Tag: Speeches

  • Jeremy Hunt – 2014 Speech on Waiting Times

    jeremyhunt

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

    Introduction

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

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

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

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

    Progress over the last decade

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

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

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

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

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

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

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

    A tougher context

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

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

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

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

    Targets can be dangerous

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    An NHS about more than targets

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

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

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

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

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

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

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

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

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

    Conclusion

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

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

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

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

    Thank you.

  • Jeremy Hunt – 2014 Speech on Good Care

    jeremyhunt

    Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at Birmingham Children’s Hospital on 16 October 2014.

    Let me start by saying what an enormous pleasure it is to be here today at Birmingham Children’s Hospital. This hospital is rightly proud of its record on quality and safety and has led the way in bringing the safety agenda to paediatric care, not least with its work on improving patient handover and on developing a safety thermometer for children and young people.

    Indeed this hospital is powerful proof of the case I want to make today: that world class care is not just better for patients, it reduces costs for the NHS as well. And in doing so creates a virtuous circle where ever more resources can be invested in improving patient care rather than wasted on picking up the pieces when things go wrong.

    A turning point

    With huge financial constraints and the pressures of an ageing population, we are at a critical moment in the history of the NHS. So today I want to challenge head on those who say that the future will be about cost and not quality; who suggest that it is time to ‘move on’ from Francis and the lessons of Mid Staffs and want to focus on the ‘next thing’ – which they usually say is about money and nothing else.

    “The path to safer care is the same one as the path to lower cost”. Those words were spoken to me earlier this year by Dr Gary Kaplan of Virginia Mason Hospital in Seattle, recognised as one of the safest hospitals in the world.

    As a result of his hospital’s journey to safer care, which started with the tragic death of a patient in 2004, his costs for acute diagnoses are between 20 and 60% lower than his major competitors. Shorter hospital stays, more motivated and productive staff and lower litigation claims have led him to believe that hospitals could double their output on the same resources simply by eliminating the waste of resources associated with harming patients.

    Not just in the US, but here in the UK too where Salford Royal is recognised as a leader in patient safety and quality improvement. Chief Executive Sir David Dalton says the focus they have had on quality improvements has yielded productivity improvements of around £5m each year, which they continue to reinvest in frontline care.

    Across the hospital sector, the enormous progress made in recent years to prevent hospital acquired infections is showing how quality improvements save money. We have reduced C. diff infections by 45% and MRSA infections by 56% in the last four years, saving patients untold trauma but also an estimated £22.5 million in costs for the NHS.

    The extraordinary ‘Sign up to Safety’ campaign that David Dalton leads has so far signed up over 100 trusts, including this one, to help spread good practice – making it one of the biggest hospital safety initiatives in the world. Indeed the enthusiasm for ‘Sign up to Safety’ is a remarkable testament to the commitment of the NHS to learn the lessons of Mid Staffs.

    But my message today is that learning those lessons is not a one-off: it’s a permanent process of constant questioning and continual improvement in which the elimination of waste and the elimination of harm walk side by side as part of the same process.

    Variation and lost value

    Today the CQC are publishing their annual ‘State of Care’ report. Inevitably there will be media focus on examples where care is sub-standard. Indeed, shining a light on poor care is essential if we are to have the highest standards.

    But the biggest lesson from today’s report is not actually the existence of poor care – it is the unacceptable variation in care outcomes across the system. And it is my job as Health Secretary to ask why it is that similar levels of resourcing, similar values and similar numbers of committed staff can produce such differences in quality.

    My conclusion is that too many people still think that providing the best care is something you do only when you can afford it – and fail to appreciate that improving care is one of the best ways to control costs in financially challenged circumstances.

    Which is why the report published today by Frontier Economics is so revealing in its analysis of the cost of poor care.

    They estimate that it could be costing the NHS up to £2.5 billion every year.

    And they highlight some of the shocking costs of poor care – from the £1.3 billion spent every year on litigation costs, to the cost of not ‘getting it right first time’ in orthopaedic care – which Professor Tim Briggs’s excellent work shows could save between £200-300 million every year.

    These are large sums of money which the NHS is potentially wasting. But we should be careful not to anonymise their impact by sticking to large numbers. So today we publish further work to look at the cost of individual episodes of avoidable harm.

    A single fall in a hospital is a tragedy – potentially life threatening – for the patient affected. It also costs the NHS on average £1,200 because of the extra care needed and longer hospital stay.

    Likewise a hospital-acquired bedsore is very dangerous for a patient. But it is also dangerous for the NHS, costing on average £2,500. And we had 19,000 of them across the NHS in 2013 to 2014.

    Catheter-acquired urinary infections are unbelievably painful. They also cost the NHS £67 million in 2013 to 2014 – which could pay the salaries of 1,300 nurses.

    So I want every director of every hospital trust to understand the impact this harm is having not just on their patients, but also on their finances.

    And I want every nurse in the country to understand that if we work together to make the NHS the safest healthcare organisation in the world, we could potentially release resources for additional nurses, additional training, and additional time to care.

    So today a poster and leaflet will go out to all NHS hospitals to display this vital message to their staff.

    If you’re short of money, poor care is about the most wasteful and expensive thing you can do.

    Good care costs less.

    The right model of change

    But it is one thing to identify lost value, quite another to develop practical strategies to release it. So how do we reduce variation and improve safety?

    In the best of NHS traditions it would be very tempting to set up a new target. Or issue a new ministerial decree.

    But that would be a mistake.

    Because the culture change we need to achieve has to come from inside, not because hospitals are being forced from the outside. What Gary Kaplan called ‘institutional culture change’ is based on listening to and valuing doctors and nurses on the frontline – the people who know more than anyone else what is needed to improve care.

    So let’s take a moment to look at some of the traits shared by organisations that have excelled in improving patient care and eliminating waste.

    The aggregation of marginal gains

    The first trait is attention to detail.

    When I was Secretary of State responsible for the Olympics I had the privilege of meeting Sir Dave Brailsford when he was training the Team GB cyclists. One of those cyclists was actually called Jeremy Hunt so I was just a tiny bit disappointed that despite their extraordinary medal haul – the best in British cycling history – Jeremy Hunt didn’t pick up a gold.

    Sir Dave famously argues that the success he brought to Team GB cyclists was not about a new big bang approach, but what he called the ‘aggregation of marginal gains’. Paying close attention to the detail, to things which, on their own, seemed insignificant – but when added up mean the difference between winning and losing. At the Manchester Velodrome Chris Hoy told me about his first ever gold medal at the Copenhagen World Championships. He won by 0.001 of a second. His aggregated marginal gain set him on the path to being our greatest ever Olympian.

    This is really important because we should not think we can unlock £2.5 billion in one go with a new policy. But we will unlock it in hospitals with a new culture. And it’s a culture that really cares about the details, the little things, all of which add up to better care and less waste.

    Some of these gains will be in the form of money – in management jargon, ‘cash releasing’. But some will be in the form of increased value for patients and staff – freeing up resources in ways that lead to better patient care, greater staff motivation and long-term productivity gains. In high-performing organisations, these two things will go hand-in-hand.

    The right relationships

    Another trait in hospitals with world-class safety standards is proper collaboration between management and frontline staff. We have recently seen powerful evidence to support this from the joint work by the Academy of Medical Royal Colleges and the NHS Confederation. They explore what they call ‘Decisions of Value’ and conclude that good relationships between clinicians and managers is critical in securing value for patients.

    Their report shows that over half of clinicians do not believe they are involved in the financial decisions that affect their service or team. But how can you break the dangerous nexus between poor care and higher cost if the clinicians responsible for patient care have no input into the financial decisions that affect their work?

    Likewise we need to build better partnerships between commissioners and providers, not least in developing integrated care pathways that we know both improve care and eliminate waste.

    Openness and transparency

    What else characterises leading organisations? Along with a focus on detail and relationships, they have an obsession with openness and transparency based on high-quality data.

    Not far from here, patients at Queen Elizabeth Hospital can log onto ‘My Stay@QEHB’ which allows them to see how their specialty performs compared to hospital expectations.

    Transparency can also be about reaching out to patients and the public: it is fantastic that one of the first things you see on the Birmingham Children’s Hospital website is a section called ‘What’s it like here?’ that makes the strange world of hospital care more familiar for children.

    The best organisations crave data as a vital tool to drive improvement. We are blazing a trail with the new MyNHS website, which makes the NHS by far the most open and transparent healthcare system in the world. Now with detailed and easily accessible information on hospital, local authority and mental health performance, I am confident that this project will demonstrate that in the modern NHS the best way to improve performance is transparency not targets.

    The best example of the power of transparency has been the way the NHS has responded to the tragedy at Mid Staffs. I could have said as part of the government response that I intended to hire another 10,000 nurses – and it would have been a disaster. Not only would we have ended up with the wrong nurses in the wrong places, but the measure of success would have been meeting an input target, not improving care for patients.

    Instead we did something far more powerful.

    Firstly we asked every hospital in the country to collect and publish information from their patients on whether they would recommend the care they received to a friend or member of their family. Based on the net promoter principle, this was the first time anywhere in the world patient views had been sought comprehensively across an entire health economy.

    Then working with Chief Nursing Officer Jane Cummings we asked every hospital to publish the number of planned and actual nursing staff for every single ward. Finally, we made patient experience a central part of the new independent CQC inspection regime.

    And the result? Yes the NHS did hire 5,000 more hospital nurses to fill in critical gaps after Mid Staffs, often in elderly care wards. But more importantly a change in attitudes to the importance of quality of care – as opposed to simply quality of treatment – saw an 8% jump in just one year of the people who believed they were treated with compassionate care by the NHS. No target, no extra money, just transparency about performance.

    And in some cases improving on this has not required more staff at all. For example, there are some Trusts – including Portsmouth, Coventry and Royal Surrey – that are using an electronic physiological surveillance system to improve the monitoring of vital signs, with impressive early impact on patient mortality that has not required large increases in staffing.

    And consider the example of Guys and St Thomas’s where they have been looking at how redesigning basic processes and using technology can give nurses more time with their patients. With only a small increase in staffing of one extra nurse working on discharge and another at night, they were able to increase contact time with patients from 48% to 75% while also reducing length of stay. Hugely beneficial to patients, and better for staff too.

    Cost and quality: challenging assumptions

    These therefore are some of the traits of high-performing organisations.

    And underlying all of them is the shared assumption that cost and quality are not alternatives to be traded off, but different aspects of the same ambition to provide safe, effective care on a sustainable basis. This directly challenges the conventional wisdom that ‘you get what you pay for’ – as does the CQC’s ‘State of Care’ report which shows massive variation despite similar input costs.

    It also challenges the received wisdom that there is little value left to get out of the system now that the so-called ‘low hanging fruit’ has been plucked.

    And it challenges the other commonly held view that only large-scale change will release significant value. Of course we will need to continue to make important changes to care pathways – but as we do that we need to support trusts in making the small improvements that, when aggregated, will make a big difference.

    Conclusion

    I hope therefore that from today in hospital board meetings up and down the country one simple change happens: patient experience and patient safety are not discussed separately to finances – but as two sides of the same coin. Wouldn’t it be fantastic if a hospital board was as focused on its ‘safety improvement plan’ as its ‘cost improvement plan’, and saw them both as part of the same objective of doing a better job for patients.

    I am proud of the additional investment this government has provided and will continue to provide to the NHS. Nobody would pretend that the financial sustainability of the NHS will be ensured by improving safety alone. But it has a critical contribution to make.

    The path to lower cost is the same as the path to safer care.

    Hospitals that embrace one embrace the other too.

    Hospital safety and hospital finances both improving and patients as the winner.

  • Jeremy Hunt – 2014 Speech on the Better Care Fund

    jeremyhunt

    Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at the National Children and Adult Services Conference on 30 October 2014.

    Let me start with a thank you.

    All of you have been talking about delivering integrated, joined-up care for a very long time and I know sometimes it has felt like banging your head against a brick wall. And now it is happening, for real. Instead of people just talking about it, you are actually delivering it. And without your vision, your determination, and your passion to do better for some of our most vulnerable citizens it wouldn’t be happening.

    I am also pleased to be saying these words in Manchester which has been at the forefront of joining up health and social care and proved beyond doubt that integrated care, driven not from Whitehall but by local enterprise and initiative, can support the transfer of hospital services to out-of-hospital settings by truly focussing on the needs of patients and service-users.

    And the fact that this kind of project is not peripheral but now central to the change we want to see in our NHS and social care system was demonstrated last week with NHS England’s visionary Five Year Forward View. It talked about inspiring new models of out-of-hospital care, exactly the change that people here have been arguing for. That plan and your ambition is completely consistent with the government’s own view about the future of health and social care.

    We all agree that change needs to happen. But to work it has to be locally led, tailored to local needs and designed by those who know those needs best. So the role for government is clear: no grand blueprints, no structural shake-ups, no one-size-fits all. But our role will be to enable, champion – and yes fund – your endeavor.

    So I want today, as my first response to the NHS England Five Year Forward View, to outline the four pillars of our plan to prepare the NHS and social care system for the challenges of an ageing population. And as social service directors your role will be absolutely central to every element of that plan.

    Funding backed by a strong economy

    The first pillar of our plan concerns funding. A strong NHS and social care system needs a strong economy to support it. The last four years have been the most challenging ever for both the NHS and social care system – and they started because of an economic crisis. It is in all of our interests to make sure the economy continues to grow, create jobs and generate the tax revenues that allow sustained ongoing financial support for health and social care. In Portugal, Spain and Greece we have seen services cut as the price of economic failure – and we don’t want that to happen here.

    And when we did have to tackle the deficit, we prioritised the NHS by protecting its budget – which meant tougher settlements for other departments including local government. But the interconnected relationship between the services we both offer to vulnerable people means that we in the NHS have a responsibility – as we move to fully integrated services – to help you deal with a tough financial settlement. If we operate in financial silos the costs will be higher for both of us – hence there is no sustainable NHS without the tremendous strategic importance of the Better Care Fund which we are celebrating today.

    Transformed out-of-hospital care

    But it isn’t just about money: it’s also about the way we deliver care.

    The NHS was set up in 1948 in a very different world. The model was essentially if you were a little bit ill you went to your GP; if you were very ill you went to hospital. You were then patched up and sent home.

    With an ageing population our challenges are profoundly different. By the time of the election we will have nearly one million more over 65s than at the start of the last parliament. Within the next two years, we will have three million people with three or more long term conditions. A few years after that we’ll have one million people with dementia. And a few years after that – by 2030 – the number of over 80s will double to 5 million people, 10% of the entire population.

    Older people with complex conditions need a different type of care, one that is usually best delivered out of hospital settings. They’ll be frequent users of the health and social care system so they need one person taking responsibility for their healthcare. And they need to know that wherever they go they will be dealing with someone who knows about them and their family, knows their medication history, and knows about their other interactions in the system.

    So if getting a strong economy is the first pillar of our plans for the NHS and social care system, getting this new model of care right for an ageing population is the second.

    Better Care Fund

    And on that front I am pleased to report today some remarkable progress with the Better Care Fund, which for the first time anywhere in the world is integrating health and social care across an entire health economy.

    Building on the excellent work by Norman Lamb on the Integration Pioneers that many of you were involved in, local authorities and local NHS commissioners have joined together and painstakingly planned commissioning for adult health and social care with pooled budgets. Budgets from the local authority side are for the first time helping to reduce emergency hospital admissions and budgets from the NHS side are for the first time helping to reduce permanent admissions to care homes.

    I want to thank my colleague Eric Pickles for making this happen, and thank the Better Care Fund Team and Andrew Ridley.

    Sceptics said this wouldn’t happen. Critics said there wasn’t the appetite among local councils or the NHS. The papers criticised it and opposition politicians called for it to be halted and when they were proved wrong said it didn’t do enough.

    Well they were all wrong. Because today I am delighted to announce the total amount of pooled budget for next year is even higher than the government’s original £3.8 billion. It has risen to a staggering £5.3 bn.

    I can announce that 97% of the 151 plans have been approved.

    And that as a result of these plans NHS England estimate that the Better Care Fund will be supporting at least 18,000 individuals in new roles delivering care in the community. This will be a range of social workers, occupational therapists, care navigators, doctors and nurses, deployed based on local needs and delivering outside hospitals care to some of our most vulnerable citizens.

    Taken together, these plans will mean savings [to the NHS] of £500m in the first year alone. More importantly in terms of patient care, they will mean 163,000 fewer hospital stays or 447 fewer hospital admissions every single day; and 100,000 fewer unnecessary days spent in hospital in total through organising better delayed discharges

    This is a great start and everyone here should feel very proud. But based on the same principles that we’ve learnt in the last year I want to ask why should we not go further?

    Accountable care organisations

    For me GPs, whose services are commissioned by NHS England, sit at the heart of NHS community care. We need them to be part of this change too. So this year, for the first time, CCGs have been offered for the chance not just to commission social care jointly with local authority colleagues, but also co-commission primary care with NHS England. I hope the result will be in many areas a single integrated approach to commissioning all out of hospital care, whether through community care, GP practices or social care, often using personal budgets to integrate care even better around the person.

    I think we can go even further than that.

    Should we not adopt the same partnership approach we have so successfully pioneered with the Better Care Fund for public health responsibilities as well? You have made a great start with your new public health responsibilities – alcohol recovery rates up, smoking down, teenage pregnancy down and health checks at an all time high. It would surely make more sense for local authorities to plan their smoking, alcohol, drugs and obesity strategies alongside NHS colleagues who have a direct financial interest in making them successful. In doing this we can turn CCGs, working alongside local government colleagues in accountable care organisations, responsible for commissioning end-to-end integrated care for their entire populations – including both care closer to home and proactive prevention programmes.

    And in the same vein, should we not also consider joint commissioning of children’s services, building on our review of Children and Adolescent Mental Health services? That review highlighted the importance of different organisations working together – so as we move to integrated care we should consider what the benefits could be for this very important patient group.

    Innovation

    A strong economy and integrated community care are the first two pillars of our plan. The third pillar involves being much better at embracing innovation and efficiency.

    The technology revolution means that now half of us bank online, nearly two thirds of us have a smart phone and three quarters of us access the internet every day. Yet still in the NHS we employ people whose main job is to input the contents of faxes from hospitals onto electronic health records in GP surgeries.

    IT investment has had a chequered history in the NHS but in the last two years we have made some good progress. By the end of this year a third of A & E departments will be able to access summary care records, as will one third of 111 call centres and one third of ambulance services. This will then be rolled out to everyone.

    I know electronic record sharing is a key part of the Better Care programme you have been working on – so let me give you one example of where I think it could make a huge difference. Shouldn’t residential care homes be able, with a patient’s consent, to update someone’s condition onto their GP record on a daily basis? We’ve introduced named GPs for all over 75s this year, rolling out to everyone next year. But we could make this much more meaningful if the responsible GP was able to check on someone’s condition on a daily basis just by looking at their record on a computer.

    Cost tracking

    But innovation is not just about electronic medical records.

    One of the most common criticisms of the NHS is that it is a slow adopter of technology, even when adopting such technology earlier would save overall costs. This tends to be because we look at costs in financial silos so people are reluctant to invest in costs upstream that benefit another part of the system downstream.

    We therefore need CCGs and local authorities to collect full real time total NHS and social care cost information by patient and service-user. Only when we can see that will commissioners invest properly in the preventative innovations that both improve health and contain cost.

    Culture change

    Innovation and efficiency is the third pillar of our plan. And then final pillar is the most difficult of all, because it is not financial, it’s not operational it’s cultural.

    We need to change the culture of a system that has too often failed to put patients at the heart of its priorities.

    Almost two years ago, after less than two months as Health Secretary, I made one of my most difficult speeches I’ve ever made when – in the wake of Mid Staffs – I talked about the normalisation of cruelty in the NHS. And we have sadly also seen at Winterbourne View the criminal abuse of vulnerable adults.

    Since that time, thanks to the huge efforts of people across the health and care system, we have made great strides in improving quality and safety in hospitals. We have 5,000 more nurses in our hospitals, every patient being asked whether they would recommend the care they receive to friends or a member of their family and with the new Chief Inspectors of Hospitals, General Practice and Adult Social Care we probably have the most robust independent inspection regime of anywhere in the world. And we are doing more as well to help adults and older people live independently, with the appropriate support, rather than in residential care.

    And these things are all important – but unless the culture changes as well they will be for nothing.

    And the heart of the problem is that for too long in the NHS, perhaps less true in the social care system, but in the NHS we have relied on top-down targets as the main way to raise standards. Whilst there will always be a role for some targets in any large organisation, the danger with too many targets people focus their energy away from the vulnerable person sitting right in front of them – as we saw at Mid Staffs with tragic consequences.

    We need to recognise that transparency of outcomes and peer review is a far more powerful way to improve care than yet more targets.

    Transparency of outcomes was pioneered by Bruce Keogh and our heart surgeons a decade ago: since they had the courage to assemble and publish, surgeon by surgeon, mortality rates we have moved from having some of the highest heart surgery mortality rates in Europe to some of the lowest.

    The MyNHS website now displays comparative performance by hospitals and local authorities on a wide range of indicators, from food to efficiency to safety and public health. I want this to be the engine that turns our NHS and social care systems into truly learning organisations.

    And as part of that cultural change we need to see, which is to make sure the primary accountability of doctors and nurses is not to system goals but to the patient standing in front of them.

    From next year every NHS patient will have a GP who is personally responsible for their care, with the GP’s name at the top of their electronic health record. Named, accountable doctors so that both patient and NHS know where the buck stops. And GPs supported to discharge that responsibility with more capacity in primary care, whether through additional GPs, practice nurses, district nurses or administrative support.

    Conclusion

    So I wanted to spend some time explaining the four pillars of our plan to transform our health and social care systems over the next parliament: increased funding backed by a strong economy; integrated, joined up out of hospital care; innovation and efficiency; and a culture where patients and service users always come first.

    If it sounds ambitious, I think it is.

    But we have a few trump cards to play.

    A social care system that has succeeded in weathering perhaps the toughest financial challenge in its history.

    We have an NHS that was rated this year by the independent Commonwealth Fund as the top-performing healthcare system in the world – ahead of America, ahead of France, ahead of Germany, ahead of France, ahead of Spain.

    The commitment and values of not just NHS staff, but also colleagues in the social care system who have given their lives to the most noble cause of all, giving dignity and respect for our most vulnerable and disadvantaged citizens.

    And we have a growing economy. But the litmus test for us as society is what we do with the fruits of economic success.

    Today shows that with hard work, imagination and commitment we can pass that litmus test and rise to the challenge of an ageing population by making Britain the best country in the world to grow old in.

    There’s a long way to go, but today the journey has started.

  • Jeremy Hunt – 2014 Speech to King’s Fund

    jeremyhunt

    Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, to the King’s Fund in London on 13 November 2014.

    Introduction

    Here at the King’s Fund, in November 2012, I made the most important and difficult speech I’ve made as Health Secretary.

    It was in the run up to the publication of the Francis report.When I described the problems at Mid Staffs and across the NHS I used words never used by a Health Secretary before – I spoke of the ‘normalisation of cruelty.’

    But rising to the challenge of Francis has not been the only thing the NHS has had to cope with.

    We’ve also had the deepest recession since the second world war with unprecedented austerity. At the same time an ageing population has given us nearly one million more over 65s than at the time of the last election.

    This triple whammy has created perhaps the toughest financial climate for the health and social care system in its history.

    Four pillars

    Big challenges. Which call for big solutions.

    Solutions that involve us all, owned not just by politicians and NHS leaders, but by doctors and nurses on the frontline.

    Solutions that improve care and reduce cost at the same time – better care for patients and better value for the taxpayer.

    And solutions that are sustainable because they go with and not against the grain of core NHS values.

    So today I want to outline the four pillars of the government’s plan for the NHS – and how we intend to make a reality of the NHS England

    Five Year Forward View

    And I will be brave: by saying I am increasingly optimistic that working together we can build a historic new compact across the NHS which not only achieves the Forward View’s £22 billion of efficiency savings but also delivers higher quality and safer care to an ageing and increasingly demanding population.

    So what are the four pillars of our plan?

    Firstly to recognise that a strong NHS needs a strong economy.   This is not a political point but economic reality. Much of the current pressure was caused by an economic crisis. The way to relieve that pressure is both to end the crisis and to make sure it is never repeated. As the Forward View makes clear, the only way to grow the £113 billion NHS annual budget is to make sure we have an economy generating the tax revenue to finance it.

    The second pillar is something you have championed for many years at the King’s Fund: the need for integrated care closer to home as the heart of our response to an ageing population.

    Within the next 2 decades the number of over 80s will double to over 5 million. The care they need is different: proactive, out of hospital care focused on prevention and management of illness – rather than a narrow focus on emergency care when it is too late.   So in the last year we have been taking important steps: a proactive care programme which commits GPs to additional care for their most vulnerable patients; named GPs personally responsible for the care of individual patients, starting with over 75s this year and rolling out to everyone next year; and two weeks ago the £5 billion integration of health and social care through the Better Care Fund. 151 local plans to improve out of hospital care including sharing medical records, jointly commissioning social care and jointly working to reduce emergency hospital admissions.

    The third pillar of our plan, is something I want to spend some time on today. How do harness innovation and value for money to improve care and make the Forward View’s £22 billion of savings?

    Innovation

    Innovation is not alien to the NHS.

    It has had more “world firsts” since its creation in 1948 than any other publicly funded health system, including the first baby born by IVF in 1978 at Oldham General; the first ever heart, lung and liver transplant at Papworth in 1987; and the link between lung cancer and smoking, discovered at NHS hospitals by Sir Richard Doll in the 1950s.

    But scientific innovation has not been matched by process innovation. We have not built a system that is good at adopting and rapidly diffusing new ways of doing things. Given that much innovation saves money as well as lives, we need to change the NHS from a lumberingly slow adopter of new technology to a world class showcase of what innovation can achieve.

    Today I am taking an important step towards making that change.

    Alongside colleagues across the health and care system on the National Information Board, I am setting out a plan to achieve personalised, 21st century healthcare for the whole NHS. We will not do this through bureaucratic top down initiatives but by encouraging and diffusing local clinical innovation. And harnessing the most powerful driving force for innovation we have: the power of individual citizens who care about their own health.

    From next spring you will have online access to a summary of your own GP record, and access to the full coded medical records by 2018. By 2018, as well as access, you will be able to record your own comments. This means everyone will be able to create and manage their own personal care record.   From next April you will be able to book GP appointments online and order repeat prescriptions without having to go into your local surgery.

    By 2018 a paperless NHS will ensure you only have to tell your story once: if you consent, your electronic care record will be available securely across most of the health system, and by 2020 across the whole of the health and care system, so that, when you need care, different health professionals have instant access to the information they need. This has already started with one third of A & E departments now able to access GP records and one third of ambulance services able to do so by the end of this year.

    From next 2016 NHS England have said you will also have access to trusted NHS health ‘apps’ and social networks – so that you can monitor your own health, or join a virtual community of friends, family or other patients who can support you.

    Personalisation and prevention

    We know in other sectors technology has made personalised service economic to deliver – whether it is home banking, on-demand TV or personalised Christmas cards.

    But in healthcare that is only the tip of the iceberg.

    More personalised, responsive and joined-up care becomes possible with shared electronic health records.

    But in healthcare, technology also unlocks personalised cures for illnesses. We know that diseases like cancer and dementia are not single diseases, but infinitely complex variations on a theme. We also know that it is often not economic – under current models – to develop cures for rarer diseases like pancreatic cancer or infantile epilepsy.   And that is why this government has committed to make the UK the first country to sequence and make research-ready 100,000 whole genomes. We want the NHS to spearhead a global revolution in personalised medicine based on individual genetic characteristics.

    But in healthcare it is not just personalised care and personalised cures that technology unlocks. It is also a revolution in prevention.

    If you are a vulnerable older person being cared for by Airedale Hospital in Yorkshire, you may well be given a big red button. This sits on your armchair and to use it, there is only one thing you need to do: and that is to make sure your TV is switched on. Then if you press the button – anytime, day or night, a nurse will appear on your TV screen to ask how you are.

    Incredibly simple – but incredibly effective at reducing emergency admissions by making good care accessible from inside your own home. Airedale estimates a 14% reduction in such admissions for these patients – while NHS Gloucestershire, where I was yesterday, estimate they have reduced the cost of emergency admissions by 35% for patients with long-term conditions using a similar remote monitoring system.

    And this is not just about the frail elderly. Google and Novartis are collaborating on a new contact lens to help people with diabetes monitor their blood sugar levels through analysing tears.

    7 million people now wear devices or use apps to monitor their own health. My own FitBit One says that today I have done 8553 of my 10,000 daily steps. In the US Kaiser Permanente are looking to integrate pedometer data into electronic health records to give physicians a better understanding of people’s prevention regimes.

    Too often, though, the NHS has lagged behind other countries in offering access to these kinds of products even though the NHS itself is the winner if costs are contained by preventing illness. This will not change until healthcare is commissioned holistically, so that the budget holder who pays for innovative prevention sees the financial benefits that accrue as a result.

    So today I can announce that as part of a step towards becoming accountable care organisations, all CCGs will be asked by NHS England – with support from HSCIC – to collect and analyse expenditure on a per-patient basis.

    CCGs will then, as co-commissioners of primary and specialist care with NHS England, and co-commissioners of social care and potentially public health with local authorities, be able to pinpoint more clearly where there is the greatest potential to improve patient outcomes by reducing avoidable costs through more innovative use of preventative measures.

    Protection

    But alongside personalisation and prevention, there is a third “p” that is vital if we are to embrace innovation – and that is the protection, protection of personal medical data. If we lose the confidence of the public that their data is safe none of this will be possible.

    So we need to be as robust in protecting personal data as we are ambitious to reap the benefits of sharing it.

    This year’s Care Act put in place a number of measures, controls and independent oversight of the use of personal data. New data security requirements will be published by October 2015 and mandatory for all providers of NHS care.

    But today I am going further.

    Just as we now have a Chief Inspector of Hospitals to speak without fear or favour about standards of care, I am today announcing the establishing of a new National Data Guardian to be the patient’s champion when it comes to the security of personal medical information.

    I am delighted that Dame Fiona Caldicott, who has done so much outstanding work in this area, has agreed to be the first National Data Guardian for health and care. She has agreed that it will be her responsibility to raise concerns publicly about improper data use. And organisations that fail to act on her recommendations will face sanctions, either through the ICO or the CQC, including potentially both fines and the removal of the right to use shared personal data.

    I have already asked Dame Fiona to provide independent advice to me on care.data. No data will be extracted from GP practice systems – including during the ‘pathfinder’ pilot phase of the programme – until she has advised me that she is satisfied with the programme’s proposals and safeguards.

    I intend to put the National Data Guardian on a legal footing at the earliest opportunity, but even before that the CQC and the ICO have committed to pay special attention to her recommendations, including sanctioning organisations where they find breaches, that do not comply with Dame Fiona’s recommendations, even before any new legislation is passed, so patients will benefit immediately from a much tougher and more transparent regime.

    Reaching the £22 billion

    A more personalised service that helps people stay healthier is not just what people want: it also reduces cost.

    The banks have persuaded more than half of us to bank online. And in doing so cut their own costs by an impressive 20%. By embracing the lower costs of virtual shopping, websites such as Amazon deliver products more conveniently but also more cheaply too. Skype is not just handy – it means international calls are free. Higher quality and reduced cost at the same time.

    And likewise this has happened in healthcare, where the Veterans Association estimates that a fully integrated, digital system including accessible electronic health records, remote monitoring, and online consultations has saved $3 billion over 6 years.   It is, now difficult, of course, to predict exactly what the savings might be for the NHS – but to give you one example, if better care at home reduced the cost of emergency admissions by 30%, we could save £5 billion by 2020. A one year delay in the onset of dementia would save £1.5 billion. Money that can be reinvested in more frontline staff and more preventative care, creating a win-win for patients and staff alike.

    The Forward View £22 billion savings challenge

    But there is also a lose-lose which we are grappling with now.

    Because every pound wracked up in deficits is a pound taken away from patient care, which is why maintaining financial balance is vital. But true financial sustainability means rethinking how we spend money not just day-to-day but more fundamentally. Just as in 2009 Sir David Nicholson set up the Nicholson Challenge to save £20 bn this parliament – something that has largely been delivered – so the Forward View sets up a £22 billion challenge for the next parliament.

    The challenge may be similar but the way we deliver it will change. As the Forward View makes clear, long-term pay freezes are unlikely to be viable if the NHS is to retain the staff it needs. But as before we will need a combination of national and local initiatives, so today I want to outline 10 savings challenges we can help NHS organisations deliver, challenges which between them could save between £7 billion and £10 billion by 2020.

    The first challenge is safer care. Last month, at Birmingham Children’s Hospital, I spoke about the huge cost that is placed onto the NHS by poor quality and unsafe care. A single avoidable fall costs the NHS £1200 because of the longer hospital stay it causes; but we also know avoidable bedsores cost the NHS £50m and orthopaedic surgery infections cost between £2-3m every year. A report by Frontier Economics, bringing together the available evidence, suggested that the total cost of preventable harm in the NHS may be between £1 and £2.5 billion.

    One of the areas identified by the Frontier report forms the second challenge: ensuring the safe, effective and optimal use of medicines. Last week, the Academy of Royal Medical Colleges estimated that adverse drug reactions resulted in costs of £466 million through additional bed days. This may be the result of prescribing errors. Or clinicians may not know that a patient has an allergy. And some patients, particularly those taking multiple medicines, may find it difficult to take the right doses at the right times. The report argued a further £85 million of savings could be found by prescribing lower cost statins, without impacting on patient care.

    So poor use of medicines is connected to the third challenge: the £300 million of waste each year in primary care from unused drugs, half of which could be avoided according to a study by the University of York and the School of Pharmacy. We have already started to help systems tackle these issues through the roll out of e-prescribing systems using the Safer Hospitals, Safer Wards fund, and through more one-to-one pharmacist consultations as part of the New Medicines Service. But there is much more to do to support patients and clinicians to get the best outcomes from medicines.

    The fourth challenge is procurement. The NHS spends almost £15 billion each year on medical equipment, devices, office supplies and facilities. Prices for surgical gloves vary from £2.43 to £5.44 across the NHS, and the NAO found variation of up to 183% in the prices paid by Trusts for the 100 most commonly ordered products. So we have established the Procurement Efficiency Programme, led by Lord Carter, which aims to deliver savings of at least £1.5 billion from the NHS procurement budget from next year. Mid Cheshire Foundation Trust made savings of 9% on their orthopaedic wards and reduced clinical time spent on stock management by 74% by embracing modern procurement and stock control principles, and I am confident we can make similar changes across the NHS by collecting and sharing data, getting a grip on stocks and supplies, and helping providers with central frameworks and core lists to purchase common products.

    My fifth challenge is agency staffing. Agency staff can be an essential way to fill difficult gaps quickly and to ensure that services continue to be delivered. But we know that a Band 5 agency nurse can cost three times more than a permanent member of staff. And data from University Hospitals Birmingham suggests that high use of temporary staffing can be a sign of poorer quality care, something that Professor Sir Mike Richards has also noted during his inspections. The amount being spent by trusts on agency fees has gone beyond a sensible response to new staffing levels required by Francis and become an unacceptable waste of money.

    So we are supporting Trusts by publishing a new toolkit to help reduce spend on agency staff. And we will bring down these costs further by working with providers to improve their processes and challenge agencies that are ripping off the NHS and the taxpayer. We know it is possible – Taunton and Somerset Foundation Trust, for example, saved £2.5 million by introducing clear rules for hiring agency staff and using electronic rostering.

    The sixth challenge is on surplus land and estates. In many areas of the country the NHS owns buildings and land that it no longer requires, as care is increasingly delivered in the community or in people’s homes. There is huge potential for that land to be used for better NHS primary care facilities or indeed housing and schools – whilst at the same time, reducing NHS overheads and generating cash for reinvestment in NHS services. The London Health Commission estimated that the total value of surplus estate in the capital alone was worth £1.5 billion.

    The seventh challenge is to ensure that visitors and migrants pay a fair contribution to our NHS. Government and the NHS need to ensure that, where people need to pay for their care, every effort is made to recover the charges. Independent research from Prederi suggests that up to £500 million can be recovered from visitors and temporary migrants accessing NHS services. That would be enough to pay the salaries of almost 10,000 nurses. To do this we are providing financial incentives to trusts to promote the identification of people who should be paying for their healthcare. Identification will also be made simpler through details listed in healthcare records of visitors and migrants.

    The eighth challenge is back office costs. The health system is on track to reduce its administration costs by one third over the course of this Parliament, which will save £1.5 billion – and we are committed to save a further £300 million in next year including through shared services and bearing down on estates costs in the department and its agencies. All of these savings go back to supporting frontline care. But it is vital that the NHS continues to look at how it can reduce back office costs in order to support better patient care and these could produce an around £0.5 billion of savings.

    The ninth challenge is to come up with more solutions ourselves by reducing the £500 million plus we spend a year on management consultants. We have the ideas and people inside our NHS to deliver the change we need. It is our doctors, nurses, healthcare assistants and managers who will create a sustainable NHS but we won’t grip this if we try to subcontract the challenge of working out the solution. The final challenge is a personal priority of mine: making better use of IT to free up time for frontline staff. A study by the Health and Social Care Information Centre found that 66% of a junior clinician’s time is spent finding, accessing and updating patient notes – compared to just 24% on patient contact. Electronic records systems could make a real difference in freeing up time to care for patients. And that is why I want all clinicians in primary, urgent and emergency care to be operating without the use of paper records by 2018.

    Taken together these changes could save a significant part of the Forward View’s £22 billion – and combined with local innovation we can surely find the rest. But some of them are not new – so why am I optimistic we can deliver them this time round?   Because I think the Department of Health has learned that simply coming up with an initiative and hoping to “roll it out” from the centre is rarely successful. These challenges will only be achieved if we construct and implement them with the full support of NHS organisations and their frontline staff.

    So I want to do something different this time.

    I want to build on the consensus around the Forward View to develop a compact around both the amount and the way we embrace innovation and efficiency to deliver the savings needed. A compact between the bodies leading the NHS and NHS organisations themselves. And a compact that goes on to be translated at a local level to agreements between Trusts and their own staff as to how we are going to improve both care and efficiency at the same time.

    Fourth pillar

    So that’s the third pillar is a compact to deliver real change in the way the NHS embraces innovation and efficiency.

    But there is a fourth pillar, perhaps the most difficult and important of all. And that is to make sure we get the culture inside the NHS absolutely right. We can make the investments, find the efficiencies, we can even invent new cures – but if those changes are delivered without the right culture of safe, compassionate care they count for little.

    I will return to this on another occasion, but let me leave you with a thought about the two biggest areas of culture we still need to improve. First of all safety: why in healthcare is it somehow acceptable that one in twenty deaths are avoidable? In the NHS in England that is 1000 avoidable deaths every single month. I want us to be the first country in the world that aims to eliminate avoidable deaths in healthcare with the same standards of safety they have in the airline, nuclear or oil industries.

    And we will do that by nurturing a new culture in which the main driver of performance improvement is not endless new targets, but a culture of openness, transparency and continual improvement through peer-review.

    And the second area we need to think about is accountability. Still too often in the NHS it is hard for patients to see where the buck stops. Whether it is frail elderly with complex conditions, adolescents with severe mental health trauma, inside hospital or outside we still have a system where corporate goals trump responsibility for individual patients. Patients will never be at the heart of our system until we have professionals truly accountable for making that happen patient by patient, person by person.

    Conclusion

    So ladies and gentleman it has been a longer speech than normal, even for a politician.

    But I wanted, in the wake of the Forward View, to put some flesh on the bone with respect to the government’s response and the plan we want to work with you on for delivering for the NHS.

    I’d like to finish then on a note of optimism: we are not alone as a country in facing these challenges. But if we implement the plan I have outlined this afternoon, we will be the first country in the world to do so across an entire health economy.

    A properly funded healthcare system backed by a strong economy.

    New models of care appropriate for an ageing population with the safe sharing of data.

    Innovation and efficiency that both saves money and puts patients in the driving seat for their own healthcare.

    And a culture of safe, compassionate care where patients always come first.

    And an NHS that turns heads across the world as it blazes a trail for 21st century healthcare.

    Thank you very much.

  • Jeremy Hunt – 2015 Speech on GPs

    jeremyhunt

    Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at the Nelson Medical Practice in London on 19 June 2015.

    When the NHS was set up nearly 70 years ago Bevan recognised that General Practice was special. Despite much opposition he put your independent contractor status at the heart of the NHS, as leaders of the NHS.

    And with good reason. Internationally, our primary care system has long been respected and envied. Much of the primary care delivered all over the world today is made in Britain: blood pressure measurement, lung function measurements for asthma, the identification of hay fever or the role of vitamins in nutrition. Today we rank in the top third of countries for primary care doctors per patient.

    Even more importantly we get top scores for quality as well. The Commonwealth Fund ranks all major countries on their health systems and it’s well known that the UK came top overall last year. Less well-known is that when you dig deeper the areas where the UK amassed many of its marks were on the quality of general practice.

    We rank:

    • best in the world for having a regular doctor who co-ordinates care
    • best in the world for patients knowing who to contact with questions about their condition or treatment
    • best in the world for the management of chronic care

    In other words a respected, independent US thinktank has made it official: general practice is the jewel in the crown of our NHS.

    A jewel we are proud of.

    But more importantly a jewel we need to shine brightly because, as I will argue today, the strategic importance of general practice to the NHS cannot be overstated.

    Within 5 years we will be looking after a million more over 70s. The number of people with 3 or more long term conditions is set to increase by 50% to nearly 3 million by 2018. By 2020 nearly 100,000 more people will need to be cared for at home.

    Put simply, if we do not find better, smarter ways to help our growing elderly population remain healthy and independent our hospitals will be overwhelmed – which is why we need effective, strong and expanding general practice more than ever before in the history of the NHS.

    The jewel in the crown?

    But the jewel in the crown of the NHS is feeling decidedly unresplendent right now.

    The uncomfortable truth is that even though 90% of all NHS contact takes place via GP consultations, successive governments have undervalued, underinvested and undermined the vital role it has to play. Reforms, always well-intentioned at the time, have often had perverse and unintended consequences.

    The 1990 contract imposition introduced more accountability but also started a process that felt to many like de-professionalisation. The 2004 GP contract was meant to increase the focus on prevention, but undermined the personal relationship with patients by scrapping named GPs. The Quality Outcomes Framework (QOF) was meant to provide a better focus on outcomes, but has too often ended up as a tick-box process. All of which suggests Ronald Reagan had a point when he said, “Governments tend not to solve problems, only to re-arrange them.”

    The result has been a profession where many GPs feel overwhelmed by demand and undervalued by the system, unable to give the comprehensive care they want to, and trapped on a daily hamster wheel of 10 minute appointments that lead inexorably to burnout, early retirement and unfilled vacancies.

    That is why a month after the general election I am keeping my pledge to announce the first steps in a new deal for general practice.

    Now deals have 2 parties, so I want to be upfront: this is not about change I can deliver on my own. If we are to have a new deal I will need your co-operation and support – both in improving the quality and continuity of care for vulnerable patients and delivering better access, 7 days a week, for everyone.

    A new deal on workforce

    How we achieve this is complex, and I do not pretend to have all the answers today. But I want to waste no time in making a start with some important elements.

    Firstly and most urgently we need to deal with concerns about the primary care workforce.

    Since 2010 the GP workforce has increased by 5% with an additional 1,700 GPs working or in training. But at the same time, because of an ageing population and changing consumer expectations, we have seen a massive increase in demand for GP appointments.

    As a result, we are delivering an estimated 45 million more appointments every year compared to 5 years ago, but even this has not kept pace with demand. The number of people unable to get an appointment has been rising and public satisfaction with access to GPs is falling. People are simply finding it too hard to see their GP and GPs are finding it harder to give the kind of personal care that is the hallmark of their profession.

    So at the election we committed to the challenging objective of increasing the primary and community care workforce by at least 10,000, including an estimated 5,000 more doctors working in general practice, as well as more practice nurses, district nurses, physicians’ associates and pharmacists. This will be informed by the important work Professor Martin Roland is doing on workforce mix for Health Education England.

    The national picture is not uniform, with wide variations from surgery to surgery in the number of GPs available per thousand of population. Even in my own parliamentary constituency, the availability varies between 0.32 and 1.32 GPs per thousand patients of population even with surgeries only a few miles apart.

    We therefore need to focus our recruitment on the most under-doctored areas where the problems are most acute.

    So today NHS England is publishing data about clinical staffing levels for every practice in the country. This is not a table of staffing needs, which will vary according to demographic and socio-economic profile. But it does indicate that even in areas with similar profiles the variation is unacceptably large.

    Tackling this problem will be challenging, but I intend to leave no stone unturned. Quite simply, at every stage of a doctor’s career we must do more to promote the attractiveness of general practice.

    First we need to transform the experience which medical students have of general practice. We are changing the focus of medical training so that time spent in primary care is not only compulsory but also a better experience. As part of this, a new pre-GP scheme has been launched by Health Education England which, in its first year, had a success rate of 82%.

    Secondly, we need to increase and fill our GP training places. They are going up from 2,600 to 3,250 annually and we are working with the Royal College of General Practitioners (RCGP) on a national marketing campaign to encourage medical students to choose general practice. This points out that general practice is likely to be the biggest growth area of the NHS in coming years with some of the most exciting transformations in care. This campaign started this year with an encouraging 300 more applicants attracted into recruitment as a result.

    Next, by working with the profession we will improve routes back to general practice for experienced doctors. An induction and ‘returner’ scheme for those returning to the profession from overseas or from a career break has been refreshed and now includes support with the cost of returning to general practice. Over 50 GPs have already taken up this offer.

    We will also explore with the BMA and RCGP new flexibilities to retain those precious GPs who are nearing retirement but may want to work part-time as they too have a critical role to play.

    Innovation in the workforce skill mix will be vital too in order to make sure GPs are supported in their work by other practitioners. I have already announced pilots for new physicians’ associates, but today I can announce those pilots are planned to ensure 1,000 physicians’ associates will be available to work in general practice by September 2020.

    Finally, as well as getting more new GPs, we need to make sure they go to parts of the country where they are most needed. Building on the success of a Health Education England pilot in the West Midlands, we will incentivise a number of newly qualified GPs with an extra year of training and support to develop specific skills needed in areas such as paediatrics, mental health and emergency medicine.

    A new deal on infrastructure

    Getting the workforce right is critical. But so too is dealing with the challenge of the buildings they work in.

    Many of our primary care facilities are simply not fit for purpose. If we are to respond to ever changing and ever increasing demand, we need significant improvements in the quality of our physical infrastructure.

    So last year we announced the £1 billion Primary Care Infrastructure Fund, spread over 4 years. Over 1,000 GP practices have now had bids provisionally approved for £190 million of investment in premises this year, backing exciting plans to expand services, house integrated services with community and pharmacy providers, and invest in digital innovation.

    These include plans – for example – to allow 2 practices in Waltham Forest to co-locate into a new purpose-built surgery, offering a more comprehensive range of services to patients, including an elderly care facility and a falls clinic. Six practices in Solihull are building additional consulting rooms to increased access to primary care services for patients. While in Crawley, the Pavilions building is being redeveloped so the practice can provide a wider range of services and increased capacity for GP training.

    Over the next 3 years we will allocate the rest of this fund to invest in further schemes so that over the course of the parliament cities and towns across the country will see visible signs of improvement in primary care facilities.

    This investment will also support digital innovation, where GPs have led the way. Online patient access to summary medical records through primary care rose from 3% to a remarkable 98% over the last year. But we need digital, real time, interoperable electronic health records for the whole NHS, so we will help practices link their patient records to NHS secondary and community care providers and the social care sector.

    A new deal on access with a 7 day NHS

    While we need to improve workforce supply and infrastructure, we will not solve the problems we face by simply doing more of the same.

    In particular, we need to address the issue of 7 day care.

    The role and purpose of 7 day primary care is about much more than convenience – it is about making sure precious hospital capacity is kept clear for those who really need it. We have clear evidence from Imperial College London that a lack of access to GPs at weekends results in increases in urgent hospital admissions. As Professor Sir Bruce Keogh develops his new model for urgent and emergency care, we need to make sure general practice plays its part in improving access to routine appointments.

    But new models of care should never be one size fits all, and while we must always respect the integrity and accountability through registered lists, different approaches will be appropriate in different parts of the country. Sam Everington says that 20 years ago his stethoscope was his most important device, now it’s his iPad. With local flexibility, local knowledge and local clinical ownership comes the prospect of change that is as exciting for the profession as it is for patients – and we want GP partners to continue to be the leaders and innovators in this process.

    We can learn from other countries that have made progress in this area, such as the 7 day networks that operate in New Zealand or Alberta, Canada. But important progress is being made here too through the Prime Minister’s Challenge Fund. Through it, 18 million people will benefit from improved access, including at evenings and weekends, by March 2016.

    This is about a flexible and balanced approach – not that every single surgery will be open in the evenings or at weekends. But at the Watford Care Alliance network of practices patients are offered evening or weekend appointments at their own or a nearby surgery, and for those who can’t make it into a surgery an appointment by phone or online, where they see a GP who has full access to their medical record. Dr Mark Semler says, “The Challenge Fund initiatives have demonstrated that – properly implemented – technology has the power and potential to transform the way we do things in primary care. Telemedicine consultations are a powerful tool to assess patients at distance and save GPs large amounts of time.”

    Other practices are helping to deliver 7 day care by better use of pharmacies. In Brighton 16 GP practices are working with local pharmacies to create 4 ‘primary care clusters’, offering evening and weekend appointments with a GP or pharmacist and giving the pharmacist equal access to GP records. Dr Jonathan Serjeant from Brighton said the pilot has been a “fantastic opportunity for practices to learn to work together…reaching out into their community to work with pharmacists to design, and provide care for people” and “help us understand how to offer more for people in more locations with a different skill mix.”

    So as we roll out the Prime Minister’s Challenge Fund to the whole country, I can today announce that £7.5 million of the primary care infrastructure fund for this year will be used to support community pharmacists with training and appropriate tools.

    These new ways of working offer great potential. But what won’t work is a return to top-down direction from the Department of Health. Innovation cannot be imposed, it can only be embraced. So please play your part by getting into the driving seat as we move towards more multi-disciplinary working, imaginative use of technology, better coordination with other parts of the NHS and re-imagining roles through federations or responsibility for new integrated community services.

    A new deal on assessing the quality of care provided

    Additional workforce, £1 billion for infrastructure, support for new models of care – but there is another area where we need a new deal, and that’s how we assess quality of care for patients provided in general practice.

    Each of us here today, as professionals and as patients, want to see continuous improvement in the quality of care across the NHS. A cornerstone of that improvement must be having the right information to assess quality, conduct meaningful peer-review and support a true learning culture.

    One of the founders of quality improvement techniques in health care, W Edwards Deming, said, “In God we trust, but all others must bring data.” There has already been a lot of good work by different groups on developing better data and metrics to assess quality in general practice.

    But I have asked the Health Foundation to work with NHS England to do a stocktake of all current metrics, involving a range of stakeholders including NHS England, the CQC, the RCGP, BMA and representatives of patients and the public. This stocktake will review where we are now, and how we can collect and publish better outcomes-driven assessments of the quality of care for different patient groups. This will support the important progress made by Professor Steve Field in establishing the new CQC inspection regime but also address the concerns expressed by many about the shortcomings of some of the data being published.

    The Health Foundation will provide an initial assessment for me in the autumn with the first new datasets based around key patient groups published next spring.

    Intelligent transparency, though, must have intelligent consequences. One of those is a change in culture – from name and shame to learning and peer review, as championed by Professor Don Berwick in his work on improving safety in the NHS.

    Another consequence needs to be much better support for practices identified as in difficulty. So I have today also asked NHS England to work with NHS Clinical Commissioners to develop a £10 million programme of support for struggling practices. This will include advice and turnaround support for the practice itself and help for the practice to work with others to change its business model.

    Bureaucracy and burnout

    The final area where we need a new deal is not about money or premises or workforce or assessments… but about you. I cannot change the growing numbers of older people who need your help. Nor can I change consumer expectations of healthcare provision that are much higher than 50 years ago. But I can do something about the bureaucracy, paperwork and inappropriate workload that takes up too much of your time and takes you away from patients.

    I have already cut the Quality and Outcomes Framework by more than a third and have reduced the reporting requirements linked to enhanced services. But there is more to be done.

    So I have asked NHS England to examine how we can reduce bureaucratic burdens on general practice to release more clinical time for patients. NHS England has already surveyed over 200 practice managers and GPs and will be running workshops to determine how to reduce the reporting burden, and will develop practical tools to help GPs better manage the mountain of bureaucracy and paperwork that leads to so much frustration and burnout. I have asked to see the results of that work this autumn.

    Your side of the bargain

    So plenty of commitments from me. But now perhaps the more tricky part: your side of the bargain.

    I am prepared to commit money to this plan – more GPs, more community nurses, more money for infrastructure, help to reduce burnout. The vision for out of hospital care set out in the ‘Five Year Forward View’ requires more investment in primary care so this is the biggest opportunity for new investment in General Practice in a generation.

    But in return I will need your help to deliver a profound change the quality of care we offer patients.

    Around a fifth of GPs’ time is spent dealing with patients’ social problems including debt, social isolation, housing, work, relationships and unemployment – yet 50% of GPs have no contact whatsoever with local social care providers.

    So we need to empower general practice by breaking down the barriers with other sectors, whether social care, community care or mental health providers, so that social prescribing becomes as normal a part of your job as medical prescribing is today.

    We need to empower general practice to deliver an even bigger role in public health. The NHS England ‘Five Year Forward View’ talks about prevention not cure – and if we are going to change lifestyle choices to improve health outcomes family doctors have a critical role to play.

    And we need to empower general practice to take real clinical responsibility for your patients. The guidance being produced by the Academy of Medical Royal Colleges this year will help us understand what this really entails – but for patients it is really very simple: knowing where the buck stops for their NHS care.

    Everybody needs to know where the buck stops for their care – and most people would like that to be their family doctor. I want to empower you so that aspiration – treasured by doctors as much as by patients – finally becomes a reality.

  • David Cameron – 2007 Speech on the Economy

    davidcameronold

    Below is the text of the speech made by David Cameron, the then Leader of the Opposition, at the LSE on 10 September 2007.

    INTRODUCTION – THE END OF ECONOMIC HISTORY?

    When I studied economics, twenty years ago, arguments raged about the most basic principles of how to run the economy.

    There may have been some agreement about aims: to save Britain from being the sick man of Europe, and raise living standards throughout the country.

    But there was a vast gulf between left and right as to how this could best be achieved.

    The left advocated more intervention and government ownership.

    Those on the right argued for monetary discipline and free enterprise.

    That debate is now settled.

    Over the past fifteen years, governments across the world have put into practice the principles of monetary discipline and free enterprise.

    The result?

    A vast increase in global wealth.

    The world economy more stable than for a generation.

    Global income doubled.

    Two billion people have escaped subsistence poverty, and joined the world economy.

    So the conclusion appears…well, conclusive.

    Francis Fukuyama argued in the early 1990s that, if we see human history as the acting-out of intellectual disputes, then history was over.

    On the political battlefield, democracy had emerged the victor; in economics, liberalism had prevailed.

    Thus in 1990 the “post-Cold War consensus” began: the idea that, as Fukuyama put it, history had ended in the triumph of liberal democracy and market economics.

    Today, Fukuyama’s political thesis – the victory of liberal democracy – has been qualified, shall we say, by events since 2001.

    And in this lecture I want to ask what has happened to his thesis in the economic sphere – the consensus on free markets.

    Have we really seen the end of economic history?

    AGREEMENT ON THE FUNDAMENTALS

    Here in Britain, it is tempting to answer that the consensus is intact.

    The principles put forward by Nigel Lawson in his 1984 Mais lecture have become standard practice:

    Use macroeconomic policy to ensure stability and control inflation.

    Use microeconomic policy to promote supply side growth.

    Less intervention; more competition; an increasingly open economy.

    Added to this, the monetary framework that we developed in the early 1990s – a combination of inflation targeting and a floating exchange rate – brought to an end decades of argument in Britain, and academic debate.

    I’m proud that this is one of the few countries in the world where all serious candidates for high office support the principles of free trade and monetary discipline.Other countries – even America or Germany – have senior politicians who disagree with economic liberalism.

    Not us.

    Indeed the whole New Labour project was built on recognising, and accepting, the free market consensus.

    When I visited India last year everyone – from the Prime Minister to the chief executive of Tata Steel – told me that Britain’s political consensus on free markets is one of our most important selling points as a destination for trade and investment.

    So I will not exaggerate the differences between myself and Gordon Brown on the overall economic framework.

    And yet my argument today is that we have in fact reached the limits of the post-Cold War consensus.

    We have reached its limits because the post-Cold War consensus was actually a consensus on how to manage Cold War-era economies.

    It does not provide answers to the questions that have emerged since 1990.

    MARKET TURBULENCE

    Of course, in many ways the times we have been living through in the past decade have been remarkably benign.

    Indeed, the recent turbulence in the credit markets has reminded us of just that fact…

    …as well as the reality that the very success of a competitive and innovative economy can lead to new challenges.

    Our hugely sophisticated financial markets match funds with ideas better than ever before.

    They have facilitated cheap credit that has helped companies expand, helped families achieve their dreams, and helped entrepreneurs put their ideas into practice.

    Yet that same cheap credit has also increased the social problems associated with over-indebtedness, and potentially has made us more vulnerable to global shocks.

    And it leaves central banks grappling with the question of whether providing help now will increase the danger in future.

    It is still too soon to know what impact this latest bout of financial turbulence will have on the real economy of jobs and investment.

    But it is clear that our economy has not been best prepared.

    Gordon Brown’s reckless strategy of excessive borrowing, leaving our economy with the largest structural deficit in Europe, has left us ill-prepared to respond if the turbulence spreads more widely.

    That is why we are determined to create a more secure framework for economic stability in this country.

    In terms of monetary policy, by enhancing the independence of the Monetary Policy Committee.

    And in fiscal policy, by giving control over monitoring of the fiscal rules to an independent body.

    These measures will strengthen monetary policy, and ensure that fiscal policy supports rather than undermines it.

    But while these differences on the execution of macroeconomic policy are important, they are not as great as the difference between the approaches of right and left on the big questions that will determine the course of economic history in this century.

    Our distinct responses to these big questions about the future give the lie to the idea that we have reached the end of economic history.

    There are three questions in particular that the modern world demands answers to – and I would like to address these questions today.

    First, the best way to stimulate economic growth in the face of globalisation.

    Second, the best way to stimulate green growth in the face of climate change.

    And third, the best way to stimulate social growth in the face of inequality and social breakdown.

    ECONOMIC GROWTH: SUPPLY SIDE REFORM

    It is globalisation that most insistently prompts us to consider afresh the question of economic growth, and whether there really is consensus about the right way to stimulate that growth in the post-Cold War era.

    History did not stop in 1990, any more than the church clock stopped at 10 to 3 one summer day in 1914.

    John Maynard Keynes’ famous description of the pre-World War One Londoner, “sipping his morning tea in bed” and ordering by telephone “the various products of the whole earth” is famous because that world abruptly ended in the guns of August.

    Many years of economic nationalism followed, until a new era of globalisation began in our own time.

    So we must not assume, like Keynes’s Edwardian Londoner, that the age of Amazon, eBay and Google is here to stay forever.

    The thousands of people who demonstrated against the WTO in Seattle, or against the G8 recently in Germany, certainly don’t think that globalisation is a necessary or inevitable process.

    As George Osborne has put it, every generation has to make the case for free markets.

    And every generation has to develop the mechanisms to make free markets work better.

    Nearly two years ago I asked our economic competitiveness policy group to set out proposals for the way Britain should meet the challenges of globalisation.

    Its findings were very clear.

    To stimulate economic growth in the new global economy, dramatic supply side reform is required.

    Government must regulate and tax enterprises less.

    But Britain’s competitiveness is not simply a matter of government getting out of the way.

    It must also do more to secure the skills, energy and transport infrastructure that help us compete.

    For example, we need a radical simplification of business taxes, to lower the rate and broaden the base.

    But we must also ensure that we remain at the cutting edge of science and technology.

    Government funding of science and technology may look to some like old-fashioned interventionism.

    Yet because the findings of primary research can be too far from the market to be commercially viable, there is a strong case for direct government intervention.

    Some of the most successful free market economies, like the United States, spend the highest proportions of their income on government-funded scientific research.

    Our taskforce on Science, Technology, Engineering & Mathematics has set out an ambitious agenda for promoting science and innovation…

    …including proposals to promote scientific research in our universities, and make it easier for innovative start-up businesses to win government contracts.

    While we bring forward supply-side reform proposals that are imaginative and appropriate to the scale of the challenges we face, the Labour government is in my view moving in the wrong direction.

    And so I do not believe there is consensus on the best way to stimulate economic growth in Britain today.

    Our economy is labouring under the highest tax burden in our peacetime history, the longest tax code in the world, and an explosion of new regulations that cost us more than £50 billion a year.

    Just last week we heard that the latest version of Tolley’s tax handbook is more than twice as long as it was in 1997.

    The publishers even had to change the formatting just to stop it going to five volumes.

    The result of all this is that Britain has fallen from 4th to 10th in league tables of economic competitiveness.

    Indeed, last week the Institute of Directors concluded from its annual survey that Britain’s competitiveness was “remarkable by its mediocrity.”

    This is not an abstract concern.

    Research done here at LSE’s Centre for Economic Performance shows that on average a British worker has to work an extra day each week, just to produce the same as an equivalent worker in France.

    Our average rate of productivity growth – what Gordon Brown himself has called the “fundamental yardstick” of economic performance – has actually fallen over the last decade.

    Meanwhile in America it has almost doubled.

    Both a symptom and a cause of Britain’s falling overall productivity is the productivity of our public services, for which the Government is responsible.

    Perhaps the biggest mystery in British politics is how Labour can have spent so much and achieved so little.

    I believe the answer is a top-down system of central control and targets that takes power away from the professionals who deliver public services and the citizens who use them.

    And at the centre of it all a Treasury that, under Gordon Brown, was so busy trying to do everything that it lost sight of its single most important role – delivering value for money.

    We believe that it’s time for change…that it’s time for modern Conservative supply-side reform to stimulate higher economic growth.

    The agenda is clear.

    We need deregulation to promote commercial competitiveness.
    We need decentralisation to promote public sector productivity.

    And overall, we need to share the proceeds of economic growth between higher investment in our public services and lower taxes.

    George Osborne and I have made clear that we will put economic stability before promises of up-front, un-funded tax cuts.

    As George Osborne has set out, we will match Labour’s spending totals, and by growing the economy more quickly than public spending over an economic cycle, we will deliver a lower tax economy over time.

    Sharing the proceeds of growth is a significant policy choice.

    There are clear dividing lines here, and I believe that in time economic history will show that once again those on the political right, and not those on the left, have the correct analysis and the most productive policy solutions.

    GREEN GROWTH: MARKETS AND GREEN TAXES

    Just as the pressing need for supply-side reform in the face of globalisation should enable us to challenge the notion of a post-Cold War consensus on economic growth…

    …and the accompanying fiction that we have reached the end of economic history…

    …the threat of imminent, irreversible, and catastrophic change to the climate of our planet should prompt us to challenge any perceived consensus on green growth…

    …the vital need to protect our environment through policy that enhances, rather than impedes, wealth creation.

    I won’t rehearse here the arguments in favour of action to halt climate change.

    Let me simply ask the big question to which economics must provide a modern answer:

    How can we make economic growth sustainable for our planet?

    This is not a question many people were asking at the end of the Cold War, but they are certainly asking it now.

    The pollution that leads to global warming is one of the greatest market failures of all time.

    Some argue that to save the planet we must stop growing altogether.

    Capitalism has brought this threat upon us, they say, and we must reduce consumption now.

    Others argue that whether or not climate change is man-made, there is nothing we can realistically do to stop it, so we should simply prepare for the consequences.

    I think both are wrong.

    As Nicholas Stern’s authoritative report showed, the likely economic cost of inaction is greater than the cost of action.

    So what is the action we need to take?

    I believe that if we blame capitalism for climate change, we should also look to capitalism for the solution.

    Jonathan Porritt, in his important book Capitalism as if the world matters, argues explicitly that we must harness the power of the market to deliver progress on the environment.

    Of course we must look at all the tools at our disposal, including green taxes, trading, regulation and technology.

    But in designing and using those tools, we must understand their limitations.

    Consider for example the choice between green taxes and carbon trading.

    In theory, the argument for trading schemes is compelling.

    Government sets the limit, and the market puts a price on carbon.

    The result is that carbon is reduced at the lowest marginal cost.

    But a growing body of evidence shows that the reality can be very different.

    Consider the EU Emissions Trading Scheme, the largest scheme of its kind.

    Partly due to government backsliding on national emissions quotas, the first phase of the scheme has suffered from low and variable carbon prices that have failed to provide the long term incentives needed to affect investment decisions.

    I support the scheme and I hope that the second and third phases will be more successful.

    But time is running out.

    More generally, trading schemes may seem the obvious free market solution, based as they are on market transactions.

    But crucially they are artificial markets dependent on government regulation and monitoring for their existence.

    A growing strand of opinion on the right argues that green taxes provide both better environmental outcomes and make more economic sense.

    In a paper for the free market think tank the American Enterprise Institute, Kenneth Green and others have gone so far as to argue that because of the cost in terms of bureaucracy, the opportunities for fraud, and the inherent incentive “to push the legality at all stages of the process”, carbon trading systems are bound to suffer limitations.

    Instead, they argue for environmental tax reform.

    I believe that to confront the challenge of climate change and to stimulate the green growth we need, we must use a combination of the tools available to us.

    Trading schemes will play an important role, but they depend crucially on real government leadership in setting quotas and ensuring they are kept to.

    Environmental taxes must also play a role.

    As taxes will always have an incentive effect – discouraging whatever they are levied on – why not use them to discourage bad things rather than good things?

    To mitigate market failure, rather than pervert good decision-making?

    Environmental tax reform can have economic benefits too – the so called “double dividend” of lower pollution and lower taxes on jobs and investment.

    But in this country, that is not what we have seen.

    By using green taxes as extra stealth taxes, Gordon Brown has given them a bad name.

    I’m determined that the Conservative approach will be different.

    With my Government, any new green taxes will be replacement taxes, not new stealth taxes.

    In a few days, our Quality of Life Policy Group will publish its report.

    It will contain many recommendations on tackling climate change, at home and abroad, including recommendations on green taxes.

    As with all the reports in our Policy Review, we will study its proposals carefully.

    But let me be clear.

    We will raise green taxes, and use the proceeds to reduce taxes elsewhere.

    That is the right direction for the environment and it’s the right direction for our economy.

    It is the best way to deliver the green growth that must be our aim.

    SOCIAL GROWTH: INEQUALITY AND WELL-BEING

    Let me turn now to the last great counter-argument to the post Cold War consensus.

    The case for the end of economic history is based on the observation that everyone now agrees on the need for economic growth and the way to achieve it – even if sometimes they don’t always practice what they preach.

    But there is an area of profound disagreement beyond this consensus.

    It concerns the need to stimulate the social growth that people demand in the face of inequality and social breakdown.

    How shall we help, firstly, those left behind by economic growth – and secondly, those for whom economic growth is not enough?

    This matters, for the simple reason that everyone is in one or other of these groups.

    First let me talk about those left behind.

    If we are to enjoy all the potential benefits of the modern economic era, we need to understand why so many people are deeply anxious about it.

    For a start, we have to be honest and admit that when the winds of globalisation are unleashed, our societies become more prosperous overall but people can get left behind.

    There are towns in Britain where the retreat of traditional industries has helped to leave a quarter of older working men on disability benefit year after year.

    Where the winds of globalisation feel like a chilling blast, not an invigorating breeze.

    As is often pointed out, globalisation tends to decrease inequalities between countries, but it can also increase inequalities within countries.

    So we should celebrate the benefits of globalisation.

    But we must also recognise our moral obligation to the people and the places left behind.

    For government that means preparing our economy to make the most of globalisation, and preparing our society to cope with the disruption it can bring.

    The tragedy is that for all their rhetoric – and for all their undoubted sincerity and effort – our present Labour government has failed in these vital tasks.

    I have already noted Labour’s economic failure, in particular with respect to supply-side reform.

    This is a record that is, I think, increasingly well-understood in the economics community and beyond.

    Perhaps less well understood is Labour’s failure to prepare our society.

    Too many people in our country are not sharing in the new global prosperity.

    There is a poverty of ambition, of capability, and of hope – increasingly passed down through generations – which the world’s rising prosperity has failed to dent.

    It is a startling fact that despite the vast rises in wealth across the world, in Britain, the poorest in our society have got poorer in the past ten years.

    Social mobility is falling.

    Some estates in Britain have a lower life expectancy than the Gaza Strip.

    But the old solutions are not working.

    Over the past decade the degree of redistribution between regions of the UK has reached unprecedented levels.

    Yet still, as the IPPR has demonstrated, regional inequality has actually risen.

    They warn that the north-east remains at the lower end of achievement in education, health and welfare-to-work despite receiving some of England’s highest total spending on public services per head over the last decade.

    And of course it is not just inequality between regions that is growing, but inequality between communities and people within regions.

    Areas of entrenched poverty sit alongside pockets of vast wealth.

    We have known for years that the old responses of the old left – hostility to markets and enterprise – were spectacularly ill-suited to the task of overcoming these challenges.

    But now we can see that the new responses of the new left – targets and transfers – have failed too.

    Child poverty is rising, despite a huge increase in means-tested benefits.

    On Government figures, 600,000 more people are in extreme poverty than in 1997.

    Massive payments from one region to another have not halted the growing disparity.

    It is clear that social growth – enabling everyone to share in growing global prosperity – requires new solutions.

    We know that high taxation and over-regulation can stifle the enterprising spirit.

    We know that without a decent education, success is ever harder.

    And we know that the greatest force for social progress is the force of people’s determination to build a better life for themselves and their family.

    So let us take those lessons and apply them across Britain.

    Our approach reflects the modern Conservative freedom agenda, aiming to give people more power and control over their lives…an approach built around enterprise, education and aspiration.

    Enterprise – where we learn from countries where radical benefits reform, with tough incentives combined with patient, personalised support from the voluntary sector, has moved people from welfare to work.

    Education – where we learn from countries where radical schools reform, enabling the creation of new schools that give parents a real choice within the state sector, has helped increase standards, discipline and achievement – particularly in poor neighbourhoods

    And aspiration – where we understand that none of this will work without a renewed drive to create a can-do culture of opportunity.

    Over the past year, across Britain the average family has seen their take home pay actually fall in real terms.

    Thanks to a rising cost of living and extra stealth taxes, families are finding their budgets increasingly squeezed.

    And when young families look to take their first steps onto the housing ladder, they find that even the bottom rung is unattainable.

    Half of all families now rely on their parents for help in buying their first home.

    Yet because the threshold has not kept up with the rise in house prices, more than a third of families now find that aspiration hampered as they fall into the inheritance tax net.

    There are so many ways in which those striving to reach their aspirations for a decent life are being hit.

    Because of the complex tax and benefits system, millions of people on low and middle incomes find that if they earn a little extra, or move from part time to full time work, the taxman takes away more than two thirds of every extra pound they earn.

    So any revenue raised from new green taxes will be used to reduce the burden on those striving hard for a better life.

    WELL-BEING

    I grew up in a home that was materially privileged.

    But as I have often said, the real privilege of my upbringing was a strong family.

    And that is the point I want to end on today.

    If a significant, unacceptably large minority of our fellow countrymen and women are trapped in poverty, in all the horrors of multiple deprivation and social injustice, the majority of us are also trapped in an economic system which can be destructive of family and community life – destructive of all the elements which contribute to well-being.

    Let me explain clearly what I mean when I talk about well-being.

    I do not mean some woolly, new-age, anti-capitalist agenda which favours downshifting rather than ambition, or a hair-shirt Puritanism rather than the legitimate pursuit of happiness.

    Capitalism is clearly the greatest agent of human fulfilment that human ingenuity has ever contrived.

    But capitalism on its own is not enough: an approach that ignores the rest of life is one that is badly misguided.

    For me, well-being is simply the opposite of the social breakdown that we see all around us in countless daily manifestations…

    …crime and anti-social behaviour, rudeness and incivility, litter on the streets and a transport system which makes it such a hassle to get around.

    For me, well-being means a determination to improve the quality of life for everyone in our country.

    Let me demonstrate my point with a quotation I am fond of from Robert Kennedy:

    “Our gross national product… if we should judge America by that – counts air pollution and cigarette advertising, and ambulances to clear our highways of carnage.

    It counts special locks for our doors and the jails for those who break them.

    It counts napalm and the cost of a nuclear warhead, and armored cars for police who fight riots in our streets.

    It counts Whitman’s rifle and Speck’s knife, and the television programs which glorify violence in order to sell toys to our children.

    Yet the gross national product does not allow for the health of our children, the quality of their education, or the joy of their play.

    It does not include the beauty of our poetry or the strength of our marriages; the intelligence of our public debate or the integrity of our public officials.

    It measures neither our wit nor our courage; neither our wisdom nor our learning; neither our compassion nor our devotion to our country; it measures everything, in short, except that which makes life worthwhile.”

    Those words have a special relevance for Britain today.

    Over the last ten years we have fallen in the league tables of quality of life.

    For example, the UN’s Human Development Index, devised by Amartya Sen and Mahbub ul Haq, found that quality of life in the UK has fallen from 10th in the world a decade ago to 18th in the world today.

    That is a terrible finding.

    How do we increase well-being alongside wealth?

    How do we stimulate the social growth that people so badly want?

    Economists are now fully engaged in this debate.

    On one side of the argument, Lord Layard has pointed out that once out of poverty, happiness doesn’t seem to rise with income, and more equal societies are happier.

    From this he draws a simple policy conclusion: more redistribution is needed.

    Yet this simple analysis only gives part of the picture.

    Recent work by Paul Ormerod and Helen Johns shows that redistribution does not increase happiness either.

    In fact, as Ormerod and Johns show, the few things that do consistently correlate with well-being are the sense of trustfulness in the society we live in, our health, and the strength of our marriages.

    And this points me to a central insight of Conservatism – central to the Conservative philosophy throughout our Party’s history.

    The value of institutions.

    Abstract national wealth – a high rate of GDP – is necessary, but not sufficient, to deliver higher GWB, or general well-being.

    We need to tackle poverty, and we need to tackle inequality – particularly the gap between the mainstream and those left behind.

    But we need more than that.

    We need above all an agenda which puts not the individual, not the state, but society at the centre of national life:

    … society in all its forms: families and local councils, trade unions and churches, small shops and great universities, charities and clubs and protest groups …

    …all the institutions and associations that in Bobby Kennedy’s words, “make life worthwhile.”

    That’s what I call a richer society.

    That, to me, is the real object of economic policy.

    CONCLUSION

    So far from this being the end of economic history, far from there being a consensus on economic matters today…

    I believe there are still great battles to fight.

    But these are different battles, on different terrain.

    The fight for supply-side reform that will deliver economic growth in the face of globalisation.

    The fight for environmental protection that will deliver green growth in the face of climate change.

    And the fight for well-being that will deliver social growth in the face of inequality and social breakdown.

    Economic growth; green growth; social growth.

    These are the big questions in the economic debates of the modern age.

    This is the new economic history that it falls to this generation to write.

    And these are the battles that the centre-right of politics is once again uniquely equipped to fight.

  • David Cameron – 2007 Speech on ‘Time for Change’

    davidcameronold

    Below is the text of the speech made by David Cameron, the then Leader of the Opposition, on 7 September 2007.

    I’ve brought you here as we face a great fight for the future of our country.

    I don’t know whether the general election will be in weeks, months or years.

    But we will be ready…

    Ready with a plan to change Britain for good, a plan that is as bold and ambitious as the one on which we fought Labour the last time we came from opposition to win.

    Ready with policies that meet the great challenges and opportunities of our times and which are the product of the most serious, comprehensive policy review ever conducted by an opposition party.

    And ready with a message that reaches every part of this country and inspires every person in this country – a message of change, optimism and hope.

    Today I want to talk about the things that drive me, why I want to put this forward and why I want to win.

    THE CHANGES WE’VE MADE

    Two years ago I said we had to change to win and I’ve led those changes.

    We changed our Party, the way we selected candidates, and now almost a third are women, but still we must go further.

    We changed the issues we talked about: NHS as well as crime, the environment as well as Europe, well-being as well as wealth creation.

    But we changed something more fundamental – our whole approach to the great challenges and opportunities Britain faces.

    We have been doing the long-term thinking we need to meet the challenges and opportunities of the future.

    I want to thank all of you for the work you’ve done with our Policy Groups.

    As a result of that work, we’re leading the argument on the big challenges …

    ….social breakdown … improving the quality of life for everyone…

    … sharpening our economic competitiveness …

    … international security … improving public services and fighting global poverty.

    Since I became leader of this Party, all the new thinking and all the new argument has come from our side of the political divide.

    While we have a fully worked up NHS white paper … the PM has an 11 month long meandering review with no idea what to do next.

    While we are making the running on discipline and standards in schools and promoting small schools, he’s wandering round the country holding focus groups to ask people what on earth he should do.

    But still we have further to go.

    Britain, and the world, are changing faster than ever before in front of our eyes.

    There will be new challenges and new opportunities.

    We need to be ready for them, ready to lead the world in shaping the future as we did in the 1980s.

    PEOPLE WANT TO KNOW MORE

    But these things are not enough. People want to know something even more profound and even more simple.

    And they want to know it of their leader more than anyone else.

    What are the beliefs that really drive you?

    What are the values that, when you’re faced with a tough choice, help you make that choice?

    They don’t just want to know about the policies in your manifesto.

    They know that leaders will be confronted with unpredictable dilemmas and difficulties …

    … so they want to know how a leader would make those decisions.

    And linked to that, there’s something else…

    What will the country look like after five or ten years of leadership and commitment, consistently putting those values into effect?

    Those are the two things I want to talk about today.

    FAMILY

    The first and most important of my values is my belief in family.

    When I think of my own life and experience it was a strong family more than anything else that gave me a good start in life.

    That was the real privilege.

    A Mum and Dad who were always there for you, brothers and sisters who always looked out for you, with help and advice about school, home, jobs…

    And today my own family shows me how there is nothing more important than your family responsibilities…and when disaster strikes, it’s your family that gives you the strength and the resources to cope.

    Anyone who says that the family is an old-fashioned idea and not relevant to the modern world and its challenges is just completely, 100% wrong.

    It’s precisely because the modern world can move so quickly, has so many varied temptations and opportunities and choices that you need the rock of the family to be a secure base.

    Just ask yourself…who is best at bringing up children with the right values, helping with the elderly, sick and disabled…Who’s picks us up when we fall, or puts us back on track when go astray…. It’s the family.

    It’s because the family is such a vital part of society that communists and socialists hate it so much.

    They always want to undermine the family, because they don’t want anything to come between the individual and the state.

    Well I do.

    And so when it comes to making choices, facing up to tough dilemmas, I think politics should begin and end with a simple question and a simple test: does this help families and the work they do?

    That’s how I will lead.

    RESPONSIBILITY

    The second belief at the heart of everything for me is my belief in responsibility.

    We are not atomised and passive individual units. We are all part of society, we have responsibilities to each other and to our neighbours.

    I think of my mother who was a magistrate for almost three decades. She believed she had a social responsibility to serve her community and do her bit.

    If that sounds idealistic or even paternalistic, I don’t care.

    I believe we all have an active responsibility to do things for each other and we’ll never have a strong society unless we make it happen.

    That’s why I go on and on about social responsibility and will not stop going on and on about social responsibility until the day I die because social responsibility is what I believe in.

    Ask Amir Khan and the youth workers I was with yesterday what social responsibility means and they will tell you.

    He doesn’t just want to be the best boxer in Britain and the world – he wants to put something back, building the gym I spoke in yesterday to get teenagers off the streets, to give them the chances and the choices that he’s made for himself.

    That is social responsibility.

    Ask doctors, nurses, teachers who went into public service through a sense of vocation what social responsibility means and they will tell you …

    … and they will tell you what it means to have that sense of social responsibility and their vocation questioned and undermined with targets and second-guessing from a government that doesn’t believe in social responsibility because it just doesn’t have faith in human nature and is fundamentally pessimistic about people’s motivations and values.

    OPPORTUNITY

    And the third belief that drives me is my belief in opportunity.

    I’ve always believed that life is what you make it, that of course life isn’t fair, you make your own luck but that there’s nothing you can’t achieve if you strive and try hard.

    I learnt from my father’s irrepressible optimism that opportunity is always there if you go for it with passion and courage.

    And so the role of the state is to clear away any and every obstacle to opportunity so that individuals really can make the most of their lives.

    That’s the real difference between left and right: they believe in equality of outcome, we believe in equality of opportunity.

    We as the government, we have to tear down the barriers to opportunity.

    You as an individual, you have to do your best, make your own luck and go for it with everything you have.

    And what makes me angry is that we’ve got a world where there have never been opportunities like this, and yet there are so many barriers still in the way of so many people …

    … poor education, bad housing, no assets…that’s the job of government, to unleash opportunity by taking down the barriers.

    A POLITICAL AGENDA OF FREEDOM AND CONTROL

    So if you believe in family, responsibility and opportunity, if you know that those are your values, what is the political agenda that flows from that?

    As night follows day it means that the most important driving force of everything you do, the principle and purpose of your politics, is to give people more freedom and control over their lives.

    Why?

    Because freedom is the real benefit of a strong family – it’s the security it gives you to get on and get out and get up, with a strong family behind you if you fall.

    It’s because if you believe in responsibility, you have to give people freedom. You literally cannot be responsible for something unless you have power and control over it.

    And it’s because opportunity means the freedom to be a doer not a done-for, taking down the barriers so that everybody can make the most of their life.

    So that will be the central test for the decisions I make: will it give people more freedom and control over their lives?

    That is the overriding aim of the government I will lead.

    A CLEAR POLITICAL PROGRAMME

    So what is the political programme that flows from this political agenda of freedom and control?

    I want to paint a picture of the kind of country Britain will be if we consistently apply these values and principles, and drive forward this political agenda.

    Conservatives, with our traditional suspicion of utopias and state-manufactured solutions, have not always been good at describing the kind of country we want to see.

    But I want you to imagine an education system where parents have a real choice of strong, independent schools within the state sector that set their own rules on discipline …

    … where the teachers are happy and proud to do their jobs without interference from on high …

    … where the kids are well behaved because the parents have made a commitment to that school and a real emotional investment in it.

    You don’t need a Citizens Jury for that, you just need a Conservative Government.

    Imagine an NHS …

    … where you can go to your GP and they have the freedom to get the best care for your needs instead of being bogged down in rules and regulations …

    … where the local hospital is being saved and improved instead of being closed down …

    … and where the doctors and nurses have the time and the energy to treat you like a king instead of having to give you the brush-off because of all the red tape and targets they’re drowning in.

    You don’t need a Citizens Jury for that, you just need a Conservative government.

    Think of those families that are caring for disabled or special needs kids …

    We don’t need Citizens Juries to work out how to improve the services they use, there are a hundred thousand experts out there already – they’re the parents of those kids.

    We just need to give them the freedom and control to get what they want, with individual budgets and direct payments so that they have the cash and they can make the choices about care, about respite, about the help and support they need.

    We don’t need Citizens Juries to work out what to do about social breakdown – everyone knows what needs to happen.

    You start with strong families, and then you need discipline in schools, active policing on the streets, strong communities with things for young people to do.

    You need welfare reform to get people off benefits and into work, tough punishments when people break the law, and every citizen to play their part in delivering it.

    Imagine a world where you know your local police officer and they know you because they’re out there in the community, free of all the ridiculous targets and paperwork and accountable to you because you voted for their boss.

    You don’t need a Citizens Jury for that, you just need a Conservative government.

    Imagine local councils that are free to respond to the needs of the local area because they have real power instead of being second-guessed by Whitehall the whole time.

    They know their areas, the problems, the opportunities … give them the money, let them get on with the job and let the local population use the ballot box to reward the good and chuck out the bad.

    Imagine a world where more people can buy their own home because the right to buy has been extended, rent to mortgage schemes are available to all and the perverse rules that stop affordable houses being built have been swept away.

    Imagine a Britain where a government says to its people we want you to keep more of the money you earn to spend as you choose … because we will share the proceeds of economic growth instead of spending all the money ourselves.

    Imagine a country where the government doesn’t change the way we’re governed without asking the people.

    Not a Prime Minister who lamely says you are the master, I am the servant and then denies you a referendum that he had previously promised.

    But one that gives this guarantee – no passing power away from Westminster without asking you in a referendum – and let’s start now with a referendum on the European constitution.

    Imagine a world where, yes, we give priority to tackling environmental degradation but with a government that says we will meet this challenge by making it easier for people to take green choices in their daily lives.

    That’s the world we’re fighting for, and it’s a world away from the ‘he knows best’ Britain of Gordon Brown.

    When I heard him talking this week about his Citizens Juries it said everything about the difference between his vision and mine, between his worldview and the way I see things.

    We don’t want people to sit on Citizens Juries and talk about what they want, we want to give them the power and the freedom and the control to get what they want.

    They shouldn’t have to ask Gordon Brown if he’d be so kind as to listen to them for once.

    NO FALSE CHOICES

    That’s the political programme I will follow, based on my values of family, responsibility and opportunity, and driving forward our political agenda of giving people more freedom and control over their lives.

    And we need to apply this with renewed rigour to every issue, not just some issues.

    That is the essence of the modern compassionate Conservatism I believe in.

    Forget about those on the left who say I shouldn’t talk about Europe, crime or lower taxes …

    … or those on the right who say I shouldn’t talk about the NHS, the environment or well-being.

    That is a false choice and I will not make it.

    All these areas of policy matter to people in Britain today and they are all long overdue for the modern Conservative freedom and control agenda.

    It is the only way we will meet the challenges and make sure of the opportunities of our time.

    It’s what Conservative leaders have always done.

    Churchill with his bonfire of war time controls to set people free.

    Macmillan with his house-building programme to deliver a property owning democracy.

    Margaret Thatcher with her great economic liberalisation, stripping power and control from trade union leaders and giving it to their members.

    We have always applied our freedom and control agenda to the challenges of the day, and that’s what I will do.

    That’s what modern compassionate Conservatism means.

    Meeting all of the challenges of the modern world all of the time, not just some of them some of the time.

    What are these people saying who think the Conservative party shouldn’t be at the forefront of the green revolution – that we should ignore the fact that we face a great environmental challenge and that people care about their quality of life as well as the money they earn?

    That would be a betrayal of the Conservative party and its values.

    And crime isn’t a right wing issue or a left wing issue – it is a daily threat that people – rich, poor, black, white, urban and rural – face in their daily lives.

    That is why I will not ignore the rising tide of crime, but meet it with a proper three dimensional approach to liberate the Police, punish the guilty and strengthen our society and our families.

    That’s modern Conservatism.

    And to those who think, even in 21st century Britain that commitment and responsibility cannot be embraced by all, I say: you will not find a stronger supporter of marriage but why not also recognise the commitment that gay couples make to each other in civil partnerships?

    That’s modern Conservatism.

    And responsibility doesn’t end at the front door of your home, it encompasses businesses as well.

    Someone who believes in responsibility should not exclude big business from the obligation to be a good neighbour and good citizen.

    That’s modern Conservatism.

    And if we believe in opportunity for all – that must really mean for all – and that’s why we must condemn racism and help to create role models within our own party that British black and asian people can aspire to.

    That is modern Conservatism.

    LEADERSHIP FOR THE INTERNET GENERATION

    We will give the leadership we need on the issues that matter.

    We will drive forward our freedom agenda, based on our values of family, responsibility and opportunity.

    This is an agenda that is right for our times and right for the next generation, who above all know the power and the joy of having freedom and control over their life.

    The internet generation, who are growing up in a world of amazing choice and control …and who expect that to be extended, not limited by government and politics.

    Gordon Brown just doesn’t get it. When I look at him one phrase comes into my mind: “Oh ye of little faith.”

    He has little faith in anyone but himself…

    … little faith in the people of this country …

    … little faith in the doctors, the nurses, the teachers, the police officers, any of us at all.

    I do have faith, faith in the men and women of Britain who make this country great and will make it greater still if we give them more power and control over their lives.

    Those are our values, that is our agenda, and this is our time.

    It’s time for change.

    This will be the choice at the election.

    State control from Labour. Freedom with the Conservatives. And we will say to the British people – choose freedom.

  • David Cameron – 2007 Speech on Youth Crime

    davidcameronold

    Below is the text of the speech made by David Cameron, the then Leader of the Opposition, in Darwen, Lancashire, on 22 August 2007.

    Thank you for coming here to listen to me today. I hope that together we can address some of the serious issues that are affecting your community. Two weekends ago, not far from here in Bacup, a young couple were viciously attacked in a skate park, leaving both unconscious. Last weekend a man was stabbed to death here in Darwen, and a 16 year-old was murdered, also with a knife, down the road in Farnworth. These terrible events are part of a national trend – a crisis of order on Britain’s streets.

    A dead father in Warrington, Gary Newlove, who went outside to confront a gang of youths and ended up bleeding to death on his doorstep. 17 dead children in London this year alone. This year Tony Blair suggested that this spate of murders in our cities is a “specific problem within a specific criminal culture” – that is, not part of a wider social problem.

    To me that betrays a deep complacency. In the last 10 years violent crime has doubled. Here in Lancashire, it’s up 140 per cent. Knife crime – mostly robberies committed at knife point – has doubled in the last two years. What Mr Blair’s remark failed to recognise is that violence grows in the fertile soil of anti-social behaviour. And here we have a real and growing problem throughout society.

    The Chief Constable of Cheshire said earlier this week that anti-social behaviour in Britain is “out of control”. And most people agree. A recent poll showed that half of British people feel more frightened on the streets than they did a decade ago. And it’s not just the fear that matters – it’s the damage to our quality of life. Vomit and broken glass in the town centres. Graffiti and litter and urine in the stairways of blocks of flats. Fly-tipping in country lanes.

    Aggression and foul language on the train and the bus … general disrespect… all the little acts of aggression and ugliness that people have to put up with in the course of a day. Is all this an inevitable feature of life? I don’t believe so. Other cities, other countries, have fought the battle with anti-social behaviour, and won.

    New York halved its murder rate between 1992 and 1996 – and it did so by a fixed concentration on low-level disorder. Litter. Fare-dodgers on public transport. Petty vandalism. Aggressive begging.
    The police targeted the minor crimes which cause the community to retreat, and thus cede the ground to more serious criminals. Helped by the police, the community advanced back, and crime retreated.
    Government approach

    So if that is what can be done, how is the British Government tackling the problem? I am often reminded of Robert Peel’s remark: “The test of police efficiency is the absence of crime and disorder, not the visible evidence of police action in dealing with it.”

    The same can be said of Government efficiency. In the last 10 years we have seen a lot of visible evidence of activity – but there is no absence of crime and disorder. Labour confuse activity with action, and initiatives with results.

    They have taken a one dimensional approach to the problem – relying on criminal justice legislation. There has been wave upon wave of legislation. Over 30 criminal justice Bills since 1997. Over 3000 new criminal offences created – one for every day Labour have been in office. Yet in all this, no real steps to reform the police, to build enough prison places, or to reverse the social breakdown which lies at the root of our crime rate. And even on Labour’s own terms – the legislative approach – they have failed.

    Their legislation has been inconsistent, contradictory, and not properly implemented. Take the 2003 Criminal Justice Act. This was presented as the centrepiece of Labour’s attack on crime. Yet one in five of the sections of this Act, and half the schedules, have been repealed in whole or in part or not implemented at all.

    If we are to tackle crime and anti-social behaviour we need a resolute and comprehensive response. Instead of a one dimensional approach – just looking at criminal justice – we need a three dimensional approach. First, the response of the courts. Second, the response of the police. And third, the response of society at large.

    Criminal Justice

    Let me deal with the courts first. Our system of criminal justice is an essential defence against disorder. People need to know that crime is punished – victims need to know it and potential criminals need to know it.

    But at the moment, this basic knowledge is missing. Detection rates are down. Conviction rates are down. And too many convicted criminals either escape prison or are let out too soon.

    The Human Rights Act simply adds insult to injury. The recent judgement in the case of Philip Lawrence’s murderer flies in the face of common sense.

    We believe there is a better way – and that is why we will replace the Human Rights Act with a British Bill of Rights that can better balance rights and responsibilities in a way that chimes with British traditions and common sense.

    My party is currently reviewing sentencing policy and our prison and probation system. Today I want to mention two proposals which we will consult upon as part of this review.

    First, I would like to see magistrates have greater powers over sentencing. One of the many provisions of the 2003 Criminal Justice Act was the power for magistrates to sentence an offender to a maximum of a year’s imprisonment, not the current maximum of six months.

    This power was never actually enacted. Instead Ministers brought forward the point at which prisoners become eligible for parole. Prisoners sentenced to less than 12 months only serve a maximum of 13 weeks. Take off the extra 18 days from the early release scheme, and magistrates’ powers are really limited to little more than two months.

    We need to scrap the early release scheme. And I suggest the Government should activate the 2003 measure, and allow magistrates to hand down sentences of up to 12 months. A 12 month sentencing power would enable the community-based lower courts to get real criminals off their streets.

    The second issue I would like our review to examine is designed to target offenders and potential offenders a little lower down the scale – to stop them before they become the sort of criminal that deserves a prison sentence. The sad fact is that the penalties available to magistrates and judges – even the power of custody – often don’t have the deterrent effect we would wish.

    Common sense suggests that with young people you need to hit them where it hurts: in their lifestyle and their aspirations. In 2000 the Government passed a law allowing judges to disqualify a young offender from holding or obtaining a driver’s license. Characteristically, this power was not actually enacted until 2004 – four years when a law lay on the statute books without being used.

    I want to see this measure more widely used – and I don’t believe it should only be targeted at driving-related offences, as the Government guidance suggests. I’d like to see judges and magistrates tell a 15 year old boy, convicted of buying alcohol or causing a disturbance, that the next time he appears in court he’ll have his driving licence delayed. And then I’d like that boy to tell his friends what the judge said.

    Policing

    Let me move on to the second dimension of a proper response to anti-social behaviour – the policing response. At the moment police officers spend more time on paperwork than they do on patrol. That’s utterly wrong. With its targets and audits and inspections the Government is guilty of wasting police time.

    Only a fifth of an officer’s time is spent on the beat. They have to fill in a form a foot long every time they stop someone. And making an arrest usually involves four hours back at the station. This has to change.

    Earlier this year we published proposals for ending the remote control of policing from Whitehall, freeing forces up to respond to local need and making the police forces of England and Wales directly accountable to local people.

    This agenda is acutely necessary when it comes to anti-social behaviour. For this is a local problem if ever there was one. It simply happens because too many young people in a particular place feel they can get away with it. And because of the way that policing is organised, too often they can get away with it.

    I quoted Cheshire’s Chief Constable earlier. He also said this:

    “The obsession with statistics makes the criminal justice system less effective in tackling anti-social behaviour… They give less room for local police officers to take into account local priorities”

    For “obsession with statistics” read the whole range of central performance management which the police are subject to. I want to see a general bonfire of the targets and measurements which the police have to comply with. I want them accountable to the communities they serve, not to officials in London.
    Community

    Finally, let me outline the third element of the proper response to anti-social behaviour: the response of society itself.

    Some people say that trying to understand the causes of crime betrays weakness. I say that failing to understand the causes of crime is simple stupidity. Those fifteen year old boys who are causing such mayhem in our towns and cities, were five years old when Labour came to power. They mostly had problems even then – but they weren’t criminal, there was nothing that the police or the courts could do. But now they are very much involved with the police and courts, and it’s often too late to stop them.
    Labour failed to address the problems those five year olds had. Let us not do the same to the next generation.

    That’s why a comprehensive approach to crime and disorder must include radical action to restore families and communities, to build up the natural networks which – far more than laws and regulations – stop crime before it starts. How do we restore families and communities?

    As I said recently we can start with schools

    – giving head teachers the power to exclude unruly pupils
    – stopping the closure of special schools, including those that address behavioural problems
    – intervening early and empowering the social enterprises that specialise in turning around children with behavioural problems.

    But as well as policy changes, we need cultural changes.

    We need to make men realise that having children is an 18-year commitment – not a one-night stand.

    We need to make mothers realise that it’s work, not welfare, that offers their family the best future.

    We need to help couples stay together, not drive them apart with the tax and benefits system.

    And we need to make society as a whole – that’s you and me – realise that we all have duties to our neighbours.

    These are duties as compelling as the taxes we pay and the laws we obey. They represent a social responsibility.

    For me the most exciting development that is happening in Britain today is the growth of social enterprises and other voluntary bodies dedicated to social justice. They’re tackling the hardest problems, the things which agencies of the state find it so difficult to get at – debt and addiction, unemployment and family breakdown.

    They are independent organisations, locally based, often amateur in their beginnings but soon highly expert. They are fired by compassion and the spirit of innovation. They work.

    I would like to make a new deal with the voluntary sector. Longer contracts. Less red tape. Full cost recovery. These are the organisations in the front line of the war against crime and exclusion, and we need to give them the weapons to do the job.

    Tough action on criminal justice.

    A radical programme for reforming the police, freeing them from paperwork and making them locally accountable.

    And concerted action to tackle social and family breakdown in Britain.

    This is the programme we need to tackle crime and lawlessness.

    This is the approach to replace disorder and fear on our streets with hope and respect.

    This is way that the modern Conservative party will help to mend our broken society.

  • David Cameron – 2007 Speech on Families

    davidcameronold

    Below is the text of the speech made by David Cameron, the then Leader of the Opposition, on 10 July 2007.

    The report published by Iain [Duncan Smith] and his team today is a landmark in British social policy.

    And I believe it is a clear vindication of this Party’s approach to policy-making.

    Iain’s Policy Group has held over 3,000 hours of public hearings.

    Over 2,000 organisations – most of them non-political – from all over the country, have contributed ideas.

    50,000 people have been surveyed.

    That’s people from broken homes…

    …people who are drug addicts today…

    …and they were asked how they wish they’d been treated by society and by government policy.

    We have engaged the people on the front line, the people who know most about the complex human and emotional challenges of social policy.

    People like Camila Batmanghelidj, whose remarkable work we celebrate with our event here today.

    What a contrast to Labour’s approach.

    We’ve had ten years of government by short term initiative – and as today’s announcement from Ed Balls shows that’s not going to change under Gordon Brown.

    We said we would be different.

    That we wouldn’t rush out policy initiatives to get headlines.

    That we would take the time to understand the big long-term challenges Britain faces.

    And that we would go back to first principles, applying our Conservative values to the problems of today and tomorrow, rather than the preoccupations of the past.

    BROKEN SOCIETY

    Let’s be clear about what most concerns people today.

    This is a great country to live in, but we all know life could be a lot better.

    That’s not just about our economy, though of course a growing economy is vital.

    It’s about our society – the level of crime, the state of the neighbourhood, our relationships.

    I think there’s a real sense of unease about what’s happening to our society.

    I spoke about it right at the start of my campaign for the leadership of this Party.

    Six year olds wandering the streets of some of our cities looking for a hot meal and an adult who will take them to school.

    Eleven year olds beating each other up and filming it on their mobile phones.

    Fourteen year olds getting pregnant…children having children.

    Gangs. Guns. Graffiti.

    It’s all part of the same story.

    And above all, the sense of social unease is reflected in the breakdown of the family, which is for me the most important institution in our society.

    The family has always been the starting point for everything I want to achieve in politics.

    And with my leadership, the Conservative Party will not shy away from saying the things that need to be said if we’re to mend our broken society.

    Well now we have all the evidence we need.

    As Iain’s report comprehensively demonstrates…

    …millions of people in Britain today still suffer from the complex and connected problems of poverty, poor education, unemployment, drug and alcohol addiction and debt.

    And at the heart of it all is family breakdown, the highest in Europe.

    As I argued in my speech to our Party’s spring conference earlier this year, the widely-held sense of social breakdown is the biggest challenge Britain faces.

    In the 1970s, as she prepared for government, Mrs Thatcher focused her energy on fixing our broken economy.

    She did that by applying Conservative principles like freedom and enterprise.

    Today, I will focus my energy on fixing our broken society.

    And just as before, Conservative values will help us through.

    SOCIAL RESPONSIBILITY

    Those values are represented by my belief in social responsibility, not state control, as the best way to solve problems.

    That means trusting people, families and communities…

    …not thinking that government has the answer to every problem.

    I believe that we’re all in this together…

    …that there is such a thing as society, it’s just not the same thing as the state.

    And as I said in my party conference speech last year, this belief in social responsibility, not state control, is the foundation of everything we do and all we hope to achieve.

    It is the big dividing line in British politics today and it is the reason we can confidently offer people change, optimism and hope.

    Because we know there is a positive alternative to Gordon Brown’s top-down, centralizing state control.

    IAIN’S REPORT

    These ideas – the importance of family; the challenge of fixing our broken society; the vital need for more social responsibility and less state control…

    …these ideas are what I am all about.

    And they are what Iain’s report is all about.

    That’s why I’m so delighted and proud that his report is the first of our main Policy Group reports to be published.

    The report of the Social Justice Policy Group does two vital things.

    It outlines, in forensic detail, the scale and the nature of Gordon Brown’s social failure.

    And it presents, in substantive and robust terms, a long-term programme for reversing that failure and fixing our broken society.

    GORDON BROWN’S SOCIAL FAILIURE

    Gordon Brown’s social failure is costing this country over a hundred billion pounds a year.

    But it is not just the financial cost that should concern us.

    It is the cost in wasted lives, dashed hopes and disappointment.

    And the scandal is, this was what the Labour government was supposed to fix.

    Gordon Brown said he wanted to get Britain back to work.

    But after ten years of his policies, five million people of working age – over one in ten adults – are out of work and on benefits.

    Gordon Brown said he wanted to give young people the best start in life.

    But after ten years of his policies, there are over a million young people not in work, education or training – more than in 1997.

    Gordon Brown said he wanted to tackle poverty.

    Yet after ten years of his policies, the poorest people in our society have got poorer – and there are more of them.

    What on earth was it all about, these last ten years, if it wasn’t about this?

    With this report as our evidence we will take Gordon Brown to pieces for his devastating social failure.

    These Labour politicians, they talk about being progressive; they pose as the champions of the poor and the vulnerable…

    …and all the while preside over a Britain where the poorest and most vulnerable sink further and further behind.

    We’ve got among the worst rates of teenage pregnancy, drug addiction and personal debt in Europe.

    It’s often said that over the past ten years Britain has become a more tolerant country, and I welcome that.

    It’s good that we’re more tolerant of social change.

    But I believe we have become far too tolerant of social failure.

    Indeed this government has all too often indulged it.

    Failing to take the tough decisions that address the fundamental causes of social breakdown.

    Clinging to an outdated view of society and relationships.

    And unable to break free from a simplistic, short-term, top-down, centralizing, mechanistic approach.

    That is what we intend to change.

    FIXING OUR BROKEN SOCIETY

    This report provides a rich and constructive menu of options.

    There are around two hundred specific policy recommendations.

    Some would make a bigger difference than others.

    Some of them would cost a lot of money; some would save money.

    Some ideas could be implemented quickly and easily; others are more complex and would take more time and effort.

    The reality of government is that you can’t “have it all.”

    You have to make hard choices between different, sometimes competing priorities.

    I won’t pretend that I can wave a magic wand and solve all our problems overnight.

    I think people have had enough of that kind of politics.

    That’s why I will not make the mistake of instantly picking and choosing policies from this report.

    I want to lead a full and serious debate with the whole country about what the priorities should be.

    I want people to get involved in debating these ideas over the next few months.

    Politics – especially Conservative politics – should be about practical, grass-roots common sense, not top-down ideology.

    That is why we will be asking the British people to get involved in shaping our next manifesto through our Stand Up Speak Up campaign.

    But politics is also about giving a lead, and I can tell you today the elements of this report that I welcome.

    THINGS WE WELCOME

    I welcome the fact that this report does not shirk the big challenges and confronts the issues head on.

    I welcome the emphasis on trusting charities and community groups.

    As the proposals in the report show, we now have the chance to make a decisive break with the Labour approach, where the government gives charities money, tells them what to do, and calls it “partnership.”

    I welcome the report’s thoughtful approach to drugs, and the emphasis on turning addicts’ lives around so they can lead drug-free lives, rather than keeping them hooked on methadone.

    FAMILY

    But above all, I welcome this report’s emphasis on the family, and on marriage, as the basis for the social progress we all want to see.

    My family, and my marriage, are the most important things in my life.

    They matter more than anything to me, and I believe that families matter more than anything else to our society.

    If we get the family right, we can fix our broken society.

    Britain is almost the only country in Europe that doesn’t recognise marriage in the tax system.

    And the benefits system actively discourages parents from living together.

    We have the highest rate of family breakdown in Europe.

    And we have the worst social problems in Europe.

    Don’t tell me these things aren’t connected.

    If Gordon Brown wants to play political games with this, let him.

    If he wants to defend the anti-marriage bias in our tax and benefits system, good luck to him.

    He’s on the side of the past, and on the side of social failure.

    CONCLUSION

    This report shows that only the Conservative Party is serious about tackling Britain’s long-term challenges.

    Gordon Brown has poured billions of pounds into the fight against poverty but the nation’s deepest social problems remain untouched.

    We are the only Party willing to face up to the root causes.

    We understand that unless we do this, we limit not just the opportunities of those trapped in poverty, but the opportunities of everyone else too.

    No-one can isolate themselves from what’s going on in our society.

    Individual opportunity depends on collective security.

    Our society, your life.

    Our support for families and for marriage puts us…

    … on the side of the mainstream majority…

    …on the side of a progressive politics…

    …on the side of change that says…

    We can stop our social decline.

    We can fix our broken society.

    We can and will make this a better place to live for everyone.

  • David Cameron – 2007 Speech on Music

    davidcameronold

    Below is the text of the speech made by David Cameron, the then Leader of the Opposition, on 6 July 2007.

    Introduction

    It’s a great pleasure to be here.

    Let me start by congratulating Geoff Taylor, who was recently made Chief Executive of the BPI, and thanking him for inviting me here to speak today.

    I am sure he did so with some trepidation.

    After all, politicians and music rarely mix well.

    I had a reminder of that the first time I went to the BRIT Awards.
    It was the year when Chumbawamba threw a bucket of water over John Prescott.

    Music Industry Today

    A flourishing music scene plays a huge role in bolstering the vibrancy of our culture and the strength of our identity.

    It plays a huge part in most peoples’ lives.

    This was brought home to me when I went on Desert Island Discs…

    And the agony of trying to condense your love of music into just eight tracks.

    We are a nation of music lovers, buying more music per head than any other country.

    Take any time in recent history, and the music of that period has come to define a generation.

    Punk in the ’70s.

    New Romantics in the early ’80s.

    Britpop in the ’90s.

    Today, British music is undergoing another renaissance.

    Last year, six out of every ten albums bought in this country were by UK artists.

    That’s the best result since 1997.

    And let’s not forget that a flourishing music scene also helps extend our identity and culture abroad.

    We should be proud of the international success newer artists like Amy Winehouse and Lily Allen are having, carrying on the global traditions set by the likes of The Rolling Stones and Elton John.

    Indeed, the UK now accounts for one in every twelve albums sold in the United States.

    When you look at the – albeit rain-sodden – success of Glastonbury, with so many British artists performing to hundreds of thousands of fans in the flesh and more than a million people watching back home….

    ….it goes to show that when it comes to fostering national self-confidence and a sense of belonging, not much compares to music.

    But the music industry deserves its seat at the top table of our national life for another important reason too.

    It’s the reason why I am here today.

    The music industry is a serious and pioneering business.

    It generates billions of pounds for our economy and nurtures some of the most creative talent in our country.

    The facts speak for themselves.

    There are nearly 100,000 people working in the music industry today.

    Retail spending on music was around £1.8 billion in 2006.

    And at a time of technological revolution, you have adapted to changes in consumer behaviour with great ingenuity, launching online and mobile services.

    Matching business acumen with creative instinct, you have shown you have the dynamism necessary to succeed in the 21st century.

    But just as this new world offers exciting new opportunities…

    It also presents incredible challenges.

    And it is two of those challenges that I want to speak about today.

    First, how do we prevent the massive fraud that is carried out against your industry every day through copyright theft.

    And second, how do we protect your investments in the long-term by looking at the issue of copyright extension in the digital age.

    The British music industry is one of the best in the world.

    I want to address these issues to make sure it continues to be so.

    But I also want to talk about a bigger challenge that we all face together.

    That of the broken society of crime, of guns and knives, of broken families, of entrenched poverty…

    And how I expect the music industry, like everyone else, to recognise their responsibility in helping to fix it.

    Anti-Piracy

    Very few people would go into a shop, lift a CD from the shelves and just walk out with it.

    But for some reason, many are happy to buy pirate CDs or illegally download music.

    Look at the figures:

    Around seven percent of the population buys pirate CDs.

    And each year, an estimated 20 billion – that’s right, 20 billion – music files are downloaded illegally.

    This alone has cost the music industry as much as £1.1 billion in lost retail sales since 2004.

    We wouldn’t tolerate fraud on such a massive scale in any other industry….

    ….. so why is there such little will on the part of government, businesses and individuals to confront it in the music industry?

    Copyright matters because it is the way artists are rewarded and businesses makes its money and invests in the future.

    So copyright theft has to be treated like other theft.

    If you cannot get protection from illegal activity, where is the incentive to continue innovating?

    So what should be done?

    The right approach means understanding that like any other crime, this will only be beaten if we all realise the part we have to play.
    By that I mean government, industry leaders like yourselves, businesses, internet service providers and the general public.

    I think government has three important responsibilities.

    First, to establish a more robust intellectual property framework.

    The Gowers Review into the UK Intellectual Property Framework rightly disappointed many in the creative industries by failing to do much more than suggest tinkering at the edges.

    Changes at the margins will not be good enough.

    If we are serious about protecting intellectual property, we need to build a framework that is both flexible and accessible.

    It has to be flexible so it reflects the changing way in which people listen to their music for personal use.

    That means decriminalising the millions of people in this country for copying their CDs onto music players for personal use, and focusing all our attention on the genuine fraudsters.

    And it has to be accessible so smaller companies, who currently find it so expensive to register their intellectual property, have the resources to do so.

    That means working at a Europe-wide level to end the need to translate all documents and applications into all the EU languages.

    The second thing the government should do to fight copyright theft is vigorously bringing offenders to book.

    There have been some recent progress here that we should welcome.

    As a result of the Gowers Review, Trading Standards Officers will now have the power to seize pirate and bootleg CDs that breach copyright law, even if they do not bear infringing trademarks.

    The key is now to make sure we actively find the perpetrators and prosecute them.

    This is a vital step towards the third thing the government should be doing in the fight against copyright theft…

    ….. and that is confronting the blasé attitude that many people have towards piracy and illegal downloading.

    Too many people think it is a victimless crime.

    But they conveniently ignore the links between CD piracy and serious and organised crime.

    I strongly believe that if people really knew the kind of criminality they were funding, sales of pirate CDs in this country would plummet.

    I want to work with figures in the music industry to get the message out that piracy and illegal file-sharing is wrong.

    I know that you already go into schools and educate young kids about this.

    This is something I wholly support.

    So when it comes to combating copyright theft, there are three things that the Conservatives will do:

    Establish a proper framework of intellectual property rights

    Enforce laws more strongly so perpetrators are brought to book.

    And work in partnership with industry leaders to get the message out there that buying pirate CDs and illegal downloading of music is wrong.

    But when in government, we alone cannot do everything.

    We need you in the music industry itself to continue to innovate and make the sort of technological progress that makes pirating CDs more and more difficult.

    We need businesses and individuals to report the sale of pirate CDs or the existence of illegal file-sharing websites whenever they see them.

    Let me also speak about one final responsibility too: that of Internet Service Providers.

    They are the gatekeepers of the internet.

    Some ISPs claim there is nothing they can do to stop illegal downloading of music.

    But last month alone, there were eight sites that hosted more than 25,000 illegal downloads.

    That is clear and visible internet traffic.

    You should know.

    In 2006, the BPI took down 60,000 illegal files from some 720 websites.

    Since 2004, you have brought 139 actions against peer-to-peer filesharing.

    But we cannot expect you to do all the work.

    ISPs can block access and indeed close down offending file-sharing sites.

    They have already established the Internet Watch Foundation to monitor child abuse and incitement to racial hatred on the internet.

    They should be doing the same when it comes to digital piracy.

    Copyright Extension

    So there is much that we could all be doing in terms of taking the fight to copyright theft.

    The second challenge I want to talk today is how we can protect your investments in the long-term.

    In the digital age, whole back catalogues from any decade are available at the click of a button.

    Previously, if you wanted to buy an old album, you would have to trawl through any number of record shops, before, in all likelihood, giving up.

    Now, there is no shop floor.

    The music industry has done so much in making all manner of music from any decade available to everyone.

    And if we expect you to keep investing, keep innovating, keep creating….

    … it is only right that you are given greater protection on your investments by the extension of copyright term.

    After all, PWC found that extending copyright term could boost the music industry by £3.3 billion over the next fifty years.

    But extending copyright term is good for musicians and consumers too.

    It’s good for musicians because it would reduce the disparity between the length given to composers and that granted to producers and performers.

    That’s only fair.

    In the UK alone, over 7000 musicians will lose rights to their recordings over the next ten years.

    Most people think these are all multi-millionaires living in some penthouse flat.

    The reality is that many of these are low-earning session musicians who will be losing a vital pension.

    And extending copyright term will also be good for consumers.

    If we increase the copyright term, so the incentive is there for you working in the industry to digitise both older and niche repertoire which more people can enjoy at no extra cost.

    That’s why, as we move on forward into the new digital age of the 21st century, I am pleased to announce today that it is Conservative Party policy to support the extension of the copyright term for sound recordings from 50 to 70 years.

    A Conservative Government will argue for this in Europe for this change to happen in order to protect investment in the future of the industry, reward our creative artists and generate more choice for consumers.

    Social Responsibility

    So I want to give you real help in the future.

    In the fight against copyright theft.

    By extending copyright term.

    But in return, you’ve got to help me too.

    The single biggest challenge facing this country today is that of the broken society.

    A few months ago, UNICEF released a report on the material, educational and emotional state of childhood in 21 developed nations.

    Britain came bottom.

    It was a wake-up call to us all.

    Take any indicator on childhood welfare, and Britain is among the worst in the developed world:

    Family breakdown…

    Rates of teenage pregnancy…

    Rates of substance abuse….

    Rates of criminal activity.

    How did we get into this mess?

    And more importantly, how will we get out?

    I believe that there has been a failure of leadership at every level.

    Put simply, we all helped break our society…

    …Now we’ve all got to help fix it.

    Of course, that must mean politicians.

    Government can’t bring up children.

    But government decisions have an influence on how children are brought up.

    For too long governments have neglected families, who do so much to bring up children with the right values and with the opportunities that everyone deserves in life.

    That’s why, in Government, we will do all we can to put families first, to back them, and give them the support they need.

    But our broken society is not just about government and politics.

    It’s about our culture too.

    Popular culture is a massive influence on our children.

    A culture, in which of course, music plays an important part.

    That’s why I need your help if we’re going to fix our broken society.

    Many of you sitting here today already do so much to use the power of music to give young kids the opportunity to fulfil their dreams and feel a part of something.

    The BRIT School is a great example of what can be achieved.

    There are other examples across the industry too.

    One is the Nordoff-Robbins Trust, which does great work in providing music therapy for children with disabilities.

    Last year, I made some remarks about rap music.

    I got a letter from one of SongBMG’s artists, Rhymefest.

    He wrote to me saying that not all rappers were responsible for negative messages – some, like him, understood their responsibilities.

    So we met for a cup of tea and what turned out to be a very positive chat.

    An idea called ‘Music for Good’ was born, and it’s already providing opportunities for kids to forge a career in the music industry.

    The simple truth is that music and musicians can influence young people much more than politicians can.

    Our message does not resonate half as much as the messages they hear from their.

    Music is what kids listen to, understand and draw inspiration from.
    So let’s ask ourselves, honestly, what inspiration are they getting from some music today?

    I don’t just mean hip hop and I don’t just mean lyrics.

    Music culture today extends beyond what people listen to on the radio to what they see online, on their televisions and in magazines.

    And in these places, we can often see the celebration of macho-materialism, a hedonistic lifestyle and the portrayal of women as nothing but sex objects.

    We’ve got a real cultural problem in our country; and it’s affecting the way young people grow up.

    It’s an anti-learning culture where it’s cool to bunk off, it’s cool to be bad, and it’s cool not to try.

    This affects what’s happening on our streets and with our kids.

    Educational achievement and aspiration is pushed aside by the dream of instant material gain.

    Now I know this is difficult territory for a politician.

    People could argue that music is just a portrayal of life today, not a cause of the way we live.

    And they argue that other, perhaps older, genres of music are also provocative, including ones that I personally have said I am a fan of.

    After all, it’s not as if Morrissey, Bob Dylan and Johnny Cash have ever shied away from violence in their lyrics.

    And there are those that will go on to say, yes, music can be violent and overtly sexual, but so are movies, video games and television.

    Of course, there is some truth in these arguments.

    But let’s ask ourselves some simple questions:

    Does music help create, rather than just reflect, a culture?

    Yes.

    Is some music, are some lyrics, are some videos and are some artists, helping to create a culture in which an anti-learning culture, truancy, promiscuousness, knifes, violence, guns, misogyny are glorified?

    Yes.

    Can we see the effects of this on our young people, in our schools and on our streets?

    Yes.

    Do we think we can combat this culture by government policies, policing and criminal justice alone?

    No.

    If change in our culture is necessary…and it is.

    If we are all responsible…. and we are….

    Then we all need to take our responsibilities seriously.

    Put simply, we have to acknowledge that all of us – as politicians, as teachers, as parents, as television producers, video game manufacturers and yes, as record industry executives – need to understand our specific responsibility in not promoting a culture of low academic aspiration or violence but instead to inspire young kids with a positive vision of how to lead their life.

    That’s why I am not calling for censorship, legislation or the banning of content.

    I am calling on you to show leadership, exercise your power responsibly and to use your judgement.

    I know music plays a small part in all this.

    But I also know, unless we all fulfil our responsibilities, however small, we cannot hope to confront the challenge of our broken society.

    Already, schemes like rhyme4respect, which encourages positive lyrics in music, is leading the way, showing that the music industry recognises its responsibility and takes this issue seriously…

    I really do welcome that…

    … but I think we all know we need more.

    So when it comes to helping fix our broken society, it is not enough for the music industry to sponsor community projects….

    You can make a difference by providing positive role models for young kids to look up to, draw inspiration from and aspire to be.

    Let me put it another way.

    Would it make any sense to say to media companies that you can simply meet your obligations for social responsibility – to be a responsible corporate citizen – through community projects which had nothing to do with your actual product?

    I know such projects are vital and companies like those here today do so much to channel your charitable energy towards giving opportunities to the young.

    But imagine if we took this approach with McDonalds or a mining company.

    Is it really enough to say that you can put anything you like in your burgers, or do anything you want to the environment when digging for precious metals…. “That’s ok, as long as you are doing some other charitable things at the same time” ?

    Of course not.

    Social responsibility is not just about community projects where you use your profits to do good, it’s about how you make those profits in the first place too.

    Conclusion

    I began by showing what I wanted to do to help make sure that the music industry in this country continues to be one of the world’s greatest.

    That’s why I want to work with you to combat piracy and illegal downloading.

    That’s why I want to extend the copyright term to 70 years.

    But in return, I want to see more from you….

    … using the influence you have over young children to help fix our broken society.

    Britain’s music scene has had an incredibly proud past.

    Together, we can ensure it has an even brighter future.