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Editorial Wednesday 20 June 2012: Andrew Lansley's NHS Confederation speech

This transcript is not verbatim - video is here.

I want to say something about tomorrow’s BMA strike. (The strike within the BMA is today.)  I want to call again on doctors to think again before taking part in a strike that must inevitably damage patient care.


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I set out to make doctors’ pensions among the best in world. I had direct meetings with all the medial trades unions and with the chair of council of the BMA. Interestingly, the chair of the BMA pensions commirttee didn’t turn up to a single meeting, which doesn’t say much about its determination to get a good deal for doctors.

Unfortunately, rather than engage with the process, the BMA chose to ignore economic realities. We all wish there was more money to go round, but there isn’t. We can't prioritise doctors over every other public servant when they have one of the most generous pensions.”

The BMA say that the raised contributions are too high, but if they were left unchanged at the 2008 level, then a nurse on £30,000 could see their take-hope pay fall £100 pcm to cover the difference.

The BMA also claim that the pension scheme is a tax on doctors, as it's currently in surplus. That is not the case. The pension scheme, like all public sector pensions, is not funded; it is a pay-as-you-go scheme. Yes, contributions are currently higher than the benefits, but in a few years they won't be, and pensions still have to be paid. For pension liablities, the total cost is £83 billion; of which  £67 billion is already likely to come from taxpayers.

This strike is pointless, and it will achieve nothing. We will implement this scheme.

The strike will create uncertainty, and cause discomofort to patients who can only dream of such a pension scheme.

I call on doctors do the right thing and ditch the strike.

Our aim with reforming the NHS is to maintain and deliver the values of the NHS. The  Future Forum is seeking to strengthen the NHS Constitution, which describes this. The NHS is there for all, comprehensive, free at the point of need, not based on the ability to pay, It's an essential part of social solidarity, and it's something we are envied for.

I speak to colleagues in charge of health ministries around the world and many don’t have universal coverage and wish they did. But we're all looking for something beyond universal coverage; we want excellence and quality. In the US, they talk about this as 'moving from volume to value'.

And that's why we titled the White Paper 'Equity And Excellence'. That describes the vision that is the central part of reforms: it's not about structure or organisations.

There are 3 objectives
1. for patients to have no decision about them without them, and for all patients to feel they have much better control over their care
2. to deliver the best care, we need managerial and clinical leadership, and we aim to create an NHS capable of delivering continuous impirvement from the learership within, not from outside
3. to know that we are delivering best possible care, which means we must measure and benchmark

Now, we can move beyond debate about structures and organisation. These reforms mean that we can create a longer period of stability for NHS than it has had in a long time. Over  the next year, the people here can create something and build for the future.

I want to say big thank you to everyone in the NHS, from David Nicholson to the nurses on the wards: you've been absolutely focused on delivering for the future and today, and the result has been the NHS's good performance continuing.

Whether in the reduction in the number of patients waiting over 18 weeks for treatment, in ambulance trusts hitting targets, in healthcare associated infection reductions, or in dignity and mixed sex accommodation, there has been improvement.

And I want to say thank you.

And this is happening in the context of major financial pressures, which is not something new since the general election. David and colleagues outlined from May 2009 the need for saving £20 billion. Now, some people think that the £4 billion annual productivity and efficiency saving must come out of the previous year’s budget. It's not like that. It’s about improving care within the resources available.

By the next election, our healthcare spending will have risen to £116 bn. Demand is constantly rising, due to pressures of cost and demography and technology. The £20 billion comes from recongnition of the need for continuous efficiency and improving the quality of what we do.

This has been a year in which the NHS delivered as planned £5.8 bn savings against QIPP targets. And many of the vital workstreams were in hospitals: £2.8 bn of that was saved in the acute sector.

You all know as hard as it's been at the outset, the efficiency and productivity challenge gets harder over time. But you also know that to make savings, and makie imprivement in the years to come, we must go beyond short-term savings to real innovations that will make us capable of delivering the savings in later years. That's why Ian Carruthers and David Nicholson's 'Innovation, Health And Wealth' work is so vital: we must diffuse innovation across the NHS.

But it's not just about innovation in technology, drugs and systems; it's about service innovation, and how we bring care together around patients' needs: that is at the heart.

Let’s not put innovation in a box.

Leadership can and will come from within the NHS, not from outside.

Politicians should absolutely be supporting service change that meets those four tests. I don't think that politicians should be substituting their view for the view either of a clinical benefit for patients or the democratically accountable view of local authorities. So from my point of view, let's focus on that. And from that point of view, the changes are already happening: the four tests have already been applied.

Politicians should support the NHS. They shouldn't try to say what local services should be or impose things from the top-down. Service change is taking place. And it's not actually by and large about shutting things down; it's about changing the character of the services you provide.

Mike (Farrar) was right: in the context of A&E across the country, not only have we established major trauma centres, so patients with major traumas should go to where there is a specialist expertise, but equally where patients have a heart attack they go to where there is a cardiologist who can do primary PCI.  For patients in different parts of the country, different configurations, but actually, recognising that patients with a stroke should go to where they can do immediate CT and if necessary, thrombolysis. If you're got an aneurysm, you want to know they you;re going to a department that has a  vascular surgeon available for that purpose.

But as you're going around the country, the configurations will, be different, the design will be different and the proper balance between access and safety will be different in different places. I think we can design emergency care through clinical networks in a way that delivers better, more consistent, safer care - and the from public point of view that while change will come, it's change that balances their desire for access with the service's imperative to deliver safe care in the right place at the right time.

It's for that reason that we have the four test around reconfiguration.

We can strike a balance about how localities deliver care. One size does not fit all

In the weeks ahead, I will publish my White Paper on the reform of social care and a progress report on how we will fund social care in the future. But it's not all about what happens with the funding of social care. The relationship with health services and with local authorities is crucial. Organisational structural integration does not necessarily do the job: far more important is the integration of delivery of care to patients - integration must be thought of as integrated care around patients, as the Future Forum said.

So as we design change, we must start with patient or care users: give them access to information, choice and persionalised care around needs.

What do I hope you achieve at this conference?

Through the recent changes in the NHS, the NHS now has the autonomy for delivering better care and outcomes. Leadership will come forward through various routes, from CCGs to CSSs and academic health science.

There are real opportunities to shape the future from within; not to have change imposed from without. This is an opportunity to look forwards and outwards, not inwards or backwards, and I look forward to looking forward and outwards with all of you in the future.

No questions were taken from delegates.

Chair Cathy Newman of Channel Four News asked Mr Lansley about the strike and doctors' anger: he feels he is not responsible for the anger among doctors over pensions.

Cathy Newman: have you done the structural change, which is perhaps easier than the cultural and delivery change ahead? Mr Lansley: I just don’t accept that at all.

CN: (reading Q from NHS Confederation stand) Do you not get the scale of change needed as outlined by Mike Farrar? Mr Lansley: I just have made the case clear of my support for it. I donl;t think hospitals will need to close.

CN: what about social care? Mr Lansley: we were waiting for Dilnot, which was for next spending review period, and we're consulting on how we can respond positively to Dilnot. I will publish a WP on the reform of social care soon, which is much wider than just the long-term funding of social care.

CN: should we curb universal benefits to help fund Dilnot? Will you publish a progress report on Dilnot and how you might implement it. Mr Lansley: My view will be in the progress report. CN: is the winter fuel allowance safe? Mr Lansley: My view will be in the progress report.

CN: do you regret your promises in opposition about Chase Farm? Mr Lansley: No, it gave us a chance to use the four tests in action.