly puts it – you are the glue that binds the NHS together. Day-in, day-out you are on the frontline of patient care. I want to help you create a patient-centred service.

    That is why nurses are in leadership positions in PCTs. It is why ward sisters have been given greater control over ward budgets. Why modern matrons have been given the clout to get the fundamentals of care – good food and clean wards – right for patients.

    All of this is about putting power in the hands of the NHS frontline. The NHS can not be run from Whitehall. We have got the national standards and shortly we’ll have a tougher inspection system in place. So it is now time for Whitehall to let go. It is time to let nurses take more control.

    Last week we announced the biggest ever funding package for the health service. Today I have announced reforms to extend and expand the power of nurses. To change traditional working practices.

    On their own they represent important new opportunities. Together, this investment and these reforms can deliver a better NHS.

    I won’t stand here and promise something I can’t deliver. I told you we would get more resources for the NHS and we have. I have told you we will deliver a fair deal for nurses and we will.

    I want you to know we will keep faith with Britain’s nurses as you kept faith with the NHS through all the difficult years of cutbacks and closures.

    No one is promising you there won’t be pressures or problems. No one is saying every difficulty and every demand will be met.

    No one is pretending everyone will be happy.

    Real life simply isn’t like that.

    But what I can say is that with this level of investment, with these reforms, with your help, the best days of the NHS can be ahead of us, not behind us.

    Together I know we will deliver for patients.

  • Alan Milburn – 2002 Speech on the NHS Plan

    Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, to the House of Commons in London on 18 April 2002.

    With permission, Mr. Deputy Speaker, I wish to make a statement on the next steps on the NHS plan. I am today laying before Parliament a Command Paper setting out those next steps, copies of which have been placed in the Vote Office.

    The NHS plan that we published in July 2000 set out a 10-year programme to rebuild and renew the health service in our country. It diagnosed the NHS problem as follows. The principles of the NHS are right-on this side of the House we believe in an NHS that is free at the point of use, funded from general taxation, and based on need, not ability to pay. But today’s NHS is the product of decades of underinvestment. It is also the product of a failure to reform. Staff-the greatest asset that the health service has-work flat out in a system which still too much resembles that of the 1940s. The NHS plan set out a 10-year programme of investment and reform based on clear national standards, more devolution of resources, greater flexibility for staff and more choice for patients.

    With the economy stabilised and the public finances sorted out, the 2000 spending review was able to give the NHS the largest ever real-terms increases in resources. Two years later, anyone who says that there are no problems in the NHS has clearly got it wrong, but those who say there has been no progress have also got it wrong. Yes, there is a long way to go-it is a 10-year plan-but those who point to an NHS black hole should in fact be pointing to dozens more hospitals, hundreds more beds, thousands more doctors, tens of thousands more nurses-and a better health service as a result.

    In July 2000, we acknowledged that three years of sustained funding was not enough. My right hon. Friend the Prime Minister had already said in January 2000 that we needed to match European Union levels of spending. Yesterday, my right hon. Friend the Chancellor of the Exchequer put NHS finances on a sustained footing, not for three years, but for five. Years of failure to invest in the past are now being replaced with years of investment for the future. Today, I can tell the House what that investment will give us: 35,000 more nurses, 15,000 more doctors, 40 new hospitals and 500 primary care centres. As investment grows, so the capacity of the NHS will grow.

    Investment in the NHS must, however, be accompanied by changes in the way in which the NHS works. Ours is not an unconditional offer. Without those reforms, we will not get the best use of the money for the taxpayer and we will not get the improvements in service for the patient. Where we have had the courage to invest, we must now have the courage to reform. Our formula is simple: investment plus reform equals results.

    First, building on the national standards already in the NHS plan, we will strengthen the system of inspection and audit to improve accountability to patients and the public. Where more resources are going in, people have the right to know what they are getting out. We will therefore legislate to establish a new Commission for Healthcare Audit and Inspection to inspect and to raise standards in health care across our country. We are clear that we need higher standards in NHS hospitals and also in private hospitals.

    The commission will assess the performance of every part of the NHS so that the public can see that every extra pound in the NHS buys something better for patients and gets something more for taxpayers. Similar arrangements will be made for social care. We will discuss the details of both with the National Assembly for Wales.

    The new commission will be independent of both the NHS and Government, and more independent than the current fragmented system. It will report annually to Parliament, not Ministers, on the state of the NHS, its performance and, most important, the use to which it has put the extra resources. The Government should not be judge and jury of the NHS. The commission will be the judge, the British people the jury.

    Secondly, we can go further in extending devolution in the NHS, building on what has been achieved. The health service should not and cannot be run from Whitehall. The NHS is delivered in hundreds of different communities by more than 1 million staff. The relationships are between the local patient and the local doctor; the local community and the local hospital. However, those relationships will not work properly until central control is replaced by local accountability. After 50 years, the time has come when the sound of bedpans being dropped in Tredegar should reverberate only in Tredegar.

    With national standards and inspection in place, power, resources and responsibilities must now move to the NHS front line. When we came to office, GPs controlled only 15 per cent. of the total NHS budget. Today, primary care trusts, with GPs and nurses in the lead, already control half the budget. In only two years, they will control three quarters of it. Just as the new commission will report nationally, so primary care trusts will need to report locally on how NHS resources have been spent.

    The best primary care trusts, like the best NHS hospitals, should enjoy greater freedoms and more rewards. We will therefore establish new foundation hospitals and foundation primary care trusts, which will be fully part of the NHS, but with more freedoms than they have now. They will have more powers, including a right to borrow, to expand their services for patients.

    Thirdly, further to the new powers that we have given nurses and others, we will radically alter the way in which staff work and introduce a new system of financial incentives throughout the health service. We will put in place new contracts of employment, not only for nurses and other staff, but for GPs and, yes, for hospital consultants, too. Our objective is to liberate the potential of all members of staff, rewarding those who do most in the NHS and, crucially, improve productivity throughout the health service.

    New incentives for individual members of staff will be matched by a new system of financial incentives for NHS organisations. The hospitals that can treat more patients will earn more money. Traditional incentives work in the opposite direction. Indeed, the poorest performers often get the most financial help.

    We will therefore introduce a new system for money to flow around the health service, ending perverse incentives and paying hospitals by results. The incentive will be to treat more patients more quickly, and to higher standards.

    Fourthly, patient choice will drive the system. Starting with those with the most serious clinical conditions, patients will have a greater choice about when and where they are treated. From this summer, patients who have been waiting six months for a heart operation will be able to choose a hospital, public or private, which has the capacity to offer quicker treatment. This level of investment means that we can grow NHS capacity as fast as it is possible to do so.

    I can also say today that it is our intention to draw into this country additional overseas capacity so that we can further expand NHS services to NHS patients. As capacity expands, so choice will grow. Within three years, all patients, with their GPs, will be able to book hospital appointments at a time and a place that is convenient to them. The reforms that we are making will mark an irreversible shift from the 1940s take-it-or-leave-it, top-down service. Hospitals will no longer choose patients; patients will choose hospitals.

    Reductions in waiting times to get into hospital must, of course, be accompanied by cuts in waiting times to get out. Older people are the generation that built the health service, and they have supported it all their lives. This generation owes that generation a guarantee of dignity and security in old age. Bed blocking denies both.

    In recent months, the extra resources that we have made available have reduced the numbers of elderly patients whose discharge from hospital has been delayed. I am grateful for the help that local councils have given us in addressing this problem. Here, however, the long-term solution is not just investment, it is reform. I can tell the House today that, to bridge the gap between health and social care, we intend to legislate, as they have done in Sweden and other European countries, to give local councils responsibility-from their 6 per cent. extra real-terms increases-for the cost of beds needlessly blocked in hospitals.

    Councils will need to use those resources to ensure that older people are able to leave hospital when their treatment is completed. If councils reduce the current level of bed blocking so that older people are able to leave hospital safely when they are well, they will have the freedom to use those resources to invest in extra services. If bed blocking goes up, councils will incur the cost of keeping older people in hospital unnecessarily. There will be similar incentives to prevent hospitals from seeking to discharge patients prematurely. In this way, we will provide local councils with the investment and the incentives to improve care for older people.

    Taken together, the NHS plan and the next steps announced today amount to the most radical and fundamental reform programme inside the NHS since 1948. I want to pay tribute to the staff of the national health service-not just the nurses, doctors and consultants, but all the staff in the different medical disciplines, the ancillary staff, the secretaries, the receptionists, the porters and the cleaners. They represent the very best of British public service and I believe that, as a nation and as a Parliament, we should be proud of the work that they do. I know and understand the enormous pressure that they are under as the NHS plans to make these big changes. But I know, too, that they share this basic goal: to rebuild the national health service around the needs of its patients.

    This programme of investment and reform will mean that each year, every year, waiting times will fall. Last year, the maximum wait for a hospital operation was 18 months. Today it is 15 months. By this time next year, it will fall to 12 months. By 2005, it will be six months, and by 2008, it will have been reduced to three months. By then, the average waiting time for a hospital operation will be just six weeks. It is our aim that people will no longer have to face the dilemma of having to wait for treatment or having to pay for it.

    As a party and as a Government, we are committed to providing opportunities to all in our society and not just to some, so there will be more effort to prevent ill health, as well as treating it. Twenty-five thousand lives a year can be saved by the investment we can now make in preventing and treating heart disease alone.

    The balance of services will shift, with more patients being seen in primary and community settings, not just in hospitals. Social services will have resources to extend by one third rehabilitation care for older people. Councils will be able to increase fees to stabilise the care home market and secure more care home beds. More investment will mean more old people will have the choice of care in their own homes rather than in care homes.

    Yesterday’s Budget and today’s reforms mean that the NHS plan will be delivered.

    I want to make two further points. First, it is a 10-year plan, as we said in July 2000. By the time of the next election, there will be real and significant improvements. However, that cannot happen overnight. It takes seven years at least to train a doctor and up to 15 years to train a consultant. Expectations will be high-I understand that-but they also need to be reasonable, and people need to understand that a 10-year plan is exactly what it says. It will take time to be delivered in full. At least now, public and patients will be able to see improvements made stage by stage, independently of Government, audited, monitored and inspected.

    Secondly, there is consensus in the country on one thing: Britain needs to spend more on health care. There is no mystery about why there are no waiting lists in Germany. It has spent more, and has done so for years.

    We can debate endlessly the system of finance, but one thing is beyond debate: the level of finance has to be raised. Once that is accepted, the choice is not between a system funded out of general taxation, which results in higher national insurance, and some other system that comes for free. Importing the German system of social insurance would cost the equivalent of an extra £1,000 per worker per year, and the French system would cost £1,500 per worker per year.

    Labour Members believe in the NHS in our heads as well as our hearts. We believe it to be the best and fairest system of providing true health insurance, because it is based on the scale of the person’s need, not the size of their wallet. It is the best insurance policy in the world.

    It is now for those who want to see the NHS not reformed but abandoned, and who routinely call it Stalinist, to say honestly what their alternative is, what it would cost and how much families and pensioners would have pay for it.

    Yesterday we made a choice, and we ask the British people to make the same choice. We are proud of the NHS and of the people working in it. We are giving it the money that it deserves. We are making the changes it needs. Investment plus reform equals results. We will be happy to be judged on them.

  • Alan Milburn – 2002 Speech to the NHS Leadership Centre Annual Conference

    Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, on 12 April 2002.

    I wanted to come to your conference today because the people here are actually the people who are changing the National Health Service. You are the people who are turning rising levels of investment in the NHS into real reforms and I hope real improvements for patients.

    We’ve seen some of that progress reported just this week – with shorter waiting times in hospitals, for ambulances and in GP surgeries too.

    Of course there is an awfully long way to go but these are real achievements. They are the achievements that you and your colleagues around the country have made. And I simply want to congratulate you for them and to thank you for the job you are doing.

    I know you work under huge pressure every day. And I know that there are lots of problems as well as signs of progress in the NHS today. But I believe the best days of the NHS are ahead of us, not behind us. It’s about time that we, as a country, started to feel a little more pride in the achievements of the million or more staff who work in the NHS and a little more confidence in the health service they provide.

    It should be a cause of national pride that health care in our country is free. That no-one asks for your insurance policy or your cheque book before you get the care you need.

    The reason the NHS continues to command such affection in the hearts of the British people is that its values are actually the values of our nation – fairness and equality, compassion and community, a belief that we can achieve more together than we ever can alone.

    But the NHS should be supported with our heads as well as our hearts. Its values – far from being the backward looking sentimentalism that our critics claim – are actually grounded in the needs of our society today.

    Without the NHS the sophistication of modern treatments – and of course their cost – would put individual provision of health care beyond the reach of all but the very wealthiest in society. For me at least the sick paying for the privilege of being sick is hardly the mark of a fair or civilised society. In a world where health care can do more and costs more than ever before having an NHS based on need and not ability to pay is a real source of strength for our country and security for our people.

    The truth is most patients – despite the problems the NHS still faces today – get good quality care. Where there are sometimes lapses in the quality of care our job is to tackle them. What we cannot allow is for the bad to detract from the good, for the isolated case to become the perceived norm. To read some of our daily newspapers you would sometimes think that the NHS is full of bad doctors, or bad nurses. It isn’t. It is full of good people – therapists and scientists, cleaners and porters, managers and paramedics as well as doctors and nurses – who come to work to care for others. It is about time we as a country got behind the people working in the NHS rather than trying as some now seek to do to actively undermine them.

    It is now clear that those who are opposed to the NHS – including some of our political opponents – are embarked on a quite deliberate and cynical strategy of first undermining the NHS as a prelude to their real agenda of tearing down the NHS and forcing people to pay for the costs of their own treatment.

    I say today to those enamoured of a private insurance alternative to the NHS: look to the USA where 40 million people have no health cover at all; see what happens with private insurance rather than community provision; and then ask yourself do we really want health care based on how much you can afford to pay rather than how ill you are? Do we really want doctors in this country reaching for your wallet before they reach for your pulse?

    I think not.

    Private insurance policies, even with all the exemptions they contain, are consistently more expensive and more bureaucratic for consumers and taxpayers than publicly funded health systems. Giving tax breaks to encourage more private insurance would involve the taxpayer subsidising people who already had insurance policies – a significant diversion of public resources from the NHS for the benefit only of a few.

    The examination that we have made, that Derek Wanless has made, that the British Medical Association has made of different systems of funding health care have all concluded one thing: that a tax-funded NHS is a fairer and more efficient way of providing health care for our country than the alternatives on offer. The NHS should be supported with our heads as well as our hearts.

    Of course there are bad things about the British health care system – whether it is staff shortages or bed shortages or long waits for treatment. But when people say to me: what about levels of health provision in France or Germany or Sweden, I say: these countries do not have a superior system for funding their health care, they have superior levels of funding for health care.

    No-one can escape the simple reality that there isn’t a health care system in the World that is cost-free. Somehow or other it has to be paid for. In Britain we pay from general taxation. In some countries employers and employees pay more. In other countries individuals pay for themselves. No country provides health care for nothing.

    As a government, we recognise that the limitations of Britain’s tax-funded health service have not been the system of funding from general taxation but the level of funding from general taxation.

    In just a few days time there will be a choice for our country. To go back to the days when the approach on the NHS was one of cutting taxes, cutting spending, cutting services and in the end therefore forcing more people to pay for their own care. Or to continue to move forward with sustained investment matched by fundamental reform.

    I believe passionately that the right way forward for our country is to continue investing and to press ahead with reform.

    Health care has to be paid for – one way or another – and World class health care costs a little more. In a world of rising health costs and greater health possibilities the NHS is the best insurance policy you can have. Putting the health service on a sustainable footing for the long term will pay dividends for us all in security for ourselves and our families.

    What we have started in the last few years we should see through. The NHS today is the fastest growing health care system of any major country in Europe. But there’s a huge amount of catching up to do. And huge problems to overcome. The waiting times are coming down but are still too long. The staff numbers are growing but there are still too many shortages. The system and the people working in it are still working under huge pressure.

    What we know is that that when we put extra resources into the NHS that delivers results for patients. Not overnight, nor with a big bang but steadily, step by step. Sustained improvement is by necessity more about evolution than revolution. The only way to keep progress coming through is to keep the investment going in. And to use the resources to reform how health care is delivered.

    Nobody I have ever spoken to in the health service – not the public, the patients or the staff – just wants more of the same. People today expect a different sort of service, a different level of service as well. People want services that are responsive, and which offer faster, higher quality care. Increasingly, and rightly so in my view, they want to make informed choices about how to be treated, where to be treated and by whom.

    Some say that that sort of service can only ever happen in a private market. I say with the right level of investment and the right programme of reform the NHS can do that better than any private provider.

    The NHS Plan that we drew up with people working in the service and patients using it is our ten year programme of reform. National standards and a tough system of inspection. New contracts for nurses, doctors and staff throughout the NHS to get more flexibility and to match pay with responsibility. More choices for patients and more partnerships between the private, voluntary and public sectors. And above all else to get the best from the investment the NHS must be run by the people delivering the care. It cannot be run from Whitehall.

    I don’t treat patients. You do. So just as schools now have greater control over resources for education so local health services should have greater control over health resources. That is what the new Primary Care Trusts are all about – with frontline staff in the lead. More than any other change the PCTs signal that half a century of centralised health care in our country is drawing to a close. The old style NHS where everything was run from the top down rather than the bottom up must now be a thing of the past.

    It will take time to complete the transformation but the direction is set. Power and resources will now move into the hands of frontline services and frontline staff. Three quarters of the NHS Budget, within just two years, will be controlled not at the centre but at the frontline. And let me just make one thing clear today: 75% represents the starting point not the finishing line in our drive for decentralisation and devolution in the NHS.

    With the right level of investment we should be seeking to unleash a new culture of public sector enterprise in the NHS capable of rivalling any spirit of private sector enterprise. It means providing better incentives to get health and social services working more effectively locally as a single care system rather than as two separate systems. It means more discretion over how local budgets are spent and where they are spent. More information and more choice for patients. Greater freedoms and more rewards for NHS organisations which are doing best alongside more help, support – and where necessary intervention – for those that are not.

    Above all else it means giving frontline staff the help you need to do the job you want to do. More staff. Fairer pay. Better childcare. Greater flexibility. A bigger sense of involvement in making change happen.

    The simple truth is the NHS works best when it harnesses the commitment and know-how of staff to improve care for patients.

    That’s why we are putting ward sisters in charge of ward budgets and giving health visitors a greater say over community health budgets. It’s why matrons are being given the power to get the fundamentals of care – like clean wards and good food – right for patients. It’s why nurses are being given new powers to prescribe drugs and discharge patients.

    All of this is about unleashing the tide of innovation that exists among staff in every health centre and every hospital. Nothing should provide us with a greater sense of optimism and confidence about the future of the NHS than the Modernisation Agency’s Report that is being published today. In example after example it shows that where staff have been given their heads they have improved services for patients.

    In North Hampshire, for example, pre-booked appointments for lung cancer scans have reduced the wait for an outpatients appointment from an average of 20 days to 2 days. In North West London new staff rotas and changed working practices have reduced waits for echocardiography from an average of 130 days down to just 7 days. In Wisbech, at the North Brink Surgery patients used to wait 16 days for a routine appointment. A month after the reform programme was put in place ‘did-not-attends’ had halved. The duty doctor emergency work was down by 85%. Today, 82.5% of patients see whichever GP they want when they want. The surgery has abolished waiting times and the duty doctor is an average of 55% quieter than 18 months ago.

    What these examples – and countless others in the Agency’s report- demonstrate is that investment only really works if it is matched by reform. And the essential ingredient that is needed are strong local clinical leaders in charge of making the process of reform happen.

    What we need to do is to support more staff through the reform process. Reform isn’t easy. It takes time and effort when on the frontline staff find that each day both are squeezed hard. That is why we will be looking at how we can give staff more protected time to improve services. How we can help more staff develop their skills and their personal potential. How we can use the introduction next year of the new NHS University and an expanded Modernisation Agency programme to develop more local clinical leaders.

    What is on offer here is a partnership between the Government and the people working in the NHS. We are prepared to commit more investment for the health service but only if it is matched by a commitment to reform. The reforms are as vital as the resources. More money going into health budgets is conditional on getting more out for patients. In every community, every hospital, every surgery reform now needs to bite. The health service – all across the health service – will need to show that extra resources are producing reforms and results for patients.

    Your leadership is vital. Without it reform will not happen. Frontline staff need to be in the driving seat to make the changes and improvements patients want to see.

    In the end this is actually not about systems. It is about values. The NHS is the right system because it has the right values. I believe in it – and the people working in it – not out of some sort of old-fashioned sentimentalism but because in the modern world the NHS is more right and more relevant than it has ever been before. Without the health service millions could never afford healthcare. With the health service all of our people can. It is the best one nation policy our country has ever seen.

    As a government we have made our choice. Our choice is for the NHS. For a reformed health service. For an NHS that enjoys higher levels of spending. Above all else our choice is for the patients who need the NHS. It is I believe the right choice for Britain.

  • Alan Milburn – 2002 Speech to the Allied Health Professions and Healthcare Scientists National Leadership Conference

    Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, on 13 March 2002.

    Since Nye Bevan created the health service, there have been 23 health secretaries. I think I am right in saying I am the first to address a conference of your professions.

    I wanted to be here today for a simple reason: to acknowledge that the work you do has not always received the attention it deserves and that it is time to put that right.

    So I want to start by thanking you for what you do day in day out in the service of others. I know that many of you are working under real pressure.

    It is invariably doctors and nurses who grab the headlines in the NHS but without you they could not do their jobs. Without your dedication and professionalism the NHS could not do its job. The work you do – whether as a scientist, therapist, radiographer, podiatrist, chiropodist, dietician, paramedic, orthoptist, prosthetist or orthotist – is absolutely key to unlocking an NHS where services are designed around the needs of individual patients.

    In my view it is no coincidence that where reform is taking hold in the health service it is often people from the allied health professions who are leading the process of change. Today I want to set out how I believe you can play a bigger role still in delivering services that are fast and convenient and which promote people’s security and their independence.

    We meet today at a critical point in the history of the NHS. When the NHS is not only going through a period of greater change than ever before but when it is subject to greater public expectations than ever before. When there is more scrutiny and where from some quarters there is more hostility than the NHS – and those working for it – have ever faced.

    To read some of our newspapers you would think no patient ever got good treatment. Or that the NHS is full of bad therapists, bad doctors and bad nurses when it is actually full of good people doing their best for others sometimes in difficult circumstances.

    People working in the NHS deserve fair coverage for their efforts. We as a nation owe the porters, cooks and cleaners, scientists, therapists and paramedics an enormous debt of gratitude. People in the NHS work well beyond the call of duty for something they passionately believe in. I believe your commitment to the ethos of public service is a huge strength in our country and that it must be preserved at all costs.

    Of course there are bad things about the NHS – whether it is staff shortages or bed shortages – and there are sometimes lapses in the quality of care. Where there are problems our job is to tackle them. But what we cannot allow is for the bad to detract from the good. The truth is most patients – despite the problem the NHS faces today – get good quality care. Most staff do a good job. And I believe that most patients know it.

    So alighting on problems and using them to damn the whole system should be exposed for what it is: denigration for a purpose. There are those who are deliberately talking down the public services as a prelude to their real agenda of running them down and then cutting them back.

    In these weeks ahead there will be a choice for our country. To return to the days when the approach on the NHS was one of cutting services, cutting taxes and getting more and more people to pay for their own care. Or to continue to move forward with sustained investment matched with fundamental reform.

    I believe passionately that the right way forward is to continue investing and to press ahead with reform.

    Our purpose as a government is to break through the barriers that hold too many of our people back: to provide opportunities for all in our nation. To give every child the best start in life through good education. To give communities hope by tackling the causes and the consequences of crime. And above all else to give people in our country the opportunity of good health through decent health care.

    For me an NHS that is funded by all and used by all makes for a stronger society for all. I think the values of the NHS are the values of our nation -fairness and equality, compassion and community, a belief that we can achieve more together than we ever can alone. And that these values – far from being the backward looking sentimentalism that our critics claim – are actually grounded in the needs of our society today. The case for collective provision of health care in my view has never been more compelling. Health is not just another commodity. It cannot be bought and sold in a market place. By definition our need for health care is unpredictable. And today the sophistication of modern treatments can put individual provision of health care beyond the reach of all but the very wealthiest in society. My very strong personal belief is that the ill paying to be ill is not the right way forward for Britain.

    It is time to remind the public that the fundamental ethos of the NHS is sound. It is a fair and efficient way of providing health care. The NHS providing care according to need not ability to pay is the right way forward for the country.

    What the NHS needs is more investment and fundamental reform.

    For too long as a nation we have pretended that somehow or other we can have world class health care on the cheap. We can’t. There is no such thing as a free lunch when it comes to health care. If we want world class health care it has to be paid for – one way or another. I believe that investing in the NHS is the right priority for our country.

    We have made a start. The NHS today is the fastest growing health care system of any major country in Europe. There’s a huge amount of catching up to do. And huge problems to overcome. The waiting times are coming down but are still too long. The staff numbers are growing but there are still shortages.

    Our opponents would like to pretend that the NHS is a bottomless pit. That isn’t true. What is true is that it will take time for improvement to fully come through. The NHS Plan is a ten-year programme not a programme for one or two years. But where we have put resources in it produces real results. You can see that in heart services for example. A year ago people were waiting up to 18 months for an operation. By the end of this month the maximum waiting time for a heart operation will be 12 months – still too long but moving decisively in the right direction. In primary care the prescribing of cholesterol lowering drugs is up by one third in just one year. 1,000 GP surgeries are being modernised. The biggest hospital building programme is underway. Last year saw a record increase in the number of nurses working in the NHS. For the first time in thirty years it saw more beds in hospitals, rather than fewer.

    I don’t say every problem has been solved. Far from it. There will be ups and downs along the way but the NHS is now on the road to recovery. The NHS Plan is on course to be delivered.

    Delivery depends on over one million people – NHS staff. The biggest obstacle to faster delivery is shortages of staff. That is why we need more of your professions working in the NHS.

    Here again we have made a start. Since 1997 OT and dietitian numbers have risen by over 20%, speech and language therapists by 17% and physiotherapists by 14%. But because there are still shortages of the precious skills that you have we now plan to drive forward the efforts to recruit and retain staff in your professions.

    First, we will be increasing training numbers. We have reversed the cuts in training places that took place in some of your professions during the mid-1990s with increases of over one third in healthcare scientist, radiography, OT and physiotherapy places. We estimate that over 1,500 more therapists and other health professionals have entered training over these last two years. I am now expecting these numbers to increase by at least a further 1,000 from April this year.

    Second, we will be targeting allied health professionals and healthcare scientists in an extended recruitment campaign. On top of our existing efforts in this area I can announce a new £1 million recruitment drive which will start this summer specifically to get more of your professions working in the NHS. I expect that at least 500 more staff who have left the NHS will return in the next year as a result.

    Third, we will want to discuss with leaders and representatives from your professions how we can build on the momentum that is underway in expanding staff numbers. What we cannot have is people coming into the NHS through the front door only to find more leaving by the back door. Retaining existing staff is as important as recruiting new ones. Here a fairer deal on pay will play a part. Negotiations on a new pay system have been going well and I am determined to see them through. I am equally determined that the NHS should become a more flexible and modern employer offering staff the support and childcare they need to balance their family and their working lives. So I can tell this conference that in June I will be hosting a summit to discuss how we can not only recruit more allied health professionals but how we can retain more too.

    What is on offer here is a partnership between the Government and people working in the NHS. We are prepared to commit more investment for the health service. What we seek in exchange is more reform.

    Indeed, the case for more investment will only be won if resources are matched by changes to the way the NHS works.

    Nobody I have ever spoken to in the health service – neither staff nor patients – wants more of the same. People today expect a different sort of service, a different level of service as well. People want services that are responsive, and which offer faster, higher quality care. Increasingly, and rightly so in my view, they want to make informed choices about how to be treated, where to be treated and by whom.

    Some say that that sort of service can only ever happen in a private market. I say with the right level of investment and the right programme of reform it can happen in the NHS.

    The NHS Plan we published 18 months ago is our programme to renew the NHS. In essence it is based on four key principles.

    First national standards and proper accountability. In a public service patients rightly expect services in one part of the country to be delivered to similar standards as another part of the country. That is what the national service frameworks for heart disease, elderly care and mental health and the National Cancer Plan are all about. It is why we have the NICE. And it is why we have introduced for the first time a strong independent inspectorate for the NHS, the CHI.

    What having national standards does not mean, however, is that the NHS should be run nationally. I do not believe a million strong service can be run from Whitehall. Half a century of experience shows us that this approach limits local leadership and stifles local innovation. Ideas and initiatives developed within the local NHS have too often played second fiddle to circulars delivered from the centre. For patient choice to thrive it needs a different environment. One in which there is greater diversity and plurality in local services which have the freedom to innovate and respond to patient needs.

    Where our first term in office was concerned with putting a national framework in place, this second term is about introducing new incentives encouraging greater local innovation and stimulating more patient choice. It is these reforms that will make the most telling contribution to improvements in services. In the weeks and months ahead we must be bold in developing these NHS Plan reforms.

    So the second principle involves the devolution of power to frontline services. We are at the start now of a transition where day to day management of the health system will move from Whitehall to the 28 new strategic health authorities in England. They will oversee the work of local NHS Trusts, PCTs and private and voluntary sector providers. The real power and resources in the NHS will move to the NHS frontline with from next month locally-run primary care trusts – involving professionals and patients – up and running in all parts of the country. Within a few years they will control three quarters of the total NHS budget. They will be able to choose from which hospitals – public or private – care is commissioned. The best hospitals are likely to be those where they too, practice the philosophy of devolution and empowerment.

    Every year CHI will rate local health services according to their performance. Those that are performing best will earn not just more rewards but greater freedom. The better the performance of the organisation the greater the freedom it will enjoy. Where the Commission decides that an NHS organisation is in trouble it will recommend special measures are taken. In the small minority of local health services where there are consistent problems for example new management could be brought in.

    Third, devolution will be accompanied by more choice for patients. From July heart patients waiting for six months or more for an operation will be able to choose in which hospital they would like to be treated. In time patients will have the information and the NHS will have the capacity to offer more people the chance to make informed choices about their treatment and care. Where the NHS can use the private and voluntary sector to benefit NHS patients and to extend choice it should do so. Nobody says this is a panacea – but it can make a contribution. The old barriers between the public and private sectors cannot be allowed to get in the way of improving care for NHS patients.

    That brings me to the fourth principle and the one that I really want to concentrate on today – securing greater flexibility between services and between staff. The old demarcations between staff and the old barriers between services need to go. This where you can make the biggest contribution to reforming our system of care.

    Indeed, your professions were modernising NHS services long before it became fashionable. Whether it is occupational therapists working in A&E to prevent inappropriate hospital admissions, or paramedics delivering clot-busting drugs to heart attack patients or physiotherapists running orthopaedic outpatient clinics – there is a huge effort going on throughout the NHS to maximise how we use the skills of clinical professionals to improve care for patients. These reforms are about liberating the commitment and know how of staff in order to transform the quality and speed of treatment for patients.

    And they are delivering results. I know that waiting times for therapists can be far too long but for example in Huntingdonshire the PCT has been testing a physio-direct service for patients so they can call and speak direct to a physiotherapist. After triaging by the physio less than one third of patients actually need to be seen but those who need treatment can have an appointment the same day. The patients get seen quickly. The physiotherapists save time. And the burden on family doctors is reduced.

    Now we need drive these sort of reforms – this local leadership and local innovation – still further – and we want to help you lead the process. For too long there has been a vicious cycle where the NHS has not been able to perform to its full potential because it has failed to support staff to perform to their full potential. It is simply absurd in my view that in some hospitals therapists can run outpatient clinics while in others they can not. Or that while some radiographers are able to prescribe painkillers others are unable to do so. Limiting the roles you play and the talents you have not only makes your professions and the medical profession the losers. The patient loses out too.

    So I can say that next month I will be bringing together leaders from your professions, from nursing and from medicine – and from NHS management too – to agree a programme of action to break down demarcations still further across the whole NHS. The programme will be underpinned by new training and career opportunities for staff. Within the next few weeks for example I expect the first generation of therapist consultants to be appointed in the NHS. Within two years there will be at least 250 of them working as equals alongside nurse consultants and medical consultants. I can also say today that the NHS Leadership Centre will be introducing next Spring a new programme to develop leadership skills for middle managers across all professional groups including AHPs. This is about breaking through the glass ceiling to put you as clinical leaders in positions of authority throughout the NHS.

    And there is one further leadership challenge I believe that you can help us meet: to break down the Berlin Wall that for too long has divided health from social care. Health and social services are two sides of the same coin. The one relies on the other. The patient relies on both.

    Inevitably the focus of public and media attention is on what happens in hospitals. And there is no doubt that we need to build hospital services up, not least to get waiting times down. But tackling waiting cannot be achieved by more investment in hospitals alone. It needs more investment in social services – alongside primary and community services – too.

    We need to stop thinking about the NHS as though it were only about hospitals and acute care. The health service is as much about the call to NHS Direct, about the child receiving speech and language therapy, the elderly person helped to keep mobile by the chiropodist as it is about the life-saving operation or the emergency service in the hospital.

    Indeed I believe we need a bigger drive to help more people to avoid going into hospital and provide more help for people to leave hospital. The taxpayer will benefit because hospital based treatment is often the most expensive form of care. And the patient benefits because it helps people – especially the old – maintain or regain their independence.

    Securing these changes requires more investment in social services. Again here we have made a start. Compared to the mid 1990s when the resources made available by the Government for social services were growing by only one tenth of 1% a year today the resources being made available are growing by more than 3% a year.

    Nonetheless social services are under real pressure and more investment still is needed. That is necessary not least to stabilise the care home market and to develop new rehabilitation, intermediate and home care services that can promote people’s independence. Here the evidence is that putting in resources delivers results. Last October I provided an extra £300 million to help councils reduce the number of patients whose discharge from hospital was being delayed. Even though delayed discharges are down compared with five years ago, about 6% of hospital beds were needlessly blocked. Since then the extra resources have helped free up 1,000 beds that would otherwise be occupied by people who are ready to move on from hospital.

    Sustained investment will be needed to maintain this progress. But there can be no question of simply pouring more money in. In social services as well as in the health service, extra investment is conditional on more reform. If more money is available for social services as well as for health services – as I believe there needs to be – there must be no more excuses for shuffling responsibility for people who are old, or disabled or mentally ill backwards and forwards between the two services. Joint working must become the norm for all and not just for some. The powers to pool budgets and to form Care Trusts so that health and social care functions are merged must be taken up. And we will need to explore new incentives to get health and social care working as one to end the decades-old culture of buck-passing and cost-shifting. Reform will mean giving patients what they need – one care system, not two.

    Here you can play a leading role. Many of you are already working across health and social care boundaries. In the way you work with your colleagues in social care you can develop a joint approach so that the user of the services can no longer distinguish between what is health and what is social. Use the opportunities of your role in the new PCTs to put in place a single process for assessing a person’s need, led by one professional rather than a multitude of agencies. And you can help develop new community-based services across the traditional divide that has separated the NHS, local government and private and voluntary sectors.

    Greater investment and radical reform – this is the path to better public services we are travelling together. It is sometimes difficult. There are competing claims for funding and dilemmas about priorities but resources and reforms are already bringing results. There is no easy route to better public services. No silver bullet which delivers improvement without it being paid for or without there being change.

    But there is I believe a real appetite across the public services – from the people running them, working in them, using them – for higher standards to accompany higher spending.

    Your role as health professionals – in leading change and improving services – is crucial to the success of our programme of investment and reform.

    Your contribution to patient care and recovery – in the community and in hospital – is central to the work of a modern health service.

    Your commitment to the NHS – to its values as well as its patients – is the rock on which a better health service is being built.

    Quite simply I believe that if we combine the right level of investment, with the right programme of reform, with the commitment of the healthcare professionals, we can continue to move the NHS along the road to recovery.