Thank you.

It’s been an incredible summer for British sport. Last month’s Olympic success in Beijing was our best Games in a hundred years. Our Paralympic athletes have already surpassed their pre-Games target of 41 Gold medals, putting Great Britain in a remarkable 2nd place behind China.

There is something special about watching people at the pinnacle of their sport compete at an Olympic Games. Even more so when those winning are so often from your own country.

But let’s not forget just how bad things once were. Our nadir was Atlanta in ‘96, when we came away with just one gold medal. Everyone realised that things had to change. So we began a determined effort to turn things around, to go from national shame to global acclaim.

Today, great sporting nations from around the world look to us to learn how to manage and improve their competitive sport.

And though I wouldn’t want to be accused of over-claiming, thinking about this incredible turn around, I can’t help seeing some parallels with the NHS.

The NHS of 1996 was a picture of ill health. Decades of under-funding had left our hospitals crumbling, our doctors and nurses struggling and under-paid and patients waiting an unforgivable length of time to receive even the most basic care.
The NHS’s journey has not been an easy one. To turn around an organisation as large and complex as the National Health Service has taken time, sustained investment and the dedication of over a million people.

Our policies have evolved as conditions changed. In the beginning, it was right to set a clear direction for the extra billions that we were investing. For example, our target for waiting times, bringing waits down from over 18 months to an average today of just 8 weeks and a maximum by the end of this year of just 18 weeks has been vital to address the main concern that the public had about the performance of the NHS.

But what the NHS needed, and what worked, for a Service starved of cash and personnel is not appropriate for today’s stronger, healthier NHS.

Ara Darzi’s Next Stage Review of the NHS, published earlier in this non-summer, presents a vision of the NHS that consistently delivers the highest quality of care to all its patients. Enabling staff to offer treatments that are personal, effective and safe.

It is not a vision dreamt up in Whitehall. But the result of a year’s work listening to staff and patients across the country.
The next 5 years are going to see that vision implemented. Not top-down change directed from centre. But change led from the ground up. Change in which the independent sector will play an important part.

The Value of the NHS to British Business

The NHS is vital to the competitiveness of Britain, bringing huge benefits to British business.

Across the Atlantic, one of the biggest election issues for business is the cost of health care. Starbucks spends more on healthcare than it does on coffee. General Motors more than it does on steel for its cars.

These costs hurt the profits of large companies, but they can be ruinous for small businesses.

The NHS helps to free our firms to focus on doing business, not on doing health care.

People are the most important asset of any company, and businesses are dependent on the health of their workforce. Take as just one example, the total cost to the UK economy of depression, anxiety and stress. It’s estimated to cause companies to lose as much as £17 billion a year through time off sick, unemployment and lower output. With billions more in carers and public service costs.

The NHS is business’s best weapon in tackling this. We’ve recently invested an extra £173 million to improve access to psychological therapy, with the aim to treat almost a million more patients over the next 3 years.
Pilot schemes in Newham and Doncaster have already seen a 10% increase in those working rather than being signed off sick.

Next year, we will pilot a Fit for Work Service. A scheme that will test early intervention of work-related support for people on long-term sick leave.

Whether it’s a bad back, depression or for any other reason, PCTs and other local partners will give people the personalised support they need to get back to the office, the factory or the farm as quickly as possible, before the potentially devastating effects associated with long-term absence can set in.

Every year, British businesses lose more working-hours to people needing to take time off work to see their GP, than they do to strike action.

Over the next year, more than 150 new GP health centres will open. Open 7 days a week, from 8 in the morning to 8 at night. Making it possible to see a doctor close to where you work or live at a time that suits you.

3,700 practices, almost 45% of GPs across England now offer extended hours, enabling more and more people to see their GP in the evening or at weekends.
Those using these new more convenient opening times are not those disparagingly referred to by David Cameron as “yuppies popping in for their jabs before flying to Thailand.”, nor those that others describe as the “worried well,” but they are hard working people who pay for the health service and welcome the fact that they don’t have to take time off work any more – in some cases losing wages as a result – just to see a doctor.

The NHS and the direction we are taking it are incredibly important to the success of business in this country.
Not just for the direct benefits they receive from it. Not just for the potential opportunities for the independent sector that it presents. But for its core NHS values.

Countries around the world are increasingly recognising that our tax-funded system is not only fairer, but more also cost effective. In Germany, where they have a system of insurance similar to that proposed by the group Reform last week, the long-term trend is towards greater public financing because of the costs and inefficiencies inherent in an insurance based system.

The US spends twice our proportion of GDP on health, but has worse health outcomes and 60 million people not covered at all.

And the OECD recently described the NHS as the fastest improving health care system in the developed world.
How Choice improves Quality

Over the last year, we have introduced two major changes. World Class Commissioning to help PCTs choose the best provider of services. And new arrangements to allow patients to choose when and where they receive treatment.

The simple ability for people to make choices propelled the British economy from the sick man of Europe in the 1970s to one of the most open, dynamic and innovative economies in the world, notwithstanding the tough times we are going through now.

People can choose who provides their mobile phone, their bank account, in fact almost every material aspect of their lives. This means that providers must constantly strive to give their customers higher quality and better value for money or risk losing them.

The NHS has to respond to this, giving people the better quality of service they rightly demand.

This means more than receiving the best clinical care. It means you can see your GP when you want. That you are treated with dignity and respect. That you get the treatment you need and the aftercare you deserve.

For the first time patients are starting to decide for themselves the most appropriate and convenient care. Perhaps they want to be seen somewhere that is close to their family rather than their home? Perhaps how long they have to wait for treatment is the most important thing to them? Or the cleanliness rating or the overall reputation of a hospital?

All of this and more is freely available on the NHS Choices website. No other healthcare system in Europe now offerers the level of choice to the public that the NHS does. Patients can see how hospitals are rated and even read what peole have to say about the care they have received.

We had a big publicity drive earlier in the summer on the back of the introduction of free choice. We are currently consulting about making a patient’s choice of elective care a legal right through the NHS Constitution.

We are also planning new measures to ensure GPs and local primary care trusts – through the annual prospectuses they deliver to every household and through other means do more to make sure people know they have a choice.

Commissioning

But if choice presents new opportunities, it presents challenges too.

First and foremost, it requires a fundamental change in how services are commissioned and managed.

The NHS is just too big for us to improve the day-to-day experience of every patient from the centre. No Government minister or Whitehall mandarin, however skilled, can centrally manage 1.3 million employees, a £100 billion budget and the health care of every person in the country.

And this would hold true too for a central, independent NHS Board proposed by some. Quite apart from the fact that it would break the link of democratic accountability between Ministers and Parliament.

When the original NHS Bill was passing through the House of Commons in 1948, Nye Bevan spoke of the “absolute necessity” of the NHS being “subject to local influence as well as to cental influence.”

So we are pushing the power to choose to the local level, to the Primary Care Trust, where the needs of the individual and of the community are properly understood.
This is a big step for PCTs. Some will adapt faster than others, but we are doing everything we can to ease the transition. To help them see competition and cooperation as a route to high quality services and value for money. Not to privatisation by the back door or any nonsense about the closure of GP practices.

The World Class Commissioning programme will help give those PCTs the skills they need to exercise their new power. And the independent sector will help provide some of the choice and competition.
The Independent Sector

From PFI built hospitals and ISTCs, to providing clinical services to Primary Care Trusts and spear-heading ‘Free Choice’ for patients; the independent sector has already played a key role in NHS reforms.

This Government is not, as David Cameron alleged his recent speech on health, “blinded by the private sector.” We believe that a mixed economy in health, true to the principles of the NHS has helped increase capacity and to cut waiting lists. It has helped drive up standards and provide better value.

As well as welcoming competition in the health service in England, we are engaged in a fascinating competition in health policy among the three main parts of the United Kingdom. The development of different approaches in Wales and Scotland, the apparent ruling out of using the independent sector there should enable us once and for all to show the benefits of the English approach.

I get fed up being told by some of the media that England suffers from health apartheid – an inappropriate word in the health context in any event – because millionaires in Wales get their prescriptions free or Scotland plans to allow anyone who wants to to park in busy hospital car parks for free.

What about the fact that in England you get your operation much more quickly, you don’t have to wait for more than 4 hours in A and E any more and it’s easier to see a GP when you want.

These things matter more to the public, we’re delivering them in England and we’ve doing so while spending less per head on health than in Scotland and Wales. So, we are already seeing the benefits of a mixed economy in England and I expect those to become even clearer as time goes on.

From the very beginning, Bevan understood that how services are delivered, and who delivers them, is never as important as the quality of the healthcare provided and that it is free at the point of need.

The independent sector has always been a partner in the NHS. GPs have always retained their independent status. The drug and equipment companies that have led to some of the greatest medical breakthroughs over the last 60 years have done so in partnership with the NHS, whilst still making a profit.

I think what concerns people about the private sector is that somehow they will end up paying for their own healthcare, like they used to before the NHS was born, or as they do abroad. Or that companies, by their very nature, will always put profit before the patient and their care will suffer.

This is wrong on both counts. First, this government, and currently neither of the main opposition parties are prepared to consider abandoning Bevan’s core principle of an NHS free at the point of need.

Second, within the NHS there are set prices for different types of care. So providers don’t compete on price, but on the quality of the service they provide. Patients will get better care, not worse. Because if what an independent sector organisation offers is not as good as what the NHS provider is offering, they simply won’t get the contract.

Excellent local commissioning from the independent sector is already bringing real benefit to patients.

B Braun Avitum, a German company, now provides the Renal Dialysis Service in Kidderminster. This means that Worcestershire patients can receive their dialysis locally rather than having to travel all the way to Birmingham for treatment.

InHealth now provide the breast screening in my own constituency, Exeter. From having a mammogram to hearing the result should take no longer than 2 weeks. But 2 years ago, the North & East Devon Breast Screening Service was failing, with almost no women getting their results in time. Today, that figure is well over 90%. That means women getting the treatment they need as quickly as they need it. A difference that is saving lives.

Fair competition

Of course, choice must work for providers too.

Public sector partners, social enterprises and private companies will all compete to supply PCTs in a free, fair and transparent way. Having an agreed NHS price means that competition focuses on innovation and the quality of provision; not on cobbling together the bare bones for the lowest price.

As part of our commitment to fair competition, the new ‘Choose and Book’ system no longer differentiates between independent sector and NHS providers. It simply sorts by who’s closest.

Through Free Choice, the nine and a half million NHS patients who need elective surgery each year can choose when and where they receive their treatment. As Free Choice expands to include patients with long-term conditions, maternity services and primary care this will grow to 15 million patients each year.

Many of these patients are already choosing the independent sector. In July alone, patients chose to have treatment worth over £34 million through the Independent Sector Extended Choice Network or ISTCs.

Accountability

Competition must be, and be seen to be, open and transparent. Fair commissioning requires strong accountability and control, to make sure the interests of all providers are represented, and any disputes swiftly and fairly settled.

At the end of last year we published the Principles and Rules for Cooperation and Competition – in effect the first ever competition policy for the NHS.
At a regional level, the Strategic Health Authority will translate this national policy into regional strategy, providing effective oversight of PCTs and NHS Trusts. Their job is to hold people to account and to intervene where necessary.

But where disputes cannot be resolved locally, they will be referred to the NHS’s own version of the Competition Commission. The Panel on Cooperation and Competition, under the leadership of Lord Patrick Carter, will provide independent, expert advice on issues arising from this new competition policy, as well as recommendations on specific disputes.

Supply2Health

This is all part of our commitment to lower barriers to entry and to make it easier to do business with the NHS.

Talking to providers of all types, what was keeping people awake at night was the thought they may have missed an opportunity. That there was a PCT out there in need of exactly what they had to offer, but they simply didn’t know about each other.

With no one place for PCTs to advertise, ads can appear in all number of places, and be easily missed. This month we are launching the Supply2Health website to change all of this.

If you want to be technical, it is an online procurement portal. But I like to think of it more as a sort of online dating agency. A Match.com for PCTs and providers.

Supply2Health is a place where PCTs looking for love and clinical services can place their ad, tell the world about who they are and what they want, and then wait for eligible suitors to come and sweep them off their feet.

Finding the perfect partner can be a difficult process. Supply2 Health helps to take some of strain out of it all.

It will help commissioners to meet their legal requirements, reduce the number of requests for more information from bidders and increase the response to their adverts.

It will bring transparency to the market. Make it easy to track down every single opportunity and to understand exactly what PCTs want. It will even email you when new opportunities come along that you might be interested in, making sure you don’t miss a thing.
And it will be mandatory for all PCTs to use Supply2Health from the 30th September.

Most important, by bringing competition to the market, it will help lead to patients getting the high quality services they demand and expect.

Conclusion

Soon we will host the Olympic and Parlympic Games ourselves. Our expectations are high. We were 4th in Beijing; perhaps we can now go even higher in London.

By staying true to its values, the National Health Service can over the next few years mirror our sporting success.

The coming years will see a more personal Health Service, with the needs of individual patients at the heart of everything it does. A more local Health Service, led by the patient, the Primary Care Trust and the clinician.

A more innovative Health Service, where competition and cooperation between providers and patient choice continually drive up quality.

A Health Service that helps make our people and our workforce healthier, boosting our economy. An NHS that goes from strength to strength with the support and involvement of the independent sector.

That prize, for me, as a Minister of Health in the year of the NHS’s 60th birthday, will be a more exciting prospect that any amount of Olympic Gold.

Thank you.