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Speech in the House of Commons, by Rt Hon Alan Johnson MP, Secretary of State for Health, 10 October 2007: NHS Interim Review

Mr Speaker, after a decade of unprecedented investment in the NHS, we see the results in more staff, one million more operations each year, 100 new hospitals, reduced waiting times and lower mortality rates, particularly for cancer and cardio vascular diseases. 

Having expanded capacity in the Service, we can now focus even more closely on raising quality.
 
Last week, Lord Darzi published his interim report, setting out a vision for world class health and healthcare in England, developed and owned by patients, staff and the public.

Yesterday’s Comprehensive Spending Review settlement enables us to take the measures necessary to begin to implement that vision.

It is a good settlement for the NHS: locking in current record levels of spending and adding real terms increases – year on year – so that total health spending will rise from just over £90 billion in 2007/08 to £110 billion in 2010/11.

This represents a real terms increase of 4.0% a year on planned spend, compared to a historic average of 3.1%. In the 18 years up to 1997, real terms growth was 3.0%. In the five years up to 1997, it was 2.6%. In 14 years under Labour up to 2010/11, real terms growth will average 5.6%. 

This extra funding is essential if we are to meet the challenges of an ageing society, the opportunities of new technology and the demands of rising public expectations of what a health service in the 21st  Century should provide. I’m proud that it is my Government that has delivered, and will continue to deliver, these necessary increases in funding.

Lord Darzi’s interim report drew out four over-arching themes for the NHS over the next ten years: fairness, personalisation, innovation and safety.

First, an NHS which is fair. No single institution has made a greater contribution to social equity in this country than the National Health Service; yet, sixty years on, whilst the health of all income groups has improved dramatically, stubborn health inequalities remain.

We will begin to address one important element of this problem with a new £250 million access fund that will deliver at least 100 new GP practices in the 25% of PCTs with the poorest provision.

These practices will bring the most modern healthcare models direct to the nation’s most deprived areas. They will offer an innovative range of services; they will be open for longer; and will also have a specific remit to prevent ill health rather than simply treat it.

This is crucial, when lifestyle choices are responsible for as much as half of the gap in health outcomes.

Second, an NHS which is personalised.

GP practices should fit around people’s lifestyles, and not the other way around.

We have set a clear aim that working with new and existing GP practices, we will ensure that at least a half of all surgeries are open either at weekends or after work.

We will also explore all the options for making it easier to see a GP nearer to the workplace for those who commute.

The new access fund will also establish at least 150 new GP run health centres in easily accessible locations, open seven days a week, from 8am to 8pm. These will offer bookable appointments, walk in services and in some cases access to physiotherapy, diagnostic and social care services, and there will be at least one in each PCT area.

More than a third of GP time is spent dealing with mental health problems from which one in six people suffer at any one time. Mental illness accounts for 40% of those on Incapacity Benefit.

Prescription medication provides a successful treatment for many, but we know that psychological therapies also work equally well, and often prove to be more effective in the long term. The time has come to do much more to help those with depression and anxiety.

I can announce today, which is of course World Mental Health Day, that we will build a ground breaking psychological therapy service in England. Backed by new investment rising to £170 million by 2010/11, this will be capable of treating 900,000 additional patients suffering from depression and anxiety over the next three years. Around half are likely to be completely cured, with many fewer people with mental health problems having to depend on sick pay and benefits.

Third, an NHS which is innovative. British scientists have been responsible for discovering some of the most important medical breakthroughs in history. In this modern age of rapid medical, scientific and technological advance, we must ensure that the NHS remains at the cutting edge of developments in products, processes and procedures.

We will establish a new Health Innovation Council to drive a more innovative NHS, identifying and removing barriers to change. This will bring together all the splendid work that is going on: from discovery through development to adoption – ensuring that ideas can efficiently pass from the labs to the patients, without any compromise to patient safety.  And we will set up a new £100 million fund for innovation, jointly funded with the Wellcome Trust.

We will also expand the single fund for health research to £1.7 billion.
 
In the 18th Century, Edward Jenner discovered the smallpox vaccine. In the 19th Century, British scientists developed anaesthetics and antiseptics. In the 20th Century, Alexander Fleming discovered antibiotics. In the 21st Century, we want British scientists to combine to lead in the fight against global killers, such as cancer and HIV/AIDS.

Fourth, Mr Speaker, an NHS which is safe. Healthcare acquired infections are a growing problem around the world.  Hospital cleanliness should be the last concern of patients and the first duty of everyone in the Health Service.
We have announced that all hospitals will be deep cleaned at least once a year. Isolation wards will be extended wherever possible. And we will empower and encourage matrons and nurses to use their expertise to fight infection on the front line.
The Health and Social Care Bill, contained in our draft legislative programme, will provide the new health and adult social regulator with tougher powers, backed by fines, to inspect, investigate and intervene in those hospitals which fail to meet hygiene and infection control standards.

And, as Lord Darzi recommended and this CSR provides for, we will invest £130 million to introduce MRSA screening for all admissions, elective and emergency over the next three years. We will also put a further £140 million into reducing C Difficile infection rates.

To develop an NHS which is clinically led and locally driven, we need more local accountability. I have already said that there will be no top down structural re-organisation of Strategic Health Authorities and Primary Care Trusts for the foreseeable future. Although we must ensure minimum standards, we will not impose a swathe of new targets. We know that future improvements will come from more local ownership, fewer top down targets and a concentration on better health outcomes. 

As Lord Darzi has said, any change to NHS services must clear a high clinical bar, based on full engagement with patients and the public. Ensuring the Health Service is clinically led will be pivotal to ensuring that the service moves from “good to great”  - world class in all aspects instead of just some.

How we match local ownership with greater local accountability will be one of the principal aspects of Lord Darzi’s continuing work.

Mr Speaker, the historic problem for the Health Service has been underinvestment. The challenge today is to ensure that we maximise the potential of this unprecedented level of investment.

The public want more money to be spent on the NHS, but they also require it to be spent well. 

Measuring productivity when quality of care is paramount is not an easy task, as Wanless has highlighted.

The Better Care, Better Value Indicators, published yesterday, showed that £363 million of productivity improvements were achieved last year.

These first step savings came from reducing the length of stay and from increasing prescriptions of low-cost generic statins for patients with high cholesterol.

These gains are modest but they point to the potential of what can be achieved without compromising patient care.
 
We must now look to build on these achievements, systematically and sensibly. Over the course of this spending round, the NHS will deliver average value for money gains of 3% every year, releasing over £8 billion a year by 2010/11 to spend on frontline care.

There are some obvious areas that can contribute to this difficult task.

Improving community based services so that people with long term conditions can receive greater support in the community could bring savings of around £500 million a year. 

Intervening with preventative action – like regular health check ups – when someone is at risk of illness, could reduce the costs of chronic lifestyle disease such as diabetes, heart disease or lung cancer.

Spreading new technologies and best practice across the Health Service could lead to savings of £1.5 billion a year.

Improving procurement could save £1 billion a year.

And, by introducing MRSA screening for all admissions, we can reduce the risk of huge costs occurring later.

Mr Speaker, in the face of unprecedented demographic change, it is clear that our social care system needs to change. The Chancellor has announced that we will develop a Green paper exploring options for reform, with the aim of increasing dignity and reducing dependency for those who rely on our social care systems.

The social care settlement is divided into two parts: local government grant and direct funding from my department for social care.

The Local Government support grant will increase by £2.6 billion by 2010/11. Direct funding from DH for adult social care, which covers, for example, carers, mental health and the social care workforce, will increase by an average of 2.3% in real terms a year, worth £190 million.

This funding will enable social services to do more to give service users and their carers greater choice and control over the way in which their needs are meet.

In particular, this investment will enable further expansion of care tailored to the individual. It will go into prevention, improving people’s quality of lives.

And it will enable more individuals to live independent lives in their own homes.  But, as the Wanless report on social care identified, we need a radical rethink about how we fund this crucial element for everyone in need, not just the elderly into the future. The Green Paper will begin this important process.

Lord Darzi and his team of 1500 clinicians will finalise the NHS Next Stage Review in time for the 60th anniversary of the NHS. This is an exciting time for everyone involved in healthcare, but as this CSR demonstrates, it is patients and the public who will continue to benefit from a National Health Service that is rising to the challenges of the 21st Century.

I commend this Statement to the House.