Editor's blog Thursday 7 July 2011: The first leak is the deepest: Andrew Lansley's speech to NHS Confederation Conference
Health Secretary Andrew Lansley – Speech to the NHS Confederation conference, Manchester Thursday 7 July 2011
Under embargo to 17.00, 7.7.11
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Thank you Sarah, and thanks to Mike and all the team at the NHS Confederation for inviting me to be with you today.
It’s great to be here with you in Manchester, where the NHS was born 63 three years ago at Trafford General Hospital, under what many people now accept was a Coalition Government, led by a Conservative former Prime Minister.
I mean, the great Winston Churchill didn’t lose his seat in 1945.
And isn’t it great to see the NHS approaching pension age – a time of dignity and respect for your contribution. The state pension – another essentially Conservative idea.
Now many of you will be wondering what I am doing here today, talking to what is in truth a bunch of wasteful bureaucrats. Because we are committed to reducing wasteful bureaucracy in the NHS.
In the interests of creating a more complex commissioning system, the Coalition Government is absolutely committed to creating:
… an NHS Commissioning Board with the unfettered power of NHS life or death;
… many more Clinical Commissioning Groups than there were primary care trusts;
… clustered PCTs and strategic health authorities to act as the intermediate management tier that we are abolishing;
… a Health And Wellbeing Board for every local council;
… re-creating Monitor as both the provider regulator and The Society For The Promotion Of Virtue And The Prevention Of Vice (because doing two things at once is efficiency in action);
… clinical senates and networks for hospital doctors to remind GPs that they’re thick;
… and the NHS Future Forum as our highly independent, directly-appointed market research bureau.
I think that makes clear to all you wasteful bureaucrats just how committed we are to ending wasteful bureaucracy.
Now some of you may be thinking,
… ‘hang on, weren’t you Opposition Health Secretary for six years? How did you spend all that time thinking about the NHS and come up with a Bill that had to actually be stopped in its tracks in Parliament because of its sheer unpopularity?
… ‘oh, and what happened to the promise of no more top-down reorganisations?’
You might be thinking that. Indeed.
But you would be, I’m afraid, rather missing the point.
You see, the point is that I am Secretary Of State For Health now.
And I am also absolutely right. And this means that people who disagree with me are completely wrong.
This is what I mean by ‘no decision about me without me’.
Because if you look on the staples of our general election manifesto, you will find written very clearly ‘no more top-down reorganisations unless Andrew Lansley really feels like changing his mind’.
And I’m afraid that if you don’t read the staples of manifestos properly, then you have very little cause to complain. This is, as the Prime Minister said, a new kind of politics. (Apparently the Lib Dems had something about asteroids hitting the Earth on their manifesto staples, so you can see my point).
And what was striking about the response to my White Paper was the broad welcome that its vision received.
No other explanation adequately reflects why the BMA, RCGP, Kings Fund, Nuffield Trust, Royal College Of Physicians and the NHS Confederation itself all warned about the scale and pace of change, risks of transition and raised major concerns about the proposed role of competition.
And if that isn’t welcoming my vision, then I don’t know what is.
I mean, clearly the consultation on the White Paper was very valuable, because people sent us all sorts of documents and responses, which gave the Post Office some much-needed revenue and confirmed that our email was receiving successfully.
So that’s a win-win.
But again, as the Prime Minister himself said, it is a sign of strength to stop your flagship legislation after its Second Reading in the House Of Commons. Because really, reading the Health And Social Care Bill just twice is completely unacceptable.
That is much too little.
So far, not one single person has commented on my witty use of an Oxford comma in the section on ‘ex ante’ and ‘ex post’ regulation legislation. To which I can only say, ‘aut disce aut discede’.
So I have asked the entirely independent NHS Future Forum that I appointed to consider whether we should amend the NHS Constitution to force anyone who wants to use NHS services to undergo a thorough, detailed exam on the Health And Social Care Bill and its Amendments.
And those of you who know me will know that when I say ‘thorough and detailed’, what I mean is that NHS demand management will be the envy of the world’s finance ministers.
Following a thorough national listening exercise, the NHS Future Forum will be confirming that I am absolutely right next Tuesday afternoon.
And we love the NHS. But we don’t, as I’ve made very clear, love bureaucrats or wasteful bureaucracy. We are, as my White Paper announced, liberating the NHS.
And who better is there to liberate the NHS than Sir David Nicholson?
Indeed. Your silence speaks volumes.
Yes, we are liberating the NHS from the dead hand of central control. The beating heart of localism will be given CPR and regulated by the NHS Commissioning Board, whose commissioning outcomes framework will sweep away the old regime of performance management to centrally-imposed targets with no understanding of locally-required flexibilities.
You see, it’s all about outcomes. And you have to measure outcomes, and validate the data, and benchmark them against comparable organisations. All of which just happens organically, without wasteful bureaucracy. Obviously.
And to re-affirm our faith that the centre does not have all the answers, we are ensuring that the NHS’s spending on the wasteful bureaucracy of management will be reduced to 45% of the management spend in 2008-9.
Now I want to make this quite clear. We do not believe that the ‘Man From The Ministry’ knows best, and we’ve been elected to prove it. But that figure of 45% is an absolute rule.
Think of it as an outcome, if that helps.
Anyone spending 46% on wasteful bureaucracy will be paying Sir David Nicholson a visit, for a seminar on the virtues of localism. Anyone spending 44% or less on wasteful bureaucracy will have their budget top-sliced by the underspend in the next financial year.
I know it has been a difficult and challenging year for me, and I’m sure that you all know that too. But just as U-turns are a sign of good planning and political strength, so we should remember that what doesn’t destroy us makes us stronger.
And I have not been destroyed. Very much the opposite.
You see, there are men …
… and there are Supermen.
Men are destroyed when widespread derision greets their plans.
But Supermen carry blithely on, regardless.
I am Superman. (DN: is this too far?)
Thank you, and now I’ll be happy to take any questions.