Website of the Department of Health

Thank you to CNO and all of you for the opportunity to speak to you today.

This is an important gathering, bringing together nursing and midwifery leaders from across the whole of the NHS as well as education and the independent sector

I would like to start by thanking you all. For ensuring that patients are provided with high quality care 24 hours a day, every day of the year.

During my first months as SoS for Health - and travelling around the country - I couldn't fail to become aware of the changes taking place in nursing.  I have been impressed by the  great variety of nursing roles and responsibilities - in all settings where health care is provided, one will find a nurse, sometimes leading -  sometimes supporting - always present. 

Nurses like Almeira Obied, an advanced nurse practitioner I met in Birmingham who visits elderly people in their homes and whose work helps to prevent many of them having to be admitted to hospital,  have played a vital role in this - learning new skills - taking more responsibility - shaping new services - working in new ways.

Sue Smith, the nurse practitioner leading a team of nurses and other health practitioners running the Walk-In Centre in south-east London, whom I met on my first visit as Secretary of State for Health.

Lorna James, who runs the midwife-led birthing unit that I visited in Mid-Yorkshire.  The unit is part of an acute hospital but the obstetricians are only allowed access to the unit with the  permission of the midwives!

Nancy  Hallett, chief executive of Homerton Hospital, has taken up the challenge of leading a large complex organisation and with her colleagues has used the new freedoms of being a Foundation Trust to establish a perinatal centre to meet the needs of this very disadvantaged East London community.

The A&E nurses at the Royal Free and of University College London hospitals, whom I met on the evening of 7 July, who had done an outstanding job caring for the victims of the terrorist atrosity.

And on Monday evening at the Nursing Times Awards, I met many more nurses who are transforming services including Anthony Kerley who told me about his work in Chelsea and Kensington developing AIDS/HIV services.

My visits offer the opportunity to learn about these new, exciting ways of working, but also to hear about the things that are not going so well.  One of the things that Sue Smith mentioned to me that was hindering her work was the limits on nurse prescribing.

That is why I am pleased to announce that the Committee of Safety of Medicines has recommended that qualified Extended Formulary nurse prescribers should be able to prescribe any licensed medicine for any medical condition - with the exception of controlled drugs. 

I am delighted to say that the Committee has also recommended that we introduce a new category of non-medical prescriber, pharmacist independent prescribers - who will have similar powers. We plan that regulations will be amended to enable this from Spring 2006.

We can be proud of the achievements of nursing and midwifery. We now have over 800 nurse consultants, 3000 modern matrons and specialist nurses in all fields of care.  We see nurse practitioners in first contact care and minor illness, emergency care practitioners in most major A & E departments, surgical care practitioners carrying out procedures such as arthroscopies and endoscopies - highly skilled nurses in hospital at night schemes - taking part in on-call rotas and managing medical emergencies.

My vision of a modern NHS is nurses and other clinicians practising at the height of their ability - and a government supporting them through funding, removing barriers and creating a climate in which they can flourish. 

We have provided unparalleled investment - the NHS budget,  £37 billion in 1997  will rise to  £92  billion by 2007/8 

And an increase in staff  - 78,600 more nurses working in the NHS since 1997.  

We have introduced initiatives to enable nurses to develop their skills:  today nurses order investigations, refer and discharge patients, and carry out activities that would have been the exception a few years ago. 

We must not underestimate the journey nursing and midwifery has taken.  What has at times been a difficult road to travel - gaining recognition and acceptance - not allowing yourselves to be type-cast  -   sometimes handmaidens - sometime angels. 

I am keenly aware many of you think too much has changed, too fast - and that you want to be left alone to do the job. 

I would love to stand before you and say 'OK, no more change', - but if I did I would be letting down the people in this country, who know that the NHS is funded as never before - and expect to see a high return for their money.  In the end - if I took the easy way -  I may win your applause today - but all of us who want to see a vibrant NHS would be the losers. 

To build a truly patient-led NHS, we must be able to see it through the eyes of patients - we must be able to hear their voice and we must have systems to give that voice expression. 

As NHS users ourselves - we know how want it to be. 

To really put patients in the driving seat we must make change at grass root level.  We must move from a top- down target-driven management system to one that has the right incentives to make sure that we respond to patients and continually improve.  Giving patients more choices -  giving the people often closest to them - GPs and nurses in primary care - more power, giving provider organisations more freedoms to respond, making sure the money follows the patient and introducing transparent standard setting and incentives. 

We need to make sure the extra resources going into NHS are achieving what patients want and are delivering value for money - not just giving us more of the same.

At the end of the year, a new White Paper, shaped by an unprecedented consultation exercise, will spell out our vision for the next stage of reform and improvement in the NHS and social care.    Emerging themes tell us people want more services close to home - easier access to GPs, continuity and communication between services including social care, 24/7 health and care services -  and more support and information to stay well.  We need to respond to people like Angela who spoke this morning - she wants services tailored to her needs and those of her family, not the other way round.

There would be no point asking people how they wanted their NHS to be if we did not take steps to ensure it was delivered.  Commissioning a Patient-Led NHS signals our intention for PCTs to become stronger organisations -  to ensure money is spent as effectively as possible -  is spent on areas of greatest need not where demand is most vocal,  - and focuses on securing the services patients tell us they want. 

I know that many of you were very unhappy about what we said at the end of July about the future of services that you currently provide through PCTs, and I am very sorry that you have been caused such anxiety. We have listened very carefully to what you and others have said.

Clearly we were too prescriptive in Commissioning a Patient-Led NHS and we have changed that. As I said to Parliament on 25 October, district nurses, health visitors and other staff delivering clinical services will continue to be employed by their PCT unless and until the PCT decides otherwise.

The situation today is that different PCTs provide different services. Some provide no or very few services themselves. Others may wish to move in that direction because they believe it will improve services and they want to concentrate on their commissioning role. They will, of course, be free to do so - provided, obviously, that they have a full consultation with their staff, patients, users and the public.

So any move away from direct provision of services will be a decision for the local NHS within the framework set out in the forthcoming White Paper and after local consultation. We will support PCTs who want to do that, but we will not instruct PCTs to do it, nor will we impose any timetable. What matters is getting the best services for each community - and that is what the White Paper will focus on.

In all these changes, there are real opportunities for nurses.  On Monday evening, at the Nursing Times awards, I met a nurse - the Director of Primary Care in a PCT - who is desperate to take her nurses out of the PCT and in to a NHS Care Trust.  She was very clear that it would help separate commissioning and provision.

Community nurses like Jo Pritchard and Tricia McGregor are looking to establish an employee owned co-operative in Surrey, with 700 staff, running their own Care Trust. 

Nurses like Linda Aldous who has found being a partner in the Bromley-By-Bow general practice, one of the most innovative practices in the country, gives her much more influence.