Below is the text of the speech made by Iain Duncan Smith, the then Leader of the Opposition, at the launch of the Conservative Consultation Document on Health on 5th June 2003.
The Labour Government is dangerously divided.
And it’s got its priorities hopelessly wrong.
That’s as plain today as it will ever be.
We are not be going to spend today talking about the euro.
We are going to talk about things that are already damaging the British people’s quality of life…
Day in, day out…
The public services on which they depend — and which are now failing them badly under Labour.
But the Government are most certainly talking about the euro today.
And they’ll still be talking about it tomorrow.
And for a long time after that.
Even as – we – speak, Mr Blair and Mr Brown are lining up their coalitions, on either side of the Cabinet table, ready for a battle over the euro — in which the losers will be the British people.
While the Government are busy talking about something people don’t want — the euro — we will be talking about something they do want – better healthcare.
This distracted and divided Government should be focusing on the things that really matter to the British people.
The British people want better public services.
Public services that work – and work well.
We’ve already begun.
For the past two years, we have been conducting the most wide-ranging policy review for a generation.
A policy review focused on making the public services better.
We have travelled – at home and abroad – learning from whatever works best for people.
So last month, we promised to scrap Labour’s university tuition fees – their tax on learning.
Today, Liam Fox and I are launching fresh, exciting proposals designed to give British people the better healthcare they need and deserve.
Today begins a full consultation with patients and professionals on something that will make a real difference to people’s lives.
The ‘patient’s passport’ is our plan to give people real choice over the health treatment they receive.
This will be a fair deal for patients.
A fair deal for everyone on healthcare.
Our proposals will mean…
Fairer healthcare, with no-one left behind, as we expand choice to everyone, not just those who can afford it.
Fairer healthcare, with no-one held back, as we recognise the contributions of those who pay for their own treatment.
Last year, a staggering number of people – 300,000 – paid for their own treatment.
Most of them were pensioners — desperate people, who had suffered for too long.
Under our proposals for a Patient’s Passport, everyone in the NHS will be able to get treatment at the hospital of their choice, free of charge.
And people who choose to go outside the NHS for their treatment will be helped, not penalised.
Our proposals would also mean…
Better healthcare for everyone, with choice driving innovation and excellence.
And more healthcare, as we expand the capacity of the health system in Britain.
Our proposals would mean nothing less than a revolution in healthcare.
We will preserve all the founding ideals of the NHS.
Healthcare, according to your need not your ability to pay, and free at the point of delivery.
But, for the first time in its history, the NHS would become a truly national health service — embracing our belief that healthcare is first and foremost about the patient.
Compared to that, everything else is surely secondary.
Our plans for a patients’ passport, combined with our plans to shift power from politicians to doctors, nurses and hospitals, will deliver a fair deal for everyone on healthcare.
We care enough to find out what people really want, and we are open-minded enough to find out what really works.
That’s why last month we promised to scrap Labour’s university tuition fees, abolishing their tax on learning.
That’s why today we are proposing to give every patient in Britain a Patient’s Passport, making real choice available to all, not just those who can afford it.
We have the courage and vision to commit Britain to a better course.
Today, we are taking forward our fight, on behalf of the British people…
For better public services — and a fair deal for everyone.
A fair deal for people who find themselves paying higher and higher taxes, but not getting the improved public services they need.
We will give them those better public services
…public services where no-one is held back…
…and no-one is left behind.
A fair deal for people who deserve better healthcare.
A fair deal for people who deserve a better education.
A fair deal for people who have been made to wait and suffer too long.
Below is the text of the speech made by Iain Duncan Smith, the then Leader of the Conservative Party, to businessmen in the North East on 20th February 2003.
Thank you for inviting me here today.
It’s a great pleasure to be here in Newcastle — and a privilege to be among you.
This opportunity to see what you do at Rite-Vent has been very valuable.
So let me say thank you, first, to the Directors and the workforce for making me so welcome and for taking the time to show me around.
And let me also take this opportunity while I’m here in Newcastle to say congratulations to Sir Bobby Robson and his team for the excellent result on Tuesday.
I wish them well as they progress in the Champions League and – as a keen Tottenham fan myself – I hope we’ll be joining them there next season.
Football is of course one of the things for which Newcastle is best known.
A tradition of manufacturing and industry is another.
But these are tough times for British manufacturing – and it’s companies like Rite-Vent which — in spite of the higher taxes and over-regulation Labour has imposed – are holding the line.
Last year manufacturing output in Britain fell by 4% — the sharpest drop year-on-year for a decade…
Manufacturing investment has suffered its sharpest drop for 20 years.
And the number of jobs in manufacturing has being falling every month for the past 4 and a half years.
In fact, under Labour we’ve been losing 303 manufacturing jobs every day.
Last Friday, the Chancellor said the economic boom had not come about by accident.
Britain’s manufacturers would say it hasn’t come about at all.
This gap between rhetoric and reality is the trademark of New Labour.
So what has happened under the New Labour government should come as no surprise –
New Labour was built on rhetoric.
And now we have the gap.
Labour promised innovation – and instead they stifled it.
They promised to support business – and instead they turned their backs on it.
They promised more choice – and instead they restricted it.
They promised to improve our public services – and instead they have led those services into spectacular failure in every important sector –
– our schools and universities,
– our hospitals and surgeries,
– our railways, our roads and our airports.
– 30,000 children leave school with no GCSEs.
– 60,000 care home places gone.
– longer commuting times than anyone else in Europe.
All the work they did in opposition to convince people to give them a chance…
All the good-will they were given in their first four years in power…
All the benefits of a strong economic inheritance…
Are gone…
Squandered.
Instead, we have had six years of waste and incompetence.
Take the New Deal for example:
Supposedly one of this Government’s crowning achievements, but now we see it as an expensive failure. Thousands of young people have to go through it 3 times before they find a job. Many of those who have jobs would have found them anyway.
And all this at a cost of £11,000 for every person on the scheme.
Or consider this Government’s approach to pensions:
They forced companies to take on stakeholder pensions – but the Insurers Association says that 90% of them have no members.
Worst of all, Gordon Brown imposed the ultimate stealth tax – a £5 billion a year tax raid on pension funds, which he foolishly sought to justify by pointing to the buoyancy of the stock market which he inherited from the Conservatives.
We all know what has happened to the Footsie after six years of Labour government. It has halved. But the Chancellor’s tax grab has made the prospect of retirement a source of fear and anxiety for millions of hard-working people.
Incompetence on this scale is extremely damaging.
New Labour promised to be different. They pretended to be Conservative even.
But you can’t be Conservative when your instincts are wrong.
I believe we are witnessing the slow death of New Labour.
This may be good news for those who were always suspicious of it – those on the Labour left who were prepared to keep quiet so long as they were in Government.
But it is bad news for the people of Britain who will be made to endure the pain.
Because as Labour reverts to type things are not going to get any better.
The Government is committed, now, to —
in the Chancellor’s own words –
‘vast increases’ in spending over the next few years.
From this April, the Labour Government will be spending £50 million an hour – that’s almost 50% faster than the rate of spending in 1996-97 before they came to power.
By the time of the next election, spending on the Health Service alone will have risen by 70% in real terms.
But if the record of this Government is anything to go by, then that profligacy will do little good for the lives of ordinary people.
But I’ll tell you where it does harm – and that’s when Government takes more and more money from the people, then spends it badly, and wastefully.
And boy, has Labour been on the take!
Since 1997 they’ve raised the national tax bill from £270 billion to £380 billion.
That’s £36 a week more for every man, woman and child in the United Kingdom . . .
Business alone has paid £47 billion in extra taxes . . .
And if all this spending had led to results then some may say it was worth it.
The problem is, it didn’t.
We didn’t get the results.
We’ve got little to show for the money we spent.
Take the health service.
A 22% increase in spending in the past two years alone . . .
For just a 1.6% increase in hospital activity.
So where’s the money going?
Well, for the first time ever, the NHS has more administrators than it has beds.
What a magnificent achievement.
They told us they’d create jobs – and they have.
The trouble is – you’re paying their wages.
Now — because they’ve failed to keep their promises — taxes are going up again.
So this April they’re putting up National Insurance contributions.
They’re taking another £4 billion a year from employers – which, for a company like Rite-Vent, means an added cost of around £10,000 a year.
And for a typical Rite-Vent employee it means another £100 a year.
This is nothing short of a tax on jobs – plain and simple. Overall, it’s the equivalent of an effective 3p increase on the basic rate of tax.
And what do Labour say this new tax increase is for?
To fund their new spending on the Health Service,
This in spite of a promise by Gordon Brown not 15 months ago that
“there will not be one penny more [spent on the Health Service] until we get [the] changes [that] let us make reforms and carry out the modernisation the health service needs”.
And have we got any of those changes yet?
Not if we’re to believe the Health Secretary.
Mr. Milburn told health professionals behind closed doors this week that he fears these additional taxes will be wasted.
So now we have it.
The reforms aren’t in place.
The Health Secretary thinks the new money won’t make much difference.
And the new money is simply going to go the way the same way as before – to waste.
Well, if that’s the case – and we have absolutely no doubt that it is – Indeed the government is now admitting privately what we have been saying in Parliament and on public platforms up and down the country for many, many months! –
If that’s the case . . .
Then the Government must think again, before more damage is done and scrap this jobs tax now before this spending goes the same way as the last.
I say again – we are witnessing the death of New Labour. . .
And the resurrection of Old Labour . . .
The whole, hopeless cycle of tax-and-spend-and-fail.
We have to break that cycle.
And we have to make up a lot of lost ground.
The stock market has touched a seven-year low.
For many people, retirement is receding further and further into the distance.
And those already in retirement are struggling.
Looking ahead —
The latest Mori poll of Business Confidence says 87% of you think economic conditions will be the same or worse.
The consumer boom is petering out as house prices appear to be stagnating
And consumers are confronting a very large debt hangover.
If we are to have any chance of making up that lost ground, then Britain needs businesses like yours to thrive. . . and thrive. . . and thrive!
And it starts by saying – enough is enough.
I’ve been travelling around the country every week for the past few months – and that’s what people say to me . . . enough is enough!
Enough tax.
Enough spend.
Enough failure.
Enough spin.
And enough time to deliver the results they promised.
And in consequence, enough is enough of this Labour government.
It’s time for a change.
It’s time to think differently — and do things differently.
And that will be our approach as a Conservative government.
Keith Joseph said something I have never forgotten —
“There are limits to the good governments can do, but there are no limits to the harm they can do.”
What he was doing was expressing, essentially, why we are, by nature, a party of lower tax.
It flows from our belief in smaller government, greater individual liberty, and greater personal responsibility.
It flows from our belief that governments should measure success not by how much they spend of your money, but how well – and how carefully – they spend it.
And our belief – also — that low-tax economies are more efficient, and more competitive, than high-tax economies.
A Conservative Government will not be trying to second-guess everything you do.
A Conservative Government won’t be over-interfering in the way you run your businesses.
And unlike the Labour Government, we mean what we say when we say we’ll cut red tape.
Most importantly, because we are determined to spend your money more carefully, we will take a different approach to the public services.
Last year, when I spoke of my belief in low taxes, Labour and the Liberal Democrats accused me of wanting to destroy public services.
They refused to admit that a lower tax regime means a healthier economy.
They could not grasp that it is possible to have both lower taxes and better public services.
They baulked at the fundamentally simple and sound proposition that by changing the way we run and deliver those services, we can cut waste and improve delivery.
And now, in desperation, Tony Blair ha resorted to the Labour lie that we would cut front-line services by 20 per cent. I call it a lie because it is fundamentally untrue. We are committed to our core strategy of public service reform, widening choice, rooting out waste and keeping taxes low.
What sets us so completely apart from Labour is that we understand how important it is to have a holistic approach.
Without strong businesses, you cannot have a strong economy.
Without a strong economy you cannot have strong public services.
Without strong public services, you cannot have strong businesses.
And without all these things you can’t have a strong country.
My friends, we are still some way out from an election.
Between now and that time, I and my party intend to fight this Government’s dangerous and damaging anti-business policies.
And when the election comes,
I believe you will fight for a Government that knows the real meaning of support for business, and why that is so important to Britain.
Below is the text of the speech made by the then Leader of the Opposition, Iain Duncan Smith, to the Welsh Conservative Conference on 24th May 2002.
I have spent much of the last three months looking first hand at the symptoms of political failure.
I have seen evidence of drug abuse – lying alongside evidence of children playing.
I have seen poverty – not just a lack of money, but of hope and ambition.
I have seen the evidence of crime – graffiti on walls of abandoned houses where people have lost respect for their own community.
The failure of politics is evident here in Wales.
We must be a Party that speaks for vulnerable people as well as for the rest of society.
And we are becoming that Party again.
Here in Wales you’re leading the way.
You have shown how the interfering policies of the Labour and Liberal Democrat parties are letting these people down.
If Labour have achieved anything through their devolution settlement, it is to expose the myth that they are on the side of people in Wales.
For they are now in government in Wales, propped up by their Liberal Democrat allies.
The Liberals claim to be the real opposition to Labour in Westminster. They stood on their manifesto here in Wales.
Yet at the very first sniff of power they have rolled over. Their cynicism takes your breath away.
So where before Labour and the Liberals blamed all Wales’ problems on the Conservatives, they now have to take responsibility themselves.
The Labour Party has to explain why hospital waiting lists in Wales are spiralling out of control.
Labour politicians have to explain why one hospital in South Wales has the longest waiting lists in the developed world.
When parents and children look at their crumbling school buildings and ask why they are being educated in such appalling conditions, they will remember that Labour told them it would all be better after devolution.
Of course, it is not.
Because Labour in Cardiff have the same instincts as their colleagues in London.
Rhodri Morgan may not call himself ‘New’ Labour, but beneath the surface the same instincts and prejudices remain.
Centralised control, rather than devolution to the front-line.
Stifling innovation, rather than encouraging initiative.
Outdated dogma, instead of new ways of thinking.
For the past five years Labour has spent its time centralising our public services with targets and ten-year plans. It has drowned individual initiative in directives and dogma.
British People deserve better than this. Wales deserves better than this.
Yet Labour plough on regardless. When something doesn’t work they throw more money at it. They are the ultimate proponents of ‘one-more-heave’ politics. They believe everything is basically fine, as long as we push a little bit harder everything will fall into place.
Wales spends more as a nation on health than Holland does, but waiting lists are longer now than they were in 1997. In Holland they get the right to treatment 4 weeks after seeing their GP.
This approach is delivering neither fairness nor efficiency.
In this new century, we are still trying to run our public services in the same way we did after the Second World War.
The result is disastrous – and vulnerable people suffer the most.
When the health service fails, it is the vulnerable who suffer. It is the elderly person who cannot be discharged from their hospital bed because there is no care home for her to go to. It is the small child left waiting hours in A&E. It is the person who has to spend their life savings on a heart by-pass operation in South Africa.
When the transport system doesn’t work, vulnerable people can’t get to work or seek out training opportunities. Pensioners can’t access health care or even do something as simple as their shopping.
When schools are struggling to find enough teachers, it is children who suffer the most.
After five years of undermining the authority of teachers in the classroom and the ability of heads run their own schools, is it any wonder that so many people are turning their backs on the profession?
These are all problems politics is supposed to help solve. Instead, Labour’s politics is making them worse.
Conservative solutions
So it falls to Conservatives to provide the solutions where Labour have failed.
And our solutions are based on a simple message – Trust People.
Trust people to choose what’s best in education.
Trust people to know what’s best for their community.
Trust people to run their own lives.
It is a concept that’s alien to our opponents.
It’s not just Labour. Liberal Democrats don’t even trust people enough to tell them the truth.
At one press conference in London during the General Election last year. Charles Kennedy said that, because of their involvement in the National Assembly: ‘Rather than just promising what we would do if we were elected, we can show you what we have done where we are in power’.
And what have they achieved?
Hospital waiting lists – up.
Teacher shortages – up.
Manufacturing job losses – up.
And what about Plaid Cymru?
Well, what about them?
They are increasingly becoming an irrelevance. Their only concern seems to be whether their former leader should stand for the Assembly again.
Frankly, I think that says more about them than anything else. While everyone else is discussing the future, they’re debating the past – or whether Merthyr should host the Olympics.
People in Wales cannot look to them for solutions to today’s problems.
So it falls to us. Wales has always been our priority. That is why I recreated the position of Shadow Secretary of State for Wales and that is why I asked Nigel Evans to join me in the Shadow Cabinet to lead the charge.
That is why I asked Nick Bourne to come to Shadow Cabinet and show us how his leadership in the assembly is proving so efficient.
And that is why I asked Jonathan Evans to come to Shadow Cabinet to show how he is battling for us in Europe.
Three big hitters – three big targets – Labour, Liberal Democrats and Plaid Cymru – I almost feel sorry for our opponents.
Next year’s Assembly elections will be a referendum on Labour’s record.
But they will also be a judgement of how much we’ve changed as a Party.
It is not enough for us to wait for Labour to lose the trust of the people. We have to ensure that people trust us again. We have to be a credible alternative. Thanks to Nick Bourne and his team, we are providing that alternative.
If it had not been for Conservatives in the National Assembly the decision to spend millions of pounds on an unnecessary new building would have gone largely unopposed.
The self-indulgent waste of time and money on new logos and titles would have gone unnoticed.
Most important of all, the Administration’s decision to spend vast amounts of money while utterly failing to improve public services in Wales would go unchallenged.
Without us, there would be no opposition at all in the Assembly. And that’s why I want to see many more Conservatives elected to serve in Cardiff Bay next year.
The Assembly elections must be the springboard for our fight back to win back Welsh seats in Parliament.
Because I am an unashamed Unionist.
I am a proud Scotsman by birth, but I was educated in Wales. Anglesey, just up the road from here, was my home for some of my formative years.
I went on to serve in Northern Ireland and now I represent a seat from an English constituency. So I know that the things which unite the constituent parts of the United Kingdom vastly outweigh the things that divide them.
And I know we need to win again in Wales.
We are already attracting support from a wider cross-section of society than ever before.
You need look no further than here in Conwy.
Your candidate for next year’s elections here is Guto Bebb.
He is the former Chairman of Plaid Cymru’s Caernarfon constituency. He even ran Dafydd Wigley’s election campaigns. But he said the Party’s lacklustre performance in the National Assembly, and its internal divisions, led him to join the Welsh Conservatives.
He is an excellent candidate, and I look forward to seeing him serving under the Conservative banner in the National Assembly.
And they’re not just coming over to us from Plaid Cymru.
Last November we welcomed Dan Munford into the Conservative fold.
Dan used to be a Liberal Democrat. He worked for them as a researcher, he even stood as their candidate for Parliament, but he came to conclude that the Party was ‘neither liberal nor democratic’.
He is an excellent addition to our team.
And just last month we welcomed back a former Conservative supporter. Heather Douglas was a Liberal Democrat councillor in Cardiff, but she has recognised that the Conservatives are the only principled opposition party in Wales.
We are glad to have her back.
The choice that these people and other like them have made to join the Conservative Party is proof that we are changing.
But as we change we will remain true to our principles. We do not have to ditch all that we believe, like Labour, to win the trust of the people again.
We want to help people be more independent of the State; we want to reduce the power of the State over people; to increase the choices available to citizens; to provide greater security for our fellow citizens; and we want to remove obstacles to enterprise, both at home and abroad.
Conservatives believe in a government that devolves power and responsibility to local communities.
A community can consist of many things – families, local schools, charities and places of worship, but it cannot consist of government taskforces and committees, run by politicians from Whitehall or even Cardiff.
This morning I visited a day centre for people with learning disabilities right here in Llandudno. It helps people cope with everyday tasks, it gives them an opportunity to take part in sport and offers the chance for them to work.
It isn’t run by Central Government or by the Assembly, but by local volunteers: people from the community supporting the community, helping vulnerable people who are too often left behind.
It is in such places that problems are confronted and overcome.
Across Wales, there are voluntary groups working in local communities to improve things like housing, childcare and the environment. There are 250,000 voluntary organisations in Wales, and hundreds of thousands of volunteers.
They are the glue that binds our society together.
Government cannot solve every social challenge but government can support these institutions and the values that energise them.
That’s why our manifesto for next year’s Assembly elections will contain practical ideas to support these groups – families, charities, social entrepreneurs.
And it will contain measures that will deliver real change in our public services.
I’m not talking about Labour’s tinkering reforms – a lot of spin and disruption, ending up with more of the same.
Labour want to replace 5 health bodies with up to 37 new organisations.
This is madness.
We want to replace 5 Health Authorities with one all-Wales health commissioning organisation.
That way we can keep politicians out of the day-to-day running of the NHS and let doctors and nurses get on with what everybody wants them to do: treating patients.
On education, we want to see more money going directly to the schools, rather than being siphoned off by politicians and bureaucrats.
On crime, we don’t just want to see more police. More police filling in more forms helps no one.
When I met Mayor Giuliani recently, he told me how he’d cut crime in New York by 60% in the past nine years.
It wasn’t by concentrating on the Mr Bigs. It was by putting more police where they belong out on our streets.
That’s what we need to work towards in this country.
These are the policies that will turn public services into services that the public want.
And people want the Welsh economy to be competitive again.
Nothing marks out the true instincts of the Labour-Liberal Administration more than its hostility to business, in this they take their lead from Westminster.
What is the £4bn tax on employers’ National Insurance if it isn’t a tax on jobs and wealth creation?
What is the extra £214 than an average worker will pay a year in tax on their income, if it isn’t an increase in income tax?
These measures say a great deal about what the Government really thinks about enterprise and working families.
And the recent speculation about the Euro says a great deal about their priorities for the country.
The Prime Minister has been dropping hints at a referendum on the single currency next year.
At a time when everyone is concerned about the state of their schools and hospitals, when we feel threatened by the rise in violent crime, he should be focusing on these issues instead of playing games.
If the Prime Minister wants Britain to adopt the single currency, he should say so, name a date and let the people to decide.
When he does, we will campaign vigorously for a ‘no’ vote.
Then get back to the urgent task of making this country fit for the century we are living in.
Helping the vulnerable means supporting communities and in Wales there is one community which has been particularly hard hit by Labour’s policies – the countryside.
Agriculture is central to the Welsh economy and to the Welsh way of life, but it is in a state of crisis.
Foot and Mouth, Bovine TB and the restrictions on the movement of livestock, Welsh farmers have received one slap in the face after another.
Labour’s refusal to sanction a full public inquiry into the foot and mouth is nothing short of a scandal.
And no-one should ever forget that the Liberal Democrats in Cardiff voted against our calls for a public inquiry. Shame on them.
Nor should anyone forget that it was Jonathan Evans, the leader of our MEPs in Strasbourg, who led the calls for a public inquiry there.
He stands up for the interests of Wales in Europe, not for the interests of Europe in Wales.
Of course the countryside is not simply about farming.
People in rural areas rely on local schools. Too many of them are in a poor condition in Wales and too many suffer from a lack of teachers.
Rural people need access to family doctors and hospitals. But they need to be able to get to them. High fuel costs continue to hit hardest in rural areas.
So does the decline in the postal service. Which is why I promise you this: whatever else happens, our commitment to universal postal delivery remains total.
These are the problems that Welsh politicians should be tackling. The Assembly would be held in higher esteem if it faced up to these issues rather than talking about banning hunting.
Welsh Conservatives face the same challenges as Conservatives everywhere.
We need to re-engage with people. That means talking about the things they want to talk about.
It means changing not who we are but the way we have been seen for far too long.
Here in Wales that process has already begun.
We are addressing people’s concerns. We are developing policies to tackle the problems they face.
Next year we have the chance to put those policies to the test.
I know that in Wales we have a team who can rise to the challenge ahead.
The tide will turn, but when it does we have to be ready.
Ready to give the people the public services they deserve.
Ready to give local communities the support they need.
Ready to make life better for all the people in Wales.
The below speech was made by the then Leader of the Conservative Party, Iain Duncan Smith, on the 21st November 2002. The speech was made as the Nicholas Ridley Memorial Lecture and held at the Portman Hotel, Portman Square, London.
There are three popular prejudices about modern politicians.
The first is that they have no interests outside politics.
The second is that they are all spin and no substance.
And the third is that they are desperate to please whoever they happen to be talking to at the time.
Well, none of these were true of Nick Ridley. It is a real privilege to give this lecture in his honour tonight.
It would be an understatement to say that Nick liked to speak his mind.
He was that rare creature in Conservative politics of the 1980’s, a dry who was a patrician dry.
He was once emerged from a debate when he was a Foreign Office Minister, having been needled by a Labour MP, and muttered under his breath: “He was my fag at Eton, I wish I had beaten him more.”
The object of his wrath was – Tam Dalyell.
Nick was a younger son, and knew he was never going to have a large and comfortable inheritance.
Instead, he was going to have to make his own way in the world.
Perhaps this is why he seemed to see himself as an outsider.
He genuinely saw himself as fighting for the little man, struggling on a modest income, who couldn’t afford high taxes. He loathed political correctness.
And Nick, of course, was gloriously and triumphantly politically incorrect.
This is what he wrote in his memoirs, “My Style of Government” –
“The French glory in making their lives as enjoyable as possible: I sometimes wonder whether the lobbies in Britain don’t glory in trying to make other people’s lives as unenjoyable as possible.
“We are told we must eat less fat, less cholesterol, fewer calories and all the rest of it. Growing numbers of people want to ban this, that or the other blood sport.
I hardly dare mention smoking; smokers, of which I am one, are treated like outcasts.”
Gordon Brown said that when Nick was a Minister his idea of the perfect office was an empty in-tray, an empty out-tray…and a full ashtray.
But Nick’s eccentricities were based on a practical judgement of what would worked and what wouldn’t.
There was a time when he was in Brussels to attend a meeting of the Council of Ministers.
The night before, he and his team of officials had a briefing meeting in his hotel room over supper, but the room was overheated.
The air conditioning was out of control and the windows were sealed, much to Nick’s fury.
So after the team of officials had left, he removed all his clothes before starting to work on his briefing papers.
At that point the waiter arrived to remove the remains of supper to find the British Minister naked at his desk, just like a scene from Monty Python.
Nick’s quirkiness and angularity, his originality and outspokenness, reflected the character of a man who had lots of interests outside politics – more than I can possibly do justice to.
Engineer, architect, writer and cook, Nick helped create one of the finest water gardens in England in his own house with his own hands, and was a distinguished painter of watercolours – one of the most gifted artists in the Commons since Winston Churchill.
He also designed the gates that now stand at the end of Downing Street a few feet away from the Cenotaph.
Apparently, there had been a bureaucratic muddle about the construction of the gates. Nick was present during a Cabinet discussion about how to resolve it.
“If my grandfather could design the Cenotaph,” he said. “I can surely design the gates.”
And he did there and then. It took him twenty seconds.
The breadth of Nick’s interests helps to explain what for me was the most important aspect of his public life.
The last century was shaped partly by those who believed that politics is the be-all and end-all of human existence.
By Lenin, Hitler, Stalin, and Mao-Tse-Tung.
By the ideologies of fascism, communism, and socialism.
Who dreamed, as T.S.Eliot once wrote, “of systems so perfect that no-one will need to be good”.
These ideologies had their differences.
But they had one belief in common.
That government could bring about the satisfaction of all human desires.
As this century begins, those over-arching systems have collapsed into a heap of rubble.
Taking with them the lives of millions of innocents.
The belief that government can make people’s lives perfect, was anathema to Nick.
Like Sir Keith Joseph, his great contemporary, he believed that there were limits to the good which government can do, but almost no limits to the harm.
And like Sir Keith again, he played an irreplaceable part in the Conservative revolution during the opposition years of the 1970s, which prepared the way for the Thatcher governments of the 1980s.
This group, Conservative Way Forward, was founded to keep the spirit of that revolution alive, and drive it into the future.
And it can truly be said that Nick Ridley always looked for the conservative way forward.
Now, once again, we are in opposition.
Again, we seek to serve the British people in government.
However, times have changed.
During the 1980s, people were menaced by double-digit inflation, trade union power and the Cold War. Their overriding concern was their standard of living.
But today, people are confronted by the declining quality of our public services. They face queues for treatment in hospitals or for places in good schools. They have to cope with trains that don’t arrive on time and roads that are clogged by traffic. Even their pensions are in peril.
They are alarmed by the rise in violent crime, anti-social behaviour, disorder and incivility. In short, their overriding concern is their quality of life.
Times may have changed, but our beliefs should not.
They are just as relevant today as they were in the 1970s and 80s.
The Conservative Party needs to take the Conservative Way Forward which inspired Nick Ridley and won us 18 uninterrupted years in office. Once again we must ignite a Conservative revolution in opposition.
And it is very clear what that revolution needs to overthrow today.
It is New Labour’s ever-growing centralised control of government, civil society and people’s lives.
Because it is centralisation which grows those queues for hospital treatment and places in good schools.
Centralisation which allows anti-social behaviour to rampage unchecked.
And centralisation which is damaging our quality of life in Britain.
It’s not just that we need less government.
We need more responsibility exercised at a local level.
I don’t just mean by that giving back more powers to local government.
I mean enabling people to take power themselves.
It’s what I call community government.
Tonight I will tell you how a Conservative Government, drawing on the concepts which inspired Nick Ridley, would help to make this idea a reality.
But first, let’s look at how the problem has grown.
There is a cycle in modern political life.
The media identifies a problem.
People demand that the problem must be solved.
They call upon central government to solve it.
So central Government forces more laws and rules and regulations through Parliament, often without proper scrutiny.
Those laws leave central Government with more power to intervene and interfere.
Because politicians at the centre feel they must keep control.
But the problem remains unsolved.
Indeed, it often gets worse.
People get frustrated with government and fed up with politicians.
Which leads to more media calls for action…
…and the cycle begins once again.
Here’s an example from the Queen’s speech.
There are media reports of bed-blocking in hospitals.
Local authorities haven’t enough places in care homes for those who are being discharged.
People demand that bed-blocking must end.
So New Labour proposes in the Queen’s Speech to fine local authorities wherever there is bed-blocking.
Of course, local authorities didn’t cause the bed-blocking.
The cause was this Labour Government.
By burdening care homes with new rafts of rules and regulations and red tape.
These rules and regulations have helped to close 60,000 care home places since New Labour came to power.
Places which would otherwise have been available to patients leaving hospital.
And which now aren’t available – hence the bed-blocking.
It is a perfect of example of central government first causing a problem and then punishing someone else for it.
And, in doing so, making the problem worse.
Because, you see, if local government is fined because beds are blocked, the consequence will be cuts in services or higher council taxes or both.
Causing people to be even more fed up and frustrated.
This is consistent with what New Labour is doing everywhere.
Five years of New Labour have seen five years of greater government power – an ever-extending web of centralization and control.
When it comes to decentralisation, their slogans are “constrained discretion” and “the new localism”.
They promise the roar of a lion – but deliver the squeak of a mouse.
Our teachers, doctors, nurses and police are being steadily buried beneath a blizzard of targets, directives, indicators, circulars, contracts, inspections, performance agreements and best practice demands.
For example, central government sets waiting times for hospital appointments.
And targets for a 50 per cent pass rate at A-C grades in GCSE exams.
But in setting artificial targets, New Labour distorts good practice.
And demoralizes doctors, teachers, nurses, and police officers at the same time.
In hospitals, urgent operations are put off so that routine operations can go ahead – because New Labour’s targets must be met.
In schools, fewer students in inner city schools gain any GCSEs at all – because New Labour’s targets must be met.
Although New Labour are incapable of meeting their own targets themselves.
New Labour has failed or is on course to fail nearly 40 percent of targets it set in 1998.
And it has failed or is on course to fail 75 percent of targets it set in 2000.
More departmental target performance figures are supposed to be released later this month. We expect more slippage, more watered down targets, more failures.This is the Labour Government’s classic combination:
More spending and more centralisation without any real reform is failing.
Productivity in the public services is actually falling.
In the Health Service, for every extra pound spent, we are only getting 60 pence worth of extra services.
But this deluge of directives is not just swamping our public services.
It is also burying what is left of local government.
Because in local government, the link between taxation and representation has been broken.
Just as, with the public services, the link between what you pay and what you get has been broken.
Central government funds 80 per cent of what local government spends.
It judges local councils against 140 specific performance indicators.
Insists they must agree up to 66 plans.
And monitors them through four different inspection regimes.
So byzantine are the financial affairs of local government that a typical local authority would need to increase council tax by two-thirds to raise local spending by 10 per cent.
And now New Labour plans to bind the hands of councils with Comprehensive Performance Assessments.
To instruct them how to spend money by using more specific grants and fewer block grants.
And impose more of John Prescott’s decisions on them through Public Service Agreements.
But this torrent of targets doesn’t just threaten public services and local government.
It threatens to bury civil society too.
Because greater centralised control by government isn’t just bad for our public services.
It isn’t just bad for local government.
And it isn’t just bad for individuals.
It’s bad for civil society as well.
There is a space between the individual and government.
Here in Britain, Jonathan Sacks, the Chief Rabbi, has referred to it as the “public square”.
In that public square live families, charities, clubs, colleges, voluntary groups and the faith communities. They are Britain’s free institutions.
I believe it is no coincidence that as government grows ever-bigger, the free institutions seem to shrink ever-smaller.
As central government does more, our free institutions do less.
And as our free institutions do less, our social capital declines.
Social capital is the connections between people: the self-knowledge, abilities and good habits we develop by working with others.
The local Church-run drugs counseling project and the Council meals-on-wheels service,
the Red Cross and the mothers-and-toddlers group,
the Rotary dinner and the school parenting class,
the local hunt and the debt advice centre,
the women’s self-defence class and the Sunday morning football league – all these are generators of social capital.
These generators, and others like them, encourage the work ethic, self-discipline, teamwork, helping others, and build opportunity and achievement.
If social capital declines, civil society declines with it.
And when civil society declines, people feel not more free, but less.
If there’s no order in the public square, you can’t be free in it.
In America, the academic Robert Puttnam has chronicled the decline of social capital there in his book “Bowling Alone”.
The same phenomenon is happening here.
In the 1970s, the centralised state was crowding out private capital.
In the early years of this century, it is crowding out social capital.
And this process is endangering democracy.
Let me be clear what I mean by that.
Democracy has many aspects.
Voting in elections is perhaps the most obvious.
As it happens, we’re not doing so well at that.
At the last general election, turnout fell to its lowest since the First World War.
And voters turned increasingly to single-issue candidates.
In Wyre Forest, they voted for an independent – a respected local doctor who campaigned to save Kidderminster Hospital.
Of course, he can’t save the hospital now he’s elected.
That’s centralisation for you.
In Hartlepool, during the recent Mayoral election there, they voted for a monkey.
Perhaps they were making a point about their local MP.
He was parachuted into Hartlepool from far-away London.
Again, that’s centralisation for you.
Political evolution in Hartlepool seems to work from man to monkey.
Indeed, Peter Mandelson is like a New Labour Washing Machine: he is the master of the Spin Cycle.
This is how the cycle works:
The media story,
The public protest,
The panic, spin and interference from central government,
The botched legislation,
The consequent frustration
…and the problem growing all over again.
There are many reasons why turnout in elections is falling.
With the defeat of old-fashioned socialism, the clash between the main parties lacks the drama of the Cold War years.
Rightly or wrongly, people feel that the combats in the Commons and the arcane procedures of Parliament are all too often meaningless.
They sense that there is a political vacuum in modern Britain.
That vacuum is being filled by a new governing class.
An elite of appointees accountable not to the people, but to central Government.
New peers, top judges, chief police officers, the people who run health authorities and oversee exam boards; who plan roads and railways or power stations; who design our welfare systems or administer health and safety.
In short, the quangocracy – an ugly word for an ugly thing.
But democracy is about more than just voting.
It’s also about participation in our public life and in civil society.
In building up our social capital.
And it’s no coincidence that voter turnout and public participation are falling together.
New Labour believe that the public services and local government are accountable to central government.
Well this is a meagre view of accountability.
We believe that the public services and local government should be accountable far more widely and diversely
To consumers.
To customers.
And to local communities.
In fact to civil society itself.
And in doing so, we are moving with the tide.
At the last election, people were willing to give the old model of centralised control one last try.
But now people’s attitudes are changing as the information age gathers pace.
They no longer trust national government to deliver.
Indeed, they no longer trust the central media to deliver.
The information they trust is the information they find for themselves.
They are better informed about the mixed blessings of public sector delivery.
And their expectations are higher.
And they recognize that in many instances they can make better provision for themselves by paying for extra services individually, such as healthcare, or paying for them communally, such as home and estate security.
Furthermore, they are no longer prepared to put up with the frustration caused by top-down systems of service delivery.
We are living in the information age.
But our public services seem rooted in the industrial age.
Just as the Soviet Union lost its power to real nations when the Berlin Wall came down. In the same way, central government is losing its power to real communities.
I have seen this for myself while travelling Britain to find out what is happening outside Westminster.
When I first went to Easterhouse, one of the poorest parts of Glasgow, I talked to local people there.
And they told me about a different kind of visit.
The great and the good gathered at a local primary school to solve the problems of Easterhouse.
They analysed.
They conjectured.
They debated.
They discussed.
And afterwards, like colonial administrators sent out to govern some far-flung part of the Empire,
they prowled the streets of Easterhouse,
peered at the local inhabitants,
met up to compare notes…
…and then went home.
Without having spoken to anyone who actually lived there.
But the people of Easterhouse are working together to build up social capital and civil society.
In Gallowgate, elsewhere in the city, local people have come together to offer support and help to the families of heroin and crack cocaine addicts.
In Barry Comprehensive in South Wales, an inspirational head teacher, David Swallow, has revitalised the school by providing vocational courses to children from disadvantaged backgrounds.
I have seen all these projects and many others at work.
And there are thousands of others like them all over Britain.
They are the very opposite of New Labour’s plans for Regional Assemblies.
Which will destroy our historic counties and create a new layer of government,
employ fresh armies of bureaucrats and create new reams of red tape,
and impose a new tier of politicians on local people and place new burdens on business.
Regional government will do nothing to bring about community government.
The people of Carlisle will not feel closer to power for being bossed around by Manchester.
And the last thing the people of Cornwall want is to be controlled by Bristol.
Regional government has one objective only.
Not devolving power down.
But grabbing power up.
Regional Assemblies and community government just don’t mix.
And I am determined to find a new Conservative Way Forward for community government in Modern Britain.
We have already begun a process of policy renewal as sweeping and extensive as that of the 1970s.
We have published a detailed critique of Labour failure in a series of pamphlets about the public services.
And recently at party conference we announced 25 new policies.
Tonight, I want to announce the next stage of our programme to restore community government.
We will further be examining ways in which this is done both here and abroad –
First of all, in the delivery of public services.
In healthcare, we will be closely examining the system used in other countries.
In Sweden, for example, patients have the right to choose hospitals, doctors and treatments.
In education, we will be doing the same.
In Holland, for example, parents have the right not just to choose schools for their children, but also to have new schools set up.
Our second aim is to strengthen society itself.
In crime prevention, we will learn from examples of community institutions which have played a major part in taking young people off the conveyor belt to crime.
In welfare reform, we will learn from the ways in which Kent County Council has begun to reduce welfare dependency by intervening early and strengthening civil society through social independence projects.
The third area we will look at is how we can revive the powers of local government.
In other countries, local government is financed in a more open and transparent way.
In Australia an independent grants commission allocates money free from central government interference.
Elsewhere, local government is allowed to borrow money or issue bonds.
In the United States, as elsewhere, both the financing and the powers of local government are different from Britain.
In America, judges, police chiefs and others are often held accountable by election.
We will want to examine how this system works and why it works.
So I am announcing today that we have set up a task force on community government which will cut across departmental boundaries.
It will be chaired by David Davis, and those Shadow Cabinet members who cover the Treasury, Home Office, Health, Education and Local Government and the Regions will also serve on it.
The task force will find the best way for the next Conservative Administration to roll back the boundaries of New Labour centralised control and roll forward the new age of community government.
In the 1970s, when Nick Ridley was pioneering the Conservative revolution, there was a sense that the tide of ideas was flowing in our direction.
It is flowing the same way today.
Away from top-down politics.
Away from the quangocrats.
Away from the control freaks in Downing Street and the Treasury.
Away from New Labour’s ever-growing centralised control of government, civil society and people’s lives.
We have always believed in our country and in the people of Britain.
A generation ago, pioneers like Nick Ridley used that conviction to transform the economic prospects of millions.
He had the courage to defy the prevailing consensus and the vision to point to a better way.
Armed with this same conviction, we must now show the same courage and capture that same sense of radicalism as we seek enrich our society, improve our public services and renew our democracy.
We can do no greater honour to Nick Ridley’s memory. We can perform no greater service to our country.
Below is the text of the speech made in December 2002 by the then Leader of the Conservative Party, Iain Duncan Smith, to the Confederation of British Industry.
A lot has happened over the past year since I spoke at your National Conference, but very little has happened to change my view of the way this Government is running our economy. Indeed, my views have only been reinforced.
Last year, I warned that Labour’s approach to the public services would not deliver the improvements we all want to see, and I said that their failure to deliver real reform would end up costing you money and eventually undermine our economic stability.
This is the message I have been giving the Government ever since I took over as Leader of my Party.
Well, they are still not listening.
The Chancellor has enjoyed the benefit of the doubt from media commentators who rarely referred to him without the words ‘iron’ or ‘prudent’ appearing in the same sentence.
The story coming out of Number 11 was one of stability and optimism.
Small wonder. When the current Government came to office in May 1997, this country had low inflation, falling unemployment that was less than in France, Germany, Italy or Spain, the lowest business taxation among our major competitors, and a third of all EU inward investment.
Until then it was so easy for him to sneer at anyone who dared to doubt him.
Only last Monday, when the Chancellor addressed the CBI, he was all-to-ready to dismiss your concerns about the incessant creep of regulation. But last Wednesday was a significant day in the history of this Government. Last Wednesday the cracks began to show.
The Iron Chancellor has got metal fatigue.
‘I do not accept that Britain is a worse place to do business than it was five years ago’, he said. ‘That would be defeatist and wrong’.
But now we know this: Just because Gordon Brown does not accept something doesn’t mean it’s not true.
In his pre-budget report, the Chancellor refused to accept that the downgrading of the growth forecasts was his fault.
He blamed it on the world economy; he blamed it on the threat of terrorism; he blamed it on everyone else.
But the fact is that the Chancellor simply got it wrong.
Forecasts for world trade and world growth have changed little since the time of the Budget. Independent forecasters told him that his estimates were too high, but he just didn’t listen.
Everybody else knew, but the Chancellor did not.
So in just 7 months he has had to nearly double the amount of UK borrowing in the coming year to safeguard the public spending increases he has promised.
And, of course, he would have far less flexibility to respond to the changing economic conditions if the UK were part of the Eurozone, because joining the Euro means giving away the ability to control our own economy.
Now I know some of you will disagree with me here, but I believe it is simply not in our long-term economic interests to enter the Euro.
However there is one thing that I think we can all agree on, that the briefing and counter-briefing between the Prime Minister, the Chancellor and their acolytes can only damage British business.
The flaws now appearing in the Government’s economic management and their failure to reform public services has sparked a bitter feud in Downing Street.
But we will all suffer if the Prime Minister and his Chancellor now indulge in the blame game.
You need certainty and stability, not spin and mutual recrimination.
If the Government wants us to join the Euro, it should make the case and get on and hold a referendum. If it does not, it should shut up and let businesses plan accordingly.
With our policy you get that, with the Government’s current policy you don’t.
The Chancellor has been able to increase borrowing by £20 billion over two years, thereby attempting to ensure he can meet the spending commitments he has set himself.
This is the way New Labour judges success. It’s about what you put in not what you get out.
So they are committed to huge increases in public sector spending over the next few years, spending which presumes a buoyant economy and a thriving business sector.
But as the CBI has shown have shown, their approach to business is threatening to undermine their approach to public services.
Over the last five years, despite what Gordon Brown thinks, Britain has become a less attractive place for business to invest.
I know that. Your members know that. Everybody knows except the Chancellor.
The burden of regulation – and the gold-plating of regulations by the British Government – will do significant damage to the performance of British businesses.
I know that. Your members know that. Everybody knows except the Chancellor.
Because the reality is that he simply doesn’t understand how business works.
Business and enterprise create jobs and generate wealth. Jobs and wealth raise living standards, encouraging a strong economy.
And a strong economy is the foundation stone of strong public services.
So you might expect a Government that says it’s committed to improving public services to be equally committed to supporting business.
But instead, this Government’s anti-business policies are striking at the very heart of our enterprise economy and threatening to undermine our public services.
They have created a vicious cycle: the Government’s approach to business contradicts its approach to public services.
And its approach to public services perpetuates its destructive approach to business.
Ultimately, the success or failure of this Government lies in the hands of the Chancellor – the man who even his own colleague calls the ‘money god’.
Well, he is a false idol.
Five years ago, he said: ‘We will not impose burdensome regulations on business, because we understand that successful business must keep costs down’.
Yet you have shown that Labour have added £47 billion of extra taxes onto business since 1997. In total, you estimate that business is paying up to £15 billion a year including tax and red-tape.
Two weeks ago, I attended a dinner at the Institute of Directors. One of their surveys shows that as many as 93% of businesses believe that the burden of red tape relating to employment law has got heavier in the past five years.
Last year, Labour passed the Regulatory Reform Act, promising more than 250 regulations would be cut. But more than a year later only six Regulatory Reform Orders have actually been passed
According to the Financial Times, Government Officials say that these orders are simply too bureaucratic to draw up.
Now, the Government wants to introduce yet more regulations through costly and bureaucratic regional assemblies throughout England. They say these will help economic regional development, but there is absolutely no basis for this claim. Indeed, the evidence suggests the opposite.
And if we wanted still more proof that this Government doesn’t understand the needs of business, let us consider the decision to increase National Insurance contributions from next year.
This means an extra £4 billion a year in higher employers’ contributions for a start. Then, of course, businesses could come under pressure to pay even more as employees seek to win back some of their extra contributions through higher pay claims.
Did Labour tell you about this before the last election?
I was struck when you said that France is the only one of our top five trading partners to have a larger burden of business taxation than we do.
In the 80s and 90s,a lot of hard work transformed a failing economy into one of the best places in the world to do business,
All that work is now being thrown away.
That transformation took place because we had a Government which understood and worked with business, not against it.
But now we have a Government that thinks it knows how to run business better than you do.
A Government that has presided over half a million manufacturing job losses over the last five years.
A Government under which business investment has suffered its sharpest fall for three decades.
And a Government under which the UK has recorded a trade deficit every month since January 1998.
Last month Patricia Hewitt blamed the quality of British management for the growing productivity gap.
Notice it is not the fault of the DTI or the Treasury or the fact that this Government has introduced one new regulation every 26 minutes of every working day. Apparently it’s all your fault.
And they must take responsibility for the problems in the wider economy too.
They must take responsibility for the massive expansion of means testing in the tax and benefits system, which has imposed yet more administrative costs on business.
The entire tax credit system is so confused that millions who are entitled to them cannot even be bothered to take them up.
The government must take responsibility for distorting incentives to work.
Because of the way tax credits work, two and a half million people on low incomes now face effective marginal tax rates of 40% or more and nearly two million face a marginal rate of 60% .
And this Government must take responsibility for reducing incentives to save.
Last week, I challenged the Chancellor to apologise for the damage he has caused to the pensions industry with his £5 billion a year raid on pension funds, a measure that will have cost £40 billion by the time of the next Election.
I told him that 300,000 stakeholder pension schemes – 90% of them – have no members.
I told him that the proportion of recently-retired pensioners taking an income from an occupational pension has fallen to just 59%.
But the Chancellor refused to apologise and refused to accept responsibility.
Once again, the Chancellor thinks he knows best.
And this is also his approach to the public services.
That is why he sets targets and imposes restrictions on professional people. Public Service Agreements were supposed to deliver value for money and ensure that the money going in to public services was met with improved outputs.
But in reality, they have simply led to a culture of deceit, where professionals are forced to manipulate figures to meet centrally decided targets.
Huge pressure is brought to bear on doctors, nurses and teachers by bureaucrats who have boxes to tick.
The government has allowed political objectives to take priority over public service.
Hospital trolleys have their wheels removed so that they can be called beds.
Hospital corridors have partitions erected so that they can be called wards.
Examining boards manipulate A-level results to meet the latest Government objective.
And if after all this the target is still missed, the Government simply changes the target.
In fact, the Government has missed 40% of the targets it set itself in 1998 and 75% of the targets it set two years ago.
All this, despite the huge amounts of money going into public services.
This Government is very good at spending people’s money but not very good at producing the results people want to see.
They’ve spent more on the police – but street crime actually rose by more than 30% last year.
They’ve spent more on education – but 200,000 seven year-olds still can’t master the basics of reading and 1 in 4 eleven year-olds can’t deal with even basic maths.
They’ve spent more on the health service – but while activity has scarcely increased the number of administrators has.
All this suggests that productivity in our public services is deteriorating rather than improving.
And yet the Chancellor’s promise of more money for the public services has raised expectations and sparked a new round of public sector wage claims.
The Government has promised that it will be uncompromising, that higher wages have to be earned through modernisation and reform.
But how are these productivity gains to be measured?
By whom are they to be measured and over what period of time?
And what will happen to the wage increases in future years if the productivity gains fail to materialise?
For all of the tough talking coming out of No. 10 and No. 11, no-one is providing the answers to these questions.
Instead, yesterday morning we had stories emanating from Downing Street that future fire disputes would be made illegal. This morning the Minister responsible for the Fire Service both denied any plans for a strike ban and said he was ‘keeping all options under review’.
At a time when lives are at stake, the public has a right to demand clarity and consistency from its political leaders; instead it is being fed a daily diet of spin and political posturing.
We simply cannot allow this current dispute to drag on for weeks or even months. I welcome the fact that the FBU has suspended its next strike and is seeking talks with its employers at ACAS.
The firemen should not go back on strike. No more lives should be put at risk from industrial action.
The Prime Minister already has the power under the Trades Union laws passed by the previous Conservative government to seek an injunction against the FBU.
How ironic that the Government talked over the weekend about new powers to ban strikes, while their new Criminal Justice Bill is about to scrap powers they already have. And he also has Emergency Powers to keep the public services running.
So he does have the tool at his disposal to bring the current dispute to a swift end. He should use them.
At the beginning of the 21st century it is simply unacceptable for people in this country to be left without adequate fire cover.
It is equally unacceptable to have a model of public service delivery that has scarcely changed since the end of the Second World War.
And why does this affect you?
Not only because business suffers when employees can’t read or write properly;
Not only because business suffers when employees spend long periods on sick leave waiting for treatment;
And not only because business suffers when employees spend hours stuck on congested roads or waiting for trains which never come.
This Government’s failure to improve public services affects you because, as they fail, Labour’s only answer is to plough more and more money in – and that ultimately means more taxes.
Labour are investing in failure and you and I are funding that investment.
But there is an alternative.
It’s not the scare tactics that the Government likes to deploy; it’s not simply a choice between spending more money or cutting that money.
The choice is this:
Between spending more and more on old, unreformed public services.
Or delivering the reforms which are the only way to achieve real improvements.
Between a Labour Government that believes taxing more, spending more and reforming nothing.
Or a Conservative Party that believes in lower taxation and less regulation as the best way to a dynamic economy and thriving public services.
We have already begun to set out how we intend to go about this task, by taking politicians out of the day-to-day running of schools and the health service and by cutting the bureaucracy Police Officers face everyday.
So our direction on public services is clear.
But it’s also a choice between a party which thinks that Governments make the best managers and one which says managers make the best managers.
I am pleased that, following on from our successful regulation summit in September, Tim Yeo and his team will be inviting respected figures from the business community to join a new Conservative Regulation Commission.
This will examine both specific regulations and the general burden of regulations and provide a systemic approach to reducing them.
I hope you will agree to play your part in this to find a way through the jungle of red-tape this Government has created.
So – the Conservative approach will be very different.
We have to break the cycle of failure this Government has created.
We have to support business.
Because we recognise that business is the very heart of a successful enterprise economy; an economy we need to create if we are ever to deliver our objective of delivering world-class public services.
Below is the text of the speech made by the then Leader of the Opposition, Iain Duncan Smith, to the Conservative Spring Forum on 24th March 2002.
Last month I visited Easterhouse in Glasgow; one of the poorest public housing estates in Europe.
I walked around part of the estate with a local Baptist minister.
The grey, wet day matched the bleakness of nearly everything that I saw.
He showed me abandoned, boarded up houses surrounded by litter and disfigured by graffiti.
We stopped in a sheltered walkway where heroin addicts inject the drug into their bodies.
I looked into one building, in a stairwell I saw a place where a child had been playing. A discarded teddy bear lay in the corner. A perfectly ordinary sight.
Except that next to it lay the paraphernalia of a crack cocaine addict. What hope does that child have?
‘What are you doing here?’ shouted one resident.
‘This has always been a Labour area,’ he told me.
‘Yes and look around you’, I said.
It’s political failure that hurts vulnerable people.
However, the bleakness of my visit to Easterhouse was redeemed through witnessing the courage and resolve of many local people.
I visited one neighbourhood project run by local people for local people.
The Baptist minister runs a breakfast club for children who would otherwise go to school hungry.
In contrast to some of the public sector schemes that come and go, the leaders of the project knew the people they helped.
And the person in need is helped by someone who has often themselves struggled with – and conquered – the same issues of literacy, desertion or addiction.
It’s not just about winning votes for the Conservative Party in places like Easterhouse.
It’s about meaning what we say: that there are no ‘no-go’ areas as far as we are concerned.
It’s about being a Party that doesn’t just drive past Easterhouse on the motorway.
Whilst there, I was told about a recent conference entitled ‘Education, schools and social inclusion’ that was held at the school. It included all the usual bureaucrats and experts, but excluded all the local people. They might as well have held it in Whitehall.
The family networks and people-sized institutions that hold communities together have no place in an ideology that sees government task forces and consultants as the solution to every problem.
But it’s not just there. Recently I visited two mothers in Faversham who had set up a drug rehabilitation unit. Their sons had stolen to feed their addiction. One of the mothers had been forced to turn her son into the police.
The authorities would do nothing to curb drug dealing on the estate, so the two women had set up a counselling and advice service. They had shown tremendous courage in taking matters into their own hands, trying to solve a problem no one else would address.
Critique of Labour
Labour won in 1997 because they said they understood the vulnerable and the problems they faced.
In his first speech as Prime Minister, Tony Blair promised the residents of Southwark’s Aylesbury estate that he would bring back the ‘will to win’.
Like much of what the Prime Minister said in those days it struck a chord. Like too much of what the Prime Minister says it has failed to come to pass.
This is a Government that had more going for it than any in the modern era.
Two landslide election victories.
The unparalleled patience of the British people.
The foundation of economic success inherited from its Conservative predecessor.
Never has a Government had so much and achieved so little.
Just compare that to the way Margaret Thatcher turned around the economic collapse she inherited 1979.
We thank her and wish her a speedy recovery with all our hearts.
Tony Blair talked about the ‘post-euphoria, pre-delivery’ phase of New Labour. The problem is he said that at the beginning of 1998.
The Prime Minister is fond of his phases. But I would offer you my own interpretation of his five years in power.
In the beginning were the promises.
‘Tough on crime, tough on the causes of crime’, ’24 hours to save the NHS’, ‘education, education, education’, ‘no plans to increase taxes at all’.
Then there were the breaking of those promises.
The rise in street violence, the lengthening waiting lists and the teacher shortages. A litany of failure paid for through stealth taxes on mortgages and marriage, pensions and petrol.
Last of all they blame everybody else.
It’s all the fault of the ‘wreckers’, the public servants who leave scars on the Prime Minister’s back. Or it’s the fault of the previous Conservative Government.
And when that doesn’t work, it’s the fault of his own ministers.
David Blunkett says it’s all Jack Straw’s fault. Jack Straw says it’s all Robin Cook’s fault. Robin Cook that it’s all Gordon Brown’s fault. Brown says it’s Blair’s fault. The only thing they can all agree on is that it really is Stephen Byers’ fault.
Shorn of any principle or purpose apart from the naked pursuit of power for its own sake, this is not a joined-up Government, it is a Government coming apart at the seams.
They used to boast about the way they would keep the private sector out of the health service, now they turn to it in desperation.
They fiddled with rail privatisation, then renationalised the rail network.
They attacked me for standing up for rail investors, and now they are being forced to compensate them.
They were once in favour of a democratic House of Lords, now they propose a Chamber of Cronies.
They claimed to be on the side of patients, but when the family of a 94 year old complained about her treatment they insulted her and sent out ministers and hospital managers to rubbish her story.
Ministers change tack almost as often as the Prime Minister changes his wardrobe on a foreign trip.
Over five years, Labour have had more summits than the Himalayas, more Czars than Imperial Russia, and more five year plans than Stalin.
The Government is in the throes of a collective nervous breakdown They have lost sight of who they are and have become fixated with how they look.
We know what the Prime Minister likes to wear up his sleeve, but the naked truth is he has no answers.
And as events lurch out of his control the Government falls back on their worst instincts.
To spin faster, to manipulate figures and to compromise public servants and the civil service even further. This not just what New Labour does, it is who they have become.
They seek headlines not policies. Slogans not solutions. This isn’t a Government; it’s an advertisement.
They are caught in a corrupting spiral where politics for its own sake is not only failing to improve people’s lives, it is also undermining everyone’s faith in our political process.
Labour’s failure doesn’t just present us with an opportunity to offer a different way of doing things, it also presents us with a challenge.
Not being Labour is insufficient, we have to be an alternative Government. We have to win the next Election, not wait for them to lose it.
We will provide solutions to the problems Labour ignore. We’re going to be patient, take the time to do it properly and get it right.
But we must also come up with a different way of presenting ourselves to an electorate disillusioned with politics.
We will never convince people of our motives simply by shouting louder.
We have to transform the way we conduct ourselves if people are to have any idea about how we wish to transform the country.
In short we need a new approach to politics.
‘New’ politics: tone
It’s been done before. Cast your minds back a couple of years to the United States.
There too, they had been living through one of the longest and largest upturns in their economic history.
There too, an administration addicted to the Third Way wasted two terms and failed to deliver on their promises.
And yet in the midst of economic success, the American people elected a Republican, George W Bush, over the then sitting Democratic Vice President.
Quite simply they trusted him to deliver the changes they thought necessary precisely because they saw someone with principles who wasn’t afraid to articulate them.
I met President Bush when I visited America last December and we can learn a great deal from him.
About showing that what we believe helps everyone particularly the most vulnerable in our society.
About mapping out a distinctively conservative agenda that appeals to the common ground.
Above all we talked about challenging those popular prejudices about conservatives.
It is the hardest thing in the world to see ourselves as others see us. They think we are not like them, they think we don’t care about them.
And yet you and I know that we share the same concerns as everyone else, we want the same things, we have the same ambitions.
The way we live our lives should be the way we practice our politics: as decent, honest, tolerant and generous people.
We need to be passionate and positive about the things and the people we are in favour of, not just the things we are against.
We all laugh at Victor Meldrew on television, but you wouldn’t want to live with him. And you certainly wouldn’t vote for him.
If we want people to vote for us, I say to everyone in this hall:
You are the people who select our candidates.
You have a vital responsibility.
I want you to select the best line-up of new MPs this country has ever seen.
I want you to seek out talented people on their merits wherever they may be – whatever their age, sex or background.
Because if we don’t reflect the Britain we want to lead, we will never be asked to lead it.
It isn’t about changing what we believe in, it is about being ourselves again.
It’s about doing the right thing and being true to our principles and values.
‘New’ politics: policies
If there’s one message that will shine out through all our policies, it is this:
Trust people.
Trust people to do their jobs.
Trust people to know what’s best for their families.
Trust people to create wealth and create jobs.
Trust people with their own money.
Trust people to live their lives.
And if you trust people, you will find that they will build communities. They will support each other.
Our job is to support them.
It marks a fundamental difference between us and Labour.
The message that shines out from Labour’s policies is equally clear.
They distrust you.
They distrust how you do your job if you are a teacher, a police officer or a doctor.
They distrust you in knowing what is best for your family.
They distrust your ability to manage your own finances, so they want to take more of it from you and hand it back like pocket money.
That’s why every week they launch a new long-term plan.
That’s why they fire off a directive a week at teachers.
That’s why they want to make police officers fill in a form before they can even stop a suspect in the street.
This Government has become the most controlling, centralising, bullying and manipulating government we have had in my lifetime.
We must break once and for all with the top-down agenda of central control.
We will base our reforms of the public services on reviving them as community institutions, not branch offices of the Government.
GPs are part of the fabric of the local community:
They understand the concerns and priorities of their neighbourhood far better than Alan Milburn can.
I want the whole of our health service to be responsive to local needs, local patients and local GPs.
As Liam Fox and I have been visiting health services across Europe to learn what makes them deliver better care, one thing is clear: the best systems are based on patients and their doctors having a choice over their hospital treatment.
We will free our hospitals from control by Whitehall.
They will be more independent of politicians.
They will be part of the communities they serve.
The same is true of our schools.
I want to axe layers of control from central government and re-establish the identity of schools as local institutions.
I’ve seen what that can mean in my own constituency. I am a trustee of Whitefields, a special needs school that was the first of its kind in the country to go grant-maintained.
Not only has it achieved amazing results for its pupils, it has also become a centre of excellence advising other schools on how best to cope with special needs pupils.
I want to replace the directives of ministers with discretion for head teachers and boards of governors.
If the head teacher and governors find a disruptive pupil is damaging the education of other children and making life a misery for teachers, out they’ll go.
Why should the education of the many be sacrificed for the rights of the few in our schools?
And why should the law-abiding majority be sacrificed for the rights of criminals?
The result of nationally set rules is that our police officers have less and less discretion in how to police.
Some police forces have themselves, often in response to Government targets, retreated into a distant and centralised form of policing within their areas.
In New York, Mayor Giuliani recognised that high-level policing – looking for the Mr Bigs of crime – was not enough to keep the streets safe.
Neighbourhoods need policing.
Officers need to know their neighbourhoods.
And neighbourhood yobs need to know their police officers. Very well indeed.
That’s what they did in New York.
They resurrected the old concept of the beat with police officers serving a close patchwork of overlapping neighbourhoods.
Oliver Letwin saw at first hand how the NYPD are no more than two minutes away from any crime that is reported.
As a result they cut crime by 60 per cent in the last 9 years.
Robbery, burglary and car theft are down by over 70 per cent.
And violent crime is down by 75 per cent.
How many of us can say that that is our experience today?
Under a Conservative government Britain will have neighbourhood policing.
In the past, Conservative governments have been guilty of taking power away from local government to Whitehall.
That was a mistake.
We will reverse this process and restore to local councils the discretion to act according to the interests of the communities they serve.
And in this hall today many of you are councillors and are making life better for the people you serve, every day.
You show, by your dedication and hard work, that we can make a difference.
And on 2 May I want more Conservative councillors.
But local councils should never be the only local institutions to which people turn.
In Manchester, I’ve seen at first hand how people have come together to create, Langdon College, a residential school for Jewish children with disabilities.
Because our policies will be built from the bottom up – on the natural communities that people feel part of – we will have no truck with Labour’s bogus regions.
Why would the people of Carlisle want to be bossed around by Manchester?
And the last thing the people of Cornwall want is to be controlled by Bristol.
When we give power to real communities in Britain, we will not stand by and let it be taken away by Brussels.
If we don’t want a Britain of bogus regions, we certainly don’t want a Europe of bogus regions.
The challenges abroad
We are the 4th largest economy on earth. We gave the world free trade, common law and the English language. We want to secure our nation’s place in the world that we have done so much to shape.
We need to work to create a European Union that is modern, outward-looking and decentralised.
An EU capable of adapting to the future.
An EU where Britain still maintains control over its own destiny.
There must be something seriously wrong with the way this Government works when British troops are sent into danger in Macedonia as part of a Euro Army simply because the Government does not want to offend our European partners.
So I tell you this. When Tony Blair finally has the courage to call a referendum on the single currency, we will fight him and we will win.
A strong foreign policy must be based on an understanding of our history, not on attempts to deny it.
Nor should we deny human nature. We need to take the world as it is, not as we would like it to be; to understand what has changed since September 11th and what in fact has remained the same.
There have always been evil people in this world but now these people have access to more terrible technologies.
Saddam Hussein poses a growing threat to us all. He should no longer be allowed to develop and deploy his weapons of mass destruction.
Time is on his side, not ours.
History teaches us that appeasement is not an option.
It also teaches us that compassion is a part of realism.
Spreading democracy, economic reform and free trade among developing countries will benefit us as well as the people who live there. This is modern conservatism.
Helping the poor, the hungry and the persecuted is a moral challenge which we must meet.
Peroration
The relentless pace of the modern world creates opportunities. Yet as these opportunities grow, so do the things which seem increasingly beyond our control.
The world has shrunk, our horizons have expanded, but our concerns are as local as ever.
We travel further, but is it safe to walk down the street?
Our jobs are more challenging, but can we get in to work in the morning?
Science can alter our genes, but who will look after us when we fall ill?
Our children can surf the internet, but are they learning to read and write properly?
Politicians can use change to help answer these questions or block change and hope the questions will go away.
Politicians can push power down to public servants and make them properly accountable for the way they use it, or we can subject them to minute-by-minute political control.
Politicians can truly modernise our public services or we can chant the mantra of modernisation to disguise fear of real reform.
What is absolutely stark is that we cannot go on using 1940s solutions to tackle 21st century problems.
We have to find a better way for all our sakes, but particularly for those whose need is greatest.
A nation that leaves its vulnerable behind, diminishes its own future.
Britain will never be all that it should be until opportunity and security mean something to people in Easterhouse.
To make this country theirs as much as it is ours.
Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, at the Virginia Mason Hospital in Seattle on 26th March 2014.
Introduction
Let me start by saying what a huge pleasure it is to be here in Seattle, and how grateful I am to Gary Kaplan and Virginia Mason for hosting us today.
This hospital is one of those remarkable and special places that faced deep tragedy and yet somehow turned things round to achieve something extraordinary. Under Gary’s inspired leadership you are now rightly regarded as one of the safest hospitals in the world.
Which is why I wanted to come here to see it for myself.
The same transformation happened on much larger scale in a number of safety critical industries. Those names now familiar to us all – Bhopal, Chernobyl, Three Mile Island, Piper Alpha, Exxon Valdez – have become bywords in their industries as turning points which heralded a profound change in culture.
Yet strangely the healthcare sector itself has not collectively embraced that change.
Too often it has been a byword for an endeavour where avoidable safety failings end up being accepted as unavoidable. “These things happen” and “we did everything we could” seem to be acceptable responses, even though they would be intolerable in other contexts.
This makes your achievements here at Virginia Mason even more impressive.
Here the tragic death of Mrs Mary McClinton ten years ago – and its impact on her family, her doctors, the hospital and the wider community – became a turning point. Your resolve in choosing to learn and change as a response is an inspiration for healthcare professionals the world over. Just as in aviation or automobile manufacturing, when something goes wrong, you “stop the line”. And as a result much harm has been avoided and many lives saved.
We too, in the UK National Health Service, face our own turning point.
The appalling cruelty and neglect that happened between 2005 and 2009 at Mid Staffordshire hospital – and failings in care subsequently uncovered at other hospitals – have profoundly shocked our nation.
Just as Mrs McClinton’s death was a turning point for this one hospital, I want to make Mid Staffs a turning point for an entire health economy.
Not for one second do I underestimate the challenge of delivering change in 260 hospital Trusts employing 1.3 million staff across the system. But I believe we can do it.
As Professor Don Berwick – who wrote an outstanding report on improving safety in the NHS last year – said, in a unified system you have the ability to make systematic change on a national scale.
We also have something else: the extraordinary dedication of the NHS staff I meet every week, who have shown in the last year a profound commitment to learning the lessons of Mid Staffs and making our care world-class in its safety, effectiveness and compassion.
And we have good foundations to build on too, with impressive improvements already made in areas like cardiac surgery, hospital infections and the safe use of medicines.
What Price Safety?
“Fine words” say the sceptics, “but where’s the money? With all the pressures we face, it is simply not affordable to raise safety standards in way you ask”.
Nothing could be more wrong.
Wrong ethically, because it can never be right to condone a system in which patients suffer harm unnecessarily.
But wrong economically too.
Because our starting point must be to recognise that unsafe care ends up being more – not less – expensive, particularly if you look at the costs to the healthcare system as a whole.
Every year the NHS spends around £1.3 bn on litigation claims, money that could and should be spent on frontline staff. At a hospital level the figures are even more startling: in recent years North Cumbria paid £3.6m to just one individual. Bromley paid £7m to another. Tameside paid a staggering £44m in compensation over just four years.
System-wide, the financial impact is much greater than simply litigation awards. Whether in England, the US, Canada, France or Germany we know about one in ten patients experience harm when they are in hospital. For England one study found that this added three million bed days a year at a cost of £1 billion, with consequential costs adding a further billion pounds – and according to that same study around half of that harm is preventable.
The best hospitals deliver safe care on tight budgets not because the two contradict each other – but because gripping safety is an essential part of gripping budgets.
At Salford Royal, they estimate they have saved £5m per annum and 25,000 hospital bed days by the introduction of safer care. Here in Virginia Mason, I understand that you have saved as much as $15m through your improvements to patient safety.
More than a financial cost
Money matters, of course, but look at the impact on staff – and above all patients and their families.
There can be no greater breach of the trust between clinician and patient than when a patient is harmed unnecessarily. There may be a profit motive in no-fault manufacturing but there is a moral motive for zero-harm healthcare. And we should welcome that – because that is what healthcare is: the privilege of helping human beings at their most vulnerable, the noble purpose that motivates doctors and nurses the world over.
And the effect on frontline healthcare workers is profound if unsafe care is not checked.
Not only does it take up huge amounts of clinical time when mistakes have to be corrected and hospital stays prolonged. It has – as I have seen for myself – a devastating effect on staff morale and self-confidence. Avoidable harm does more than damage institutional reputations – it is a violation of the values and ideals that unite everyone in the provision of health.
Financially, reputationally and morally unsafe care carries a price – a price we cannot and should not pay.
Sign up to Safety Movement
So today, I sign up to safety.
I want today to mark the start of a new movement within the NHS in which each and every part of our remarkable healthcare system signs up to safety, heart and soul, board to ward.
Professor Berwick said the heart of safe care is a culture of learning.
So the engine room of this new movement will be a new national network housed in NHS England, a collaboration of all NHS organisations and local patients, who share, learn and improve ideas for reducing harm and saving lives.
The first 12 vanguard hospitals signed up to the movement this week. Within the next few months I will write to every NHS organisation in England, inviting them to join and sign up to safety. I hope over time that every hospital in England will rise to the challenge and join the campaign.
Every hospital Trust that chooses to join will commit to a new ambition: to reduce avoidable harm by a half, reduce the costs of harm by one half, and in doing so contribute to saving up to 6,000 lives nationally over the next three years.
I have asked NHS England, Monitor and the Trust Development Authority to work together to put in place support for hospitals to develop their plans to do this. They will provide advice to ensure that each plan takes full account of the international evidence as to what measures have the most impact. For those hospitals that sign up, The Chief Inspector of Hospitals will include progress against these plans as important evidence to inform the inspection and ratings regime. They will also be reviewed by the NHS Litigation Authority, which indemnifies trusts against law suits, and, when approved, they will reduce the premiums paid by all hospitals successfully implementing them.
Starting this year, the campaign will recruit 5,000 safety champions as local change agents and experts – safety ambassadors, safety agitators, safety evangelists – a grassroots safety insurgency across England which will seek out harm, confront it and help to fix it.
We will go beyond institutions to seek to sign as many staff in the NHS as we can to the safety campaign. Just as more than 500,000 people this month made individual pledges to improve care for patients on NHS Change Day, the movement will seek to harness that great well of values and expertise in the NHS to a common endeavour on safety.
Members of the campaign, which will be formally launched in June, will be supported by a new team, Safety Action For England, consisting of senior clinicians, managers and patients with a proven track record in tackling unsafe care – people frontline staff will respect, listen to and work with. They will ensure fast, flexible and intensive support when the line needs to be stopped and a lesson needs to be learned in England.
A whole system will be wired together so that where unsafe practice is detected at one end of the country, the lesson is learned at the other end as well.
An Open Culture
Critical to the success of this movement will be a culture of openness and transparency.
Again, though, “easy to say”.
Because being open when something is going wrong demands change. It challenges established practices to which people are attached. It shakes up the consensus that develops in some places that poor care is normal – the “normalisation of cruelty” as I have called it.
Openness acknowledges problems, studies them and fixes them. It doesn’t shrug. It “stops the line”.
So we must start by acknowledging that the NHS has not always done the right thing by people who speak out about poor care. Relatives like Julie Bailey and James Titcombe, campaigning after the loss of a loved one. Whistle-blowers like Helene Donnelly and Kay Sheldon. And politicians like Ann Clywd and Andrew Davies who have spoken out about poor care in Wales. Never should speaking out be confused with a lack of commitment to NHS values or “running down the NHS”. The highest form of commitment to our NHS is surely the courage to speak out against the system when the system gets it wrong.
So we have already taken a number of important steps to nurture an open and transparent culture.
First, I have implemented a series of measures to help staff speak up when they have concerns about poor care. I have banned “gagging clauses” in severance agreements when staff leave their employers, which prevent them from talking about harm to patients. There will be a new duty of candour in professional codes, making clear the need for all doctors and nurses to come clean quickly when things go wrong – and to encourage a blame-free culture, agreement that early candour should act as a clear mitigating factor in any investigation of misconduct.
I am also introducing a new statutory duty of candour on organisations, giving them a clear legal duty to tell patients when they have been harmed. Today I can announce the start of a consultation to include all significant harm – death, serious and moderate harm – in the new duty, as recommended by Professor Norman Williams, President of the Royal College of Surgeons and Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust. This will help to make English NHS hospitals amongst the most open and transparent in the world and mark the start of a transformation in our safety culture.
Legislation, however, is not enough. We also need to equip staff with the skills and confidence to speak up. So today I am announcing two important additional measures. First, I have asked Health Education England to work with brave whistleblower Helene Donnelly to ensure that raising concerns about patient care and safety becomes part of mandatory training requirements for all NHS staff – her current role at Staffordshire and Stoke on Trent Partnership Trust, incidentally, is a model for what the new cohort of safety ambassadors should aspire to. And secondly, we will also ensure that the new Care Certificate we are introducing for healthcare assistants includes training on how to raise concerns about poor patient care.
Safety in Numbers
To support that drive for openness, we have overhauled our national regulator, the Care Quality Commission, to underline its independence and reinstate thorough and expert inspection of hospitals to ensure the quality of their care. The safety and culture of a hospital will be critical subjects of the scrutiny, as will complaints handling, incident reporting, falls, pressure sores, staffing levels and so forth.
The inspectors are also listening to staff and patients and the board to get a proper feel for a place – and make an expert judgment about whether its leaders really are alert to safety and keen to learn when things go wrong.
I suspect Virginia Mason would be assessed by our regulators as “outstanding”.
Whilst I suspect it, I think you know it – because you have the numbers to prove it. Once we have our culture in the right place, the next thing we reach for is the data. It allows us to manage improvement. It allows us to ring alarm bells. And it provides evidence to patients that they can place their trust in us when they are at their most vulnerable.
So for many organisations, the first step will be to collect safety data more reliably. And as that happens, the level of reported harm will increase. Not because avoidable harm is actually increasing – but because it is being properly reported for the first time. Indeed, halving avoidable harm may mean doubling reported harm.
I am pleased that Professor Sir Bruce Keogh is currently working with senior clinicians across the system to develop an indicator so that we can properly understand whether particular reporting levels indicate the right reporting culture in an organisation.
And from June a dedicated section of the NHS Choices website – “How Safe is my Hospital” – will allow the public to compare hospitals in England on a range of safety indicators. For safe staffing, from this June it will be at ward level, every month, allowing the public to check the wards used by their own loved-ones.
They will also be able to check incident reporting levels, MRSA and C difficile rates, pressure ulcers, falls, and compliance with patient safety alerts. Here, the power of peer pressure should spur hospitals to ever higher standards of safety and patient care.
But I intend to go further still. We need to ensure that unsafe care has nowhere to hide.
We need a much more reliable measure of actual harm that allows proper comparisons. So NHS England are developing a new system based on external reviews of the case notes of where people have died or experienced harm. Together with new independent Medical Examiners, this will give us, for the first time, a more reliable national average of avoidable hospital deaths and a more effective “smoke alarm”, triggering closer scrutiny of the outliers.
Conclusion
Let me finish on an optimistic note. Because progress on safety has not gone unnoticed.
In our latest annual survey of public opinion on the NHS, public confidence dipped a little: unsurprising in the wake of the Mid Staffs scandal. But 77% of the public agreed with the statement: “if I was ill I would feel safe in an NHS hospital”, the highest level ever recorded. And 73% agreed that people are treated with dignity and respect in the NHS, again the highest ever.
We still have further to go, but this is real progress and a sign of what can be achieved if we really focus our efforts.
Today, 12 hospitals in England have ‘Signed up to Safety’. They are the pioneers. Throughout this year, the movement will be signing up more champions, more hospitals and more staff.
So let us make today the moment we stopped the line on wasteful and unsafe care in the NHS and reaffirmed our conviction in everything it stands for. Let today mark the moment when we resolved the NHS should not only be the fairest healthcare system in the world, but also the safest.
Below is the Christmas Message made by Jeremy Hunt, the Secretary of State for Health, to NHS Staff on 23rd December 2013.
As we go into the Christmas period, I want to start by thanking the many of you who will be working over the next two weeks. You are giving up precious time with your families so that everyone else can enjoy Christmas secure in the knowledge that a superb NHS is there for them if anything goes wrong. I know the public are incredibly grateful – and I also know how much you will be doing to cheer up people in your care who would rather be home with their families even if they can’t this year. A & E departments in particular can be busy in the festive period and I am urging people who use the NHS to take the trouble to thank staff for the sacrifices they are making.
This month we held the world’s first ever G8 Summit on dementia. I remember meeting an NHS care home manager in north London, who told me the efforts she went to for her patients: “If I can put a smile on their face, they won’t remember it tomorrow but I will – and I go home with an even bigger smile on mine.” There is so much amazing care – but also a lot of misunderstanding of dementia.
That’s why it is so significant that the leading countries of the world have agreed not just to work together to find a cure or a disease modifying therapy for dementia by 2025, but also to collaborate on ways of improving care. France in particular has a care model that I want to study carefully, to see what we can learn. In the meantime, I hope as many of you as possible will speak to your family and friends about dementia and spread the word about becoming a Dementia Friend. The training only takes a couple of hours, but will help raise everyone’s understanding of this very challenging condition.
Finally, I would like to say a particular thank you to district nurses who will be spending the festive period visiting vulnerable and often lonely older people. You do an inspiring job not just over Christmas but throughout the year and we need more of you!
We need to be better as a society at looking after lonely older people, particularly the 5 million people who say their main company is TV. I would encourage everyone to sign up to NHS England’s fantastic Winter Friend scheme, and take time this winter to look in on an elderly friend or neighbour to check they are warm, well and safe.
Below is the text of the speech made by Jeremy Hunt, the Secretary of State for Health, on 11th December 2013.
Ladies and gentlemen,
It is fantastic to see you all here today for the world’s first G8 Dementia Summit.
And it is right we should be here. As life expectancy goes up, our generation has a unique challenge: will those extra years at the end of our lives be ones we can look forward to with anticipation – or will they be ones we end up dreading?
One in three of us will get dementia. And if we don’t do better, for one in three those later years could be years of agony, heartbreak and despair – not just for those of us with the condition, but for our families, friends and loved ones too.
9 years ago Britain hosted the G8 in Gleneagles in Scotland. And we faced up to a different health challenge – HIV/AIDS. We did a brave and wonderful thing, declaring that anti-retroviral drugs should become available to all who needed them. Thanks to that, we have turned the global tide in the battle against AIDS.
Now we need to do it again.
We will bankrupt our healthcare systems if we don’t. Here in the UK the cost of dementia is £23 billion and globally it is approaching $600 billion. One in four people in UK hospitals have dementia, but the costs extend well beyond hospital care into social care, community care and the opportunity costs for carers.
But the real reason to do something about dementia is not financial.
The real reason is human. Everyone deserves to live their final years with dignity, respect and the support of loved-ones. That was the dream of universal healthcare coverage when we founded the NHS in the UK 65 years ago. Now with an ageing population we need to reinvent the model.
So let us focus on three areas of action for this summit.
Firstly to redouble our efforts to find a drug that can halt or reverse the brain decay caused by dementia. We thought we could never combat HIV. But just 9 years after the Gleneagles summit and with the involvement of some of Britain’s best universities, we are talking about a potential vaccine. We need that spirit of scientific endeavour for dementia and Alzheimer’s as well – and there is some fantastic work going on in our universities and research laboratories.
Secondly we need to improve diagnosis rates. In this country, despite our brilliant NHS, less than half of dementia patients get a diagnosis. Too many people – even some doctors – think there is no point. But with a diagnosis we can give out medicines that help some people; we can put in place support for families; we can encourage lifestyle change – all of which can mean people live at home happily and healthily for many years longer.
Thirdly let’s fight the stigma around dementia in society. When I was born in the 1960s, people didn’t like talking about cancer. The first step to improving treatment was to make it normal – we need to do that for dementia. So following the inspiring programme in Japan, we are trying to recruit one million dementia friends in England – people who know the basics and can be ambassadors for fighting stigma.
Right here we have the A team. Health ministers, science ministers, pharmaceutical companies, researchers, voluntary organisations, the OECD and the WHO. And we have some even more special guests: people who themselves have dementia and have had the courage to come today. Let us recognise them.
Let us today match their courage by daring to aim big. By showing future generations we were up to this challenge, ready to do what it takes to harness science, research and humanity to turn one of humanity’s greatest threats into one of its greatest achievements.
Below is the text of the speech made by the Health Secretary, Jeremy Hunt, on the 18th October 2013.
Introduction
Last month I visited the superb Woodside Care Home in Bath.
Woodside has a scheme where GPs make regular, proactive visits. This provides great reassurance and has reduced hospital admissions by 40 per cent.
The Care Quality Commission has praised Woodside for its kindness and warmth, regular assessments of residents’ needs, joined-working, and encouragement of activity and independence.
That’s exactly what I saw.
Staff who treated residents as they would their own parent or grandparent.
Managers who had braved difficult conversations about end of life care with residents and their families.
GPs who visited residents regularly with a seamless interface of care between the home and the local NHS.
Thoughtful, proactive, skilful, world-class care.
I was put to work helping with sandwiches, cakes and drinks – fantastically straightforward compared to many tasks the professionals face. But the kind of job that makes a real difference to quality of life if it is done with humour and kindness, as it clearly was there.
Dealing with complex medical conditions takes real skill. Developing a bond with someone who may not have long to live takes courage. Helping a person with intimate tasks demands both respect and compassion. And devoting yourself to the care of others – often with little public recognition – takes moral fibre. So let me start by thanking you and your teams for the remarkable, unsung contribution you make to our national life.
The forgotten million
Everyone’s care matters equally. I am deeply moved and hugely impressed by the best of children’s services, who help to ensure that everyone – whatever their background – has the right start in life. No work could be more important than that. But I want to focus on older people today.
And inspiring though the care at places like Woodside is, we all know there are many places that do not meet those high standards.
We also know there is a broader problem of loneliness that in our busy lives we have utterly failed to confront as a society.
There are now around 400,000 people in care homes. But according to the Campaign to End Loneliness, there are double that number – 800,000 people in England – who are chronically lonely.
46 per cent of people aged 80 or over report feeling lonely some of the time or often.
Some five million people say television is their main form of company. That’s 10% of the population.
And apart from the sheer cost of human unhappiness, there are massive health implications too.
Loneliness is as bad for one’s health as smoking fifteen cigarettes a day.
It is actually worse for you than obesity because it increases the risk of heart disease, blood clots and dementia.
Lonely people have poorer function in daily activities. They drink more. They are more likely to undergo early admission into residential or nursing care.
And perhaps we should talk not about the cost in terms of human unhappiness, but the cost in terms of avoidable human unhappiness. Because each and every lonely person has someone who could visit them and offer companionship. A forgotten million who live amongst us – ignored to our national shame.
This challenge cannot be solved by ministerial or local government diktat. But there is a great deal we can do to make things better and today I want to talk about three areas in particular.
Raising standards
The first is the need to apply rigorous, unflinchingly high standards of care – not just in the NHS, but in the social care sector too.
Last month a court found that an 86-year-old Bedfordshire care home resident with Alzheimer’s was picked up by the scruff of his neck and dumped in a wheelchair, having initially been ignored on the floor after a fall. He has since died.
His name was Albert Riches.
It is an outrage that anyone should be treated like this, let alone a vulnerable, older man. But it was not an isolated case.
112,000 cases of alleged abuse were referred to English councils in 2012-13, the majority involving over-65’s. And of those that have been investigated, nearly half have been partly or fully substantiated.
Something is badly wrong in a society where potentially one thousand such instances are happening every single week.
I totally reject the notion that such talk undermines the workforce as a whole.
In reality, the opposite is true.
When failings are not tackled head-on, dedicated staff face the double whammy of both having to deal with the individual tragedies and taking the hit to their own profession’s standing.
An Age UK survey this year found that just 26% of the general public are confident that older people who receive social care are treated with dignity.
What is worse is when lecturers in ethics legitimise such behaviour by saying – as was reported last month – that “compassion is not a necessary component of healthcare.” If compassion does not run through every vein of the health and social care system then we are betraying not only an entire generation of vulnerable older people, but our own values too.
Transparency
The only way to deal with poor standards is total transparency.
Which is why I am delighted that this year, for the first time, we have appointed a Chief Inspector of Social Care, Andrea Sutcliffe. She is putting together a comprehensive new rating system for social care providers, working closely with the sector. Like all our new chief inspectors, she will act as a champion of the people who use the services.
The nation’s whistleblower-in-chief.
From April 2014, there will be new style inspections against five key questions – is it safe; effective; caring; responsive and well-led – and Andrea will start giving ratings to care homes from October 2014. All locations – some 25,000 in total – will be inspected by March 2016 and then receive official ratings. These will be accessible to the public online and easy to understand.
She is absolutely right to demand that they all pass a “good enough for my mum” test and to denounce a tick-box culture. The involvement of “experts by experience”, residents, carers, and specialist inspectors will make a huge difference.
Andrea is also going to gather opinions on covert filming. It is of course vital that people’s privacy and dignity are fully respected. But covert filming has already helped to uncover abuse, inspectors need solid information, and I understand why more consideration is being given to this.
Andrea’s determination to combine her role as whistleblower-in-chief with celebrating the best of care is something I fully endorse.
Just as we know how good all our local schools are thanks to rigorous, independent inspections by Ofsted, I want us all to know how good our local care is. Simple, resident-focused inspections which look at the things that really matter, rather than simply the boxes that have been ticked.
And end up with an Ofsted-style rating that tells us in plain language if a service is outstanding, good, requiring improvement or inadequate.
And we will underpin this by legislating in the Care Bill to give the CQC statutory independence over the content of its inspections. Ministers must never again lean on the CQC over the issuing of news about quality inspections. Sunlight is the best disinfectant, and the biggest weapon we have to drive up standards, making sure failings are exposed as quickly as possible.
Training and development
1.6 million people work in the care industry, so the second area we need to focus on is improving their training and development.
Lyn Romeo, the newly appointed and first Chief Social Worker, will support and challenge social workers to ensure that vulnerable adults get the best possible help, with improved safeguards for residential and domiciliary care.
Camilla Cavendish’s review into healthcare assistants and support workers expressed deep concern at variations in training standards, and she wrote, damningly, that she had “been struck by how disconnected the systems are which care for the public,” adding “the NHS operates in silos, and social care is seen as a distant land occupied by a different tribe.”
We will issue a formal response soon but hope to adopt many if not all of her recommendations.
My department is also spending £12 million on the Workforce Development Fund for training and we will work closely with Skills for Care and the National Skills Academy Social Care to improve skill levels in adult social care. And we are doubling to 100,000 the number of apprentices that get high-quality training and support by 2017.
All of which I hope will make a big difference.
Social care funding
The third area we need to address is funding.
I recognise there have been cuts in funding to local authorities as we seek to deal with the deficit. Perhaps less recognised is that funding per head for adult social care fell under the last government too. But politicians of all parties need to be honest that the pattern of gradually reducing funding in the face of an ageing population is simply not sustainable – and we need to change the model.
Let’s talk about the money we have allocated first.
We have committed an additional £7.2 billion, including a contribution from the NHS budget, for adult social care over the course of this parliament.
On top of the Dilnot reforms, we are committed to increasing government investment in social care through a £3.8 billion pooled budget for health and social care in 2015-16. It comes on top of an extra £200 million for social care in 2014-15.
But those reforms do something else as well.
By implementing a cap on care costs of £72,000, they make it possible for people to plan for their social care costs in the same way they plan for their pension. Which will lead to a dramatic increase in planned funding being put aside to fund end-of-life care costs.
Our objective is to be one of the first countries in the world where, as part of their pension plans, most people save throughout their lives for their likely care costs.
But even additional financial support will not be adequate unless we also change the model.
It is high time we closed the gaps that see people being sent round the houses, breakdowns in communication, and wrangling over budgets.
Which is why rather than simply adding £2 billon to existing support for social care in 2015-16, we are combining both into a £3.8 billion single health and social care transformation fund. To access this, each local plan will have to offer genuinely integrated care: joint commissioning, joint provision, seven-day services, full record-sharing and professionals accountable for seamless, joined-up care.
I have asked for all integration plans to be approved and in place by next April because although the funding does not start until April 2015, many authorities will want to start earlier as the potential for both improving care and making savings is immense.
A social solution
But this is not just a government – or even a local government – solution.
There has to be a social solution too.
My wife is Chinese and I am struck by the reverence and respect for older people in Asian culture. In China and Japan, it is quite normal for elderly parents to live with their children and their families. The Indian government has even announced recently that it plans to name and shame people who abandon their parents.
Let me be absolutely clear. There are occasions where it’s right and necessary for older people to go into care homes and no family should feel condemned for taking that difficult decision.
In those countries, when living alone is no longer possible, residential care is a last rather than a first option. And the social contract is stronger because as children see how their own grandparents are looked after, they develop higher expectations of how they too will be treated when they get old.
If we are to tackle the challenge of an ageing society, we must learn from this – and restore and reinvigorate the social contract between generations. And uncomfortable though it is to say it, it will only start with changes in the way we personally treat our own parents and grandparents.
Conclusion
Professor Tom Kirkwood of Newcastle University’s Institute for Ageing and Health talks of a 29-hour day. For every decade we live, life expectancy goes up two years – which works out as five hours for every 24 we live.
So we are putting aside five additional hours at the end of our lives for every day we live.
And the cruel irony of the pockets of failure that let the whole system down is that old age can be wonderful. Freed from the responsibility of work – and having cast off some of the stresses and preoccupations that can dominate earlier years – many older people thrive like never before, even as they battle infirmity.
Not everyone can have healthy last years. But our ambition must be that everyone has happy ones.
And all of us in this room share that ambition – indeed are dedicating their lives to meeting it.
We may have different roles to play, but together we can challenge society, celebrate and promote best practice, and agree that “good enough” is never enough.
And if we persist, we can do something even more amazing: really and truly make this country the best place in the world to grow old in.