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NHS Modernisation

3.30 pm

The Prime Minister (Mr. Tony Blair): With permission, Madam Speaker, I wish to make a statement.

Yesterday the Chancellor announced funding for the national health service, not just for the coming financial year, but for the three years following. Taken together with this year--the first year of the current comprehensive spending review--it means the biggest sustained investment for the health service: a 35 per cent. real-terms rise over five years, and a real-terms average increase of 6.1 per cent. per year over the next four years. That is a rise of more than double the average under the previous Government.

Yes, there have been larger one-off rises, but never a rise sustained in this way. It means that by 2003-04, NHS spending will have risen to 7.6 per cent. of gross domestic product. That is a huge increase in any terms. In a period of predicted economic growth, it is unique. It comes with an immediate injection this year of £2 billion extra for the UK, which includes the tobacco duty increase of £300 million.

We have done this because we believe in the national health service. We never want to see it broken up, reduced to a rump service for those who cannot afford to pay for private health care. The NHS is a unifying force in this country, and under us it will remain so.

Here is the challenge to us in government and to all who work in the health service, however. Everybody knows that the NHS needed the new money announced yesterday, but everybody knows, too, that the NHS needs fundamental reform if it is to provide the standard of care that people deserve in the 21st century. With the money must come the modernisation. A step change in resources must mean a step change in reform.

In our schools, we now accept that, though more investment is necessary, it is not sufficient. There is a real and often hard debate about standards, performance and reform. No one really believes that the one without the other will work. Now it is time to raise the same debate in the national health service.

This afternoon, I will set out the key challenges facing the health service, the means by which we intend to tackle them and the methods for involving the people who work in the health service in this vital task.

I say to our hard-working and dedicated staff in the health service: "You challenged us to come up with the money. We have done so. It was hard won and hard fought. There were many calls upon it--many places where it might have been spent. We rose to your challenge. Now I ask you to rise to ours. Work with us to make sure that this money is spent well: make sure that the national health service confronts the hard necessities of reform to improve the value that we get for the money that we spend."

Some health authorities and trusts carry out four times more hip replacement operations than others. We need to know why. How is it that some trusts can provide elective surgery for all their patients within six months, while in others one in eight patients have to wait more than 12 months?

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In some accident and emergency departments, non-urgent patients are treated within half an hour, while in others there is a four or five hour wait. There are trusts that see nearly 100 per cent. of their out-patients within three months, while others manage less than 60 per cent.

The proportion of operations done as day cases varies from 75 per cent. in some places to less than 30 per cent. in others. There are around 5,000 elderly patients who do not need to be in hospital but are there because of complications between social services and hospitals over their care arrangements.

Some hospitals employ twice as many nurses as others to staff critical care beds. Why is there a twofold difference in the cost of care between the best and the least efficient hospitals? Some hospitals manage without long trolley waits while others have them on a regular basis. Some patients can get a routine GP appointment within 24 hours in some surgeries, but have to wait four or five days in others. The top 25 per cent. of trusts use their consultants twice as productively as the bottom 25 per cent.

There are huge variations in the proportion of patients at risk from heart disease, who get the appropriate drugs to help control their blood pressure and cholesterol. Nurses in some hospitals discharge patients from accident and emergency, and in others they do not. Some hospitals use physiotherapists to help reduce waiting times for orthopaedic appointments; others do not. Links between social services and GPs work well in some areas, but in others are virtually non-existent. Some medical teams are so much better at preventing and managing conditions such as diabetes and asthma than others.

Those are big issues. The reasons for the variations are of course complex. Some of the problems will be because of a shortage of staff and equipment, but some will be the result of poor management and inefficient organisation. Some will arise out of outdated demarcations between professionals within the service. Some will be systems failures, and some will be professional failures. Each of them must be confronted and analysed, and solutions found.

These are the five challenges that I set for the health service. First, there is the partnership challenge for all parts of the health system--GPs, hospitals, their consultants, primary care groups, social services and community health services. How do we work together to end bed blocking, reduce unnecessary hospital admissions and provide the right level of beds and services for each level of care?

Secondly, there is the performance challenge, to ensure that, using information, incentives and inspection, all trusts and primary care groups come up to the standard of the best; that we provide the right support and intervention for those that struggle to provide proper standards of care; and that the systems are in place to identify and root out poor clinical practice.

As a first step towards meeting that challenge, the Secretary of State for Health will later this afternoon give details of £660 million of the extra £2 billion for next year that will be allocated straight away to health authorities, trusts and primary care groups. He will set out how the extra money will be coupled with new incentives to ensure that every pound provides value for money.

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Thirdly, there is the challenge for the professions to strip out unnecessary demarcations, introduce more flexible training and working practices and ensure that doctors do not use time dealing with patients who could be treated safely by other health care staff.

Fourthly, there is the patient care challenge. Hospitals and primary care groups should ensure that they all adopt best practice, design out delays and introduce convenient booking systems so that patients with the most serious conditions get treated quickly, and no one has to wait too long for an operation that they need.

Fifthly, there is the challenge on prevention: to balance spending on tackling the causes of ill health with treating illness; to develop a more systematic approach to treating people at risk from chronic diseases; and to persuade more people to play their part in achieving better health by adopting a more healthy life style.

Those are tough challenges. Together we need to find answers. If excellence can happen in one part of the country, I say, "Why can it not happen in all parts of the country?"

In the past two to three years, there has been substantial change and improvement. The internal market has gone. A record number of hospitals have been built. Nurses are returning to the health service. More doctors are in training. There are new services, such as NHS Direct. New standard procedures have just been published for cancer and heart treatment. Casualty departments are being modernised. There is the new Commission for Health Improvement, an Ofsted for the NHS, charged with raising standards in all hospitals, and a new institute to advise on the best treatments and drugs.

But we all know that that has not been enough, and too often the pressure of change has been made doubly painful by the pressure of scarce resources. Now we have a chance to put the extra money to work.

I have set out the challenges, but I offer to meet them in partnership with those in the NHS. In the next few months, the Secretary of State for Health and I will meet and talk to the people responsible for health care in every part of the country. We will consult the leaders of the professions and the health organisations.

For each of the five challenge areas, there will be a dedicated unit to examine the problems and come up with solutions.

Madam Speaker: Order. There are too many conversations taking place around the Chamber.

The Prime Minister: The units will be jointly led by a Health Minister and a key leader from the health service.

The health service is a national health service, and I have therefore invited the First Minister in Scotland and the First Secretary in Wales to join me in a UK-wide group to develop and drive through the reform that we devise.

In addition, for England, a new Cabinet committee chaired by me will be established to agree and monitor the standards of service and improvements that people can expect by the end of the financial year 2003-04.

In July, we will publish a detailed four-year action plan for the NHS. It will outline the improvements that we seek, the changes necessary to achieve them and the

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timetable for their delivery. That will not complete the journey of renewal for the NHS, but it will take us a long way towards our destination.

It will take tough, often painful decisions about change in order to make progress. However, I want all parts of the health service to sign up to the plan, to feel ownership of it, to agree the priorities we set out, and to help us deliver them. I want the country to unite around it for the future.

However, I do not and will not yield to those who believe that the NHS has had its day. It has not. A modernised health service, not private medical insurance, is the future. The values of the health service are every bit as relevant today as they were 50 years ago, but they have to be applied in a different way, for a different age.

The health service is one of the great institutions that binds our country together. It is one of the great civilising achievements of the 20th century.

It is our task as the party that created the national health service to renew it for the 21st century and defeat the pessimists and the privatisers who would see it dismantled.

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