Website of the Department of Health

Speech by the Rt Hon Alan Johnson MP, Secretary of State for Health, 1st November 2007: Chief Nursing Officer's Summit

I am delighted to make my first address to the Chief Nursing Officers Summit – an un-missable date in the health calendar.

I would like to begin by paying tribute to you for the incredibly important, frequently unrecognised work that you do. You epitomise the public service ethos which forms the backbone of the NHS - an ethos that we should perhaps celebrate a little more as we work towards the final report from Lord Darzi, setting out the next stage of the NHS journey.
 
The challenges for today’s NHS are very different to the ones we faced ten years ago.

Then, the amount we invested in health as a proportion of our GDP was similar to the levels invested in the Czech Republic and Poland, and well below the levels of France, Germany and Sweden.

Waiting lists topped 1 million; and chronic bed shortages meant that patients could be left for hours or even days on trolleys in accident and emergency departments. Today, nearly 98% of patients are either admitted, transferred or discharged within four hours of arrival at A & E.

284,000 patients had been waiting for an operation for longer than six months in 1997. Today the number is less than 500.

Then, half of all NHS hospital buildings had been constructed before the NHS was created. Now, thanks to the biggest hospital building programme ever seen in this country, it is less than a fifth.

The enormous improvements are due to the efforts of the people who work in the Health Service, combined with unprecedented levels of investment.

This has led to an unprecedented level of hyperbole from some media commentators who use the most spurious arguments to suggest that the money has been wasted: that its been squandered on over generous pay settlements; that staff are over-burdened by bureaucracy; that the real problem is poor productivity.

Yet, without drawing breath, these same commentators also complain about staff shortages, that we should monitor healthcare more closely and that nurses are overworked.

A Sunday newspaper last week suggested that 70,000 British people going abroad for operations provided clear evidence of a failing system. 70,000 compared to the 350 million episodes which the NHS deals with every year - and those mainly private patients in pursuit of cheaper operations.

The fact that the Healthcare Commission’s survey of 80,000 recent inpatients found that 92% said that their care was either excellent, very good or good made no headlines at all.

Such are the burdens that everyone in the NHS must bear. Nobody knows more than the staff who work in the Service that there is a huge gap between perception and reality and that staff morale is not as high as it should be.

Obviously, the problems with MTAS and the staged pay increase are factors but it seems to run deeper than this. Staff feel that change has been done to them rather than with them and that much of it was driven by ideology, instead of clinical need.

The next stage review is a chance to re-burnish the spirit of social solidarity that led to the foundation of the NHS, by setting aside structural change and concentrating instead on what gets NHS staff out of bed every day – better and safer patient care.

Over the last few months, Lord Darzi has led an unprecedented consultation exercise, talking to 1,500 NHS staff, along with hundreds of patients and members of the public across the country.

Everyone in the NHS knows that the Service cannot stand still in the face of profound social, scientific, demographic and technological change. 

People’s expectations are constantly growing. Medical advances bring new cures, but also extra costs. And, whilst modern life is less physically strenuous, this in itself is sparking a dramatic increase in lifestyle diseases, such as diabetes and obesity.

The problem of obesity was brought into sharp focus with the recent report from the Government’s Chief Scientific Adviser, which predicted that 60% of men, 50% of women and 26% of children and young people will be obese by 2050. Cases of diabetes are set to increase by 70%, strokes by 30% and coronary heart disease by 20% -  costing the nation a further £45 billion a year.

In our discussions, a new vision is emerging of an NHS able to withstand these growing pressures: delivering a service which is universally accessible, but personalised to the individual; that is world class: not just in some respects, but in all;.an NHS that focuses on prevention as much as cure.

By doing more to promote well being today, we can substantially reduce chronic diseases in the future. A shift towards a prevention based society can’t be achieved by the NHS alone: it requires individuals to pay more attention to safeguarding their own health, eating healthily, exercising regularly and receiving essential vaccinations.

The Foresight report also highlighted the responsibilities of employers towards their employees health. And of Local Authorities to plan housing developments so that walking, cycling and playing sport are essential features of the design.  

Over the coming months, the Prime Minister and I will announce further ways to promote the healthy society, building on recent measures: such as legislating for smoke free environments, making psychological therapies available nationwide and vaccinations against cervical cancer.

The next stage in the evolution of the Health Service must come from the bottom up rather than the top down. Targets have proved to be powerful drivers of improvements - reducing waiting times and increasing cancer and CVD survival rates - but their potential for bringing about change diminishes over time.

Part of our transformation must include a shift away from top down targets - Lord Darzi’s interim report focuses on safety, accessibility, personalisation and innovation.

Over the next few months, as we translate this vision into public policy, we will require a genuine dialogue across the workforce, with CNOs fully involved in the clinical pathway discussion groups which are underway.

This necessary dialogue does not mean that we enter a period of suspended animation.

The Healthcare Commission report into Maidstone and Tunbridge Wells  exposed standards of hygiene which should not have been acceptable in the 19th Century, let alone in the 21st.

The report exposed failures at every level: the board seemed insulated from problems on the wards; the director of infection had little understanding of the nature of his role; and there was confusion about who managed the infection control team.

Patients rightly expect the highest standards of treatment. Trusts must be held accountable where they fail to deliver such standards. The Maidstone and Tunbridge Wells Trust, under the leadership of a new Chairman, has decided that it should not pay the severance package originally proposed with the former Chief Executive.

I entirely support that decision. The public and those who work in the NHS are united in their concern that public money should not be squandered on questionable exit packages, and David Nicholson has recently written to all PCTs setting out the procedures which must be followed in the cases where services are terminated prematurely.

What David Nicholson and I have also made clear is that patient safety must be the priority of every senior executive in the NHS. We are not unique in facing the perils of HCAIs: every country in the world is grappling with something that has always been a factor in health care. We are however the only country which has a mandatory universal surveillance system.

The statistics show that: firstly, in the periodic assessments mode, the level of HCAIs has remained consistent at around 5-10% of patient episodes; and, secondly, this is roughly the same level of HCAIs across the developed world (ie 8% in Denmark, 6-10% in France, and 7% in Netherlands). The difference is that our statistics are robust and other countries are only now seeking to adopt mandatory surveillance.

The Health Protection Agency has today published figures covering the period from April to June. For the first time, these include the under 65 age group, for the first time. They demonstrate that the rate of infections for the over 65s, is falling. 

A whole range of measures is being introduced to improve the situation further.

Last month, we changed the uniform rules to ensure that all garments are bare below the elbows, ensuring rigorous handwashing and high levels of hygiene. 

Last week, I set out plans to create a tough new regulator, with new powers to investigate, impose fines and close down entire wards if strict standards of cleanliness are not adhered to. 

And, today, we have issued instructions to all NHS directors on the need to improve cleanliness and infection control, based on other measures we have introduced since July, including:-

• Providing extra funding for 5000 matrons by next spring, one for every two hospital wards, each of whom will bring a renewed focus on safety and cleanliness

• Empowering Matrons and clinical directors to report at least quarterly direct to the Trust Board on cleanliness and infection control.

• Enabling matrons to set standards for cleaning and, where necessary, withholding payments and terminating cleaning  contracts.

• Authorising nurses to request additional cleaning.

We have announced in CSR that we will pre-screen for MSRA in elective & emergency surgery. We have also set aside £50 million so that every hospital in the country is deep cleaned over the next year.  This will be managed by the SHA’s, reporting to the department on progress.

The deep clean supplements the important essentials of rigorous handwashing, careful prescription of antibiotics and isolation with cohort nursing for affected patients.

The guidance we have issued today sets out the basics of deep cleaning, and the process Trusts must follow at the local level to implement this policy over the winter period.

As Ara Darzi’s interim report highlighted, safety, quality and personalization are the essential themes emerging from his widespread consultation.

A 21st Century healthcare system must fit with modern lifestyles. 

We are investing in 150 new health centres, situated in easily accessible locations and open seven days a week, open from 8am to 8pm. These new centres will offer book-able appointments, walk in services and, in most cases, access to physiotherapy, diagnostic and social care services.

There will be at least one of these new centres in each PCT area. In addition, there will be 100 new GP practices opening in the 25% of PCTs with the poorest primary care provision, bringing the most modern healthcare models to the areas of worst deprivation, with a specific remit to prevent as well as treat poor health.

We are also seeking to ensure that at least half of all GP surgeries are open at weekends and after work.

It is in local communities that our healthcare will increasingly be shaped and personalised in future. We must open new, more efficient and convenient routes into primary care, fully utilising the potential of pharmacies, sports centres and high street walk-in centres to meet patient needs.

We also need to bring down the barriers between healthcare and social care.

Following extensive public consultation next year, we will publish a Green Paper focussed on the long term issues for adult social care, whilst simultaneously beginning the reform process through greater independence and control over this 3 year CSR period.

These measures will be key to tackling health inequalities. People from all social classes have seen significant improvements in their health, but disparities between the income groups remain. Again, this needs a more integrated approach, recognizing that the NHS alone cannot close the gap.

Our vision is of a Health Service which is clinically led, patient centred and locally driven – looking out to the local community rather than up to Whitehall.

For the NHS to reach its collective objectives, every single member of staff must be able to reach their individual potential.

Last year, Christine Beasley published “Modernising Nursing Careers”. As the nature of nursing changes, so the way that nurses are trained must evolve.

Of course, all staff should already receive performance reviews, training opportunities and development plans, as part of the Knowledge and Skills Framework.

We are already world class in areas like nurse prescribing but must spread out into more community focussed work.

To provide clearer career frameworks for nurses, I am today publishing a consultation document on post registration careers. This will run alongside a consultation from the Nursing and Midwifery Council on pre registration frameworks, so that the two issues are considered in tandem.

By linking career paths with the patient pathways that are emerging from the Darzi Review, we can link enhanced professional development to improved patient outcomes. An improved NHS will not come from making staff work harder, but ensuring that the Service works smarter.

The Productive Ward Programme demonstrates how small changes in staff routines can make a real difference to overall efficiency. Through the Institute for Innovation and Improvement, a number of time savers have been identified – with suggested methods for ways to improve and speed up shift handovers, the preparation of medicines and meal delivery times. More trusts should take advantage of these improved working practices.

Next year, we celebrate the 60th anniversary of the NHS. Whilst we commemorate the enduring nature of this remarkable institution, we must also hold back the creeping tide of complacency which so frequently accompanies familiarity.

This week, I saw Michael Moore’s film, “Sicko”. It's salutatory to see the NHS through the eyes of someone unfamiliar with our system. He was amazed at the high quality expensive medical care, free at the point of need.

As we approach the 60th anniversary of the NHS, the nation will, I’m sure, be united in its appreciation for a healthcare system which, whilst by no means perfect, remains a source of national pride and international envy.