Editorial Tuesday 9 October 2012: The Bellflinger Orates - on Jeremy Hunt's speech to the 2012 Conservative Party Conference

Here are some observations on the inaugural public speech of Jeremy 'Bellflinger' Hunt as Health Secretary at the Conservative Party conference in Birmingham.

I have two top-line thoughts. Hunt's speech emphasises financial discipline and care quality discipline as being equally P45-inducing for NHS managers.

Managers are adept Kremlinologists (this is, after all, the Nicholson Health Service), and will notice that save for one mention of the welcome cut to very long waiting times, access did not get a mention.

Managers might reasonably conclude that if in broad terms, acute care is about balancing cash, care quality and waiting times, they have been given a broad hint which corner of the triangle can slip.

The second issue is related to that. Hunt tells managers that letting care quality slip will be a career-ending offence.

How will he bring that about? FTs are already beyond his ability to micro-manage - let alone to interfere in independent and third sector providers.

Has The Bellflinger just promised something that these reforms will leave him unable to deliver?

Or does he intend to renationalise the entire healthcare provision network in England? To deliver what he promised in this speech, that is what he would have to do.

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Click here for details of 'Lansleyshambles - game over, as Jeremy ‘Bellflnger’ Hunt does the reconfiguration hokey-cokey', the new issue of subscription-based Health Policy Intelligence.

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Jeremy Hunt's speech to the 2012 Conservative Party Conference
Today I am so proud to talk about the NHS. Millions of us use the NHS every week and we’re all deeply proud to live in a country where everyone, regardless of their financial circumstances, can expect to get the best healthcare.

You will note that he said 'expect'; not 'get'.

For that we have to thank the extraordinary dedication of GPs, doctors, nurses and other professionals – including the wonderful team who delivered my own daughter this spring.

The 2012 Olympics made us proud this summer. But the commitment of Team NHS makes us proud every day of every week of every year. On behalf of everyone here – and indeed the whole country - I want to thank them all.

Don't mention the fact The Bellflinger tried to get Danny Boyle to cut the NHS sequence from the opening ceremony.

At a critical moment for the NHS, my priorities will be to give patients in Britain the best survival rates in Europe for major diseases and to transform the way the health and social care system looks after older people. Not just our approach to conditions like dementia, but the way we care for people.

Since it was set up in 1948 the NHS has come to symbolise a deeply held belief about what it means to be British: a country fit for heroes where everyone should have a roof over their heads, a school for their children and proper treatment for their family when they’re sick.

That was under the Attlee government. But the NHS does not belong to Labour any more than victory in the second world war belongs to the Conservatives. No party has a monopoly on compassion and it is an insult to common decency for any party to claim it.

Don't mention the fact there was a national government throughout almost the entirety of the second world war.

Because the NHS belongs to all of us.

To my children born on the NHS. To my father who worked as a manager for the NHS and my mother who worked as an A & E nurse and midwife. But most of all, to the 3 million of us who use it every week.

And just as all of us depend on it, so too do all of us have a responsibility to help it adapt to the huge challenge of an ageing population.

So let me start by saying about Andrew Lansley's reforms: they are brave, they are right and they will make our NHS stronger.

Brave enough, right enough and strengthening enough to get Our Saviour And Liberator the sack and The Bellflinger the job. Go figure!

The centralised structures that have run the NHS since 1948 make it famously the fifth largest organisation in the world, smaller than the Red Army but bigger than the Indian Railways.

Just about every reorganisation of the NHS since the 1980s has significantly increased the centralisation of power.

Conference, we will never meet the challenges we face with over a million people trying to meet a thousand targets to satisfy one Secretary of State sitting behind his desk in Whitehall.

Look at how it failed completely on reducing access times from 18 months to under 18 weeks, waits in A&E and (eventually) HCAIs. National targets aren;t the answer to everything, and do have perverse incentives, but they're certainly not unimportant.

We know what happens when you do that, don’t we? We had the perfect case study under Labour: 48 hour GP appointment targets that made it harder not easier to see your GP, and billions wasted on central NHS IT contracts.

They weren't central IT contracts; they were regional monopolies, due to misconceived, ex-private sector-led procurement.

“To believe in the NHS is to believe in its reform.” Not my words but those of Lord Darzi, Labour Health Minister under Andy Burnham.

But now he’s in opposition, Andy Burnham sings a different tune.

Let me try out a little quiz on you.

Last week Andy Burnham complained about Foundation Trusts setting their own employment conditions in the South West. But guess who was Minister when the act enshrining those powers got royal assent? Andy Burnham.

The audience really didn't "Andy Burnham" along to this section as he or his speechwriter had obviously hoped.

He criticised private sector involvement in the NHS. But who was the Health Secretary who ensured a private company would run a district general hospital for the very first time? Andy Burnham.

And finally he railed against so-called cuts. But whilst we are increasing the NHS budget by over £12bn, who was the Health Secretary who went into the last election saying it would be irresponsible to increase it? Andy Burnham.

First rule of opposition Andy: criticise what the new lot do, not what you did yourself.

And as for Ed Miliband: how totally disingenuous for the man whose government had nine reorganisations of the NHS to criticise us over one – and then announce another when he says he will repeal the Health Act. Our one nation won’t be fooled by that.

Nine? Don't think so. Ending GP fundholding & start of PCGs and NICE 1999; CHI, end of CHCs, little PCTs and 30 SHAs 2002; big PCTs and 10 SHAs 2006. That's three. I know about inflation in healthcare, but being out by a factor of three is quite a lot.

But it isn’t just inconsistency, it’s substance.

Nye Bevan’s vision wasn’t about monopoly provision. It was about universal provision. And to deliver it we must understand the difference between the two.

To succeed the NHS needs to tap into the energy, ideas and commitment not just of ministers and mandarins - but of thousands of frontline NHS staff who do a superb job day in day out looking after patients.

Thanks to their commitment, our nurses, doctors, managers and professional staff have delivered brilliant results over the last 2 years: long waits cut from nearly 20,000 to just 3,000; hospital-acquired infections down; mixed sex wards nearly eliminated; access to cancer drugs up; and access to NHS dentistry up by more than a million.

NHS improvement did not just start two years ago.

This year, for the first time there are more pensioners than children. So looking to the future, our biggest priority must be to transform what we offer to meet the challenge of an ageing population. Fail to address this and our healthcare system will not be sustainable for them – or indeed for any of us.

If Andrew is the Health Secretary who helped give us the structures for a modern NHS, I want to be the Health Secretary who helped transform the culture of the system - to make it the best in the world at looking after older people.

This is a really good idea and very necessary.

Let me start with the best of what I have seen, so far.

Last month I visited St.Thomas’, the hospital where I was born. I met a nurse who had been caring for a dying man who had lost touch with his family 20 years earlier. She searched out the family on Google, found them in Ireland, arranged to fly him back there so he was able to spend his last two weeks reunited with his family.

So much of the NHS is like that. Unsung heroes who represent the very best of our values.

But as we celebrate excellence, we must be honest about failure.

I’m going to name names now because I don’t want anything to be swept under the carpet.

The shocking failures of care at Mid Staffs where a patient with C-Diff was left to lie naked in their own excrement. The bullying of a man with Parkinsons at East Surrey hospital. The kicking of disabled residents at Winterbourne View care home. The slapping of an older woman with dementia at Ash Court care home.

A fair selection, which indicates that failures of care happen in private providers as well as public ones.

Last month the Royal College of Physicians published a report about the way older people are looked after in our hospitals. It said "the system continues to treat older patients as a surprise, at best, or unwelcome at worst." Strong words.

We have many committed managers in hospitals and care homes. But I need to say this to all managers: you will be held responsible for the care in your establishments. You wouldn’t expect to keep your job if you lost control of your finances. Well, don't expect to keep it if you lose control of your care.

So independent foundation trust managers, private and third sector provider managers will lose their jobs too?

Good care matters as much as good treatment. And I will expect the highest standards in both.

So as of today, I have asked my Department and the Care Quality Commission how we can make sure managers are held accountable for the care they provide, both in the NHS and social care sectors.

It's already possible: just read their contracts of employment as accountable officers. The risk with the current reforms is that responsibility in the new system looks much more diffuse.

And as of next year all hospitals will be assessed against the number of patients who would recommend the care they received to friends or family.

I also want to see a big change in the way we look after people with dementia, something that will sadly affect one in three of us over 65.

Again, a good priority.

Every day in hospitals and homes you can see one of the most moving sights imaginable: the love of a partner for a dear one who no longer even recognises them.

With the right care and support people can live well for many years. However shockingly less than half of cases are diagnosed. Which means thousands of people doing without the medicine that can hold the condition at bay.

The Prime Minister established the dementia challenge: to radically improve attitudes, treatment and research. I want us to raise our game further – and say by the next election we will be among the best in Europe at dealing with this most challenging of conditions.

And while we are talking about the challenges of an ageing population, we need to face up to some hard truths about how we are going to pay for social care. I am proud that next year’s Care and Support Bill will mean that no one is forced to sell their house in their lifetime to pay for care.

No-one was forced to sell their house as things stood before. Read this article by Paul Lewis; it's very clear indeed.

A historic change. But we also want to go further and implement the Dilnot cap on social care costs as soon as  we are able.

When is that? "As soon as we are able" is so vague as to be meaningless.

An NHS and social care system fit for an ageing population. But up for other challenges too.

So let me ask this: why are our survival rates from the big killer diseases still not the best in Europe?

All of us know families who have lost a precious loved one sooner than expected. Those golden years snatched away by what is seen a cruel twist of fate. But in truth many such tragedies are avoidable, much more avoidable than we think.

We have the most admired health system in the world (by what measure?) so we should surely be getting the best results.

Results relate in part to funding: we still spend less than most of our European neighbours on health as a percentage of GDP.

We’ve made good progress in heart disease.

Mainly due to the smoking ban and mandatory publication of cardiac surgery data. Rather top-down approaches, but very effective.

But sadly our cancer survival rates are lower than the European average, deaths from liver disease are going up and we lose more people to respiratory diseases than anywhere else in the EU15.

A clinical expect will have to dig into these, but our cancer performance is certainly improving significantly.

If our mortality rates for the five major killer diseases were as good as the best in Europe, we would save 20,000 lives a year. 20,000 personal tragedies that we could be avoiding – but are not.

We have made a start by introducing the cancer drugs fund and speeding up NICE approval for new drugs. Today I am also announcing that from April next year, we will guarantee access to all innovative radiotherapy wherever clinically appropriate and cost-effective.

Great. Will there be new funding for this, and if not, what will the NHS stop doing or commissioning?

But there is much more to do, in particular working with partners in local government who will be responsible for public health under the reforms.

The final challenge I want to mention today is the technology revolution, something that in terms of patient experience has barely touched the NHS. Why can people access their bank records online but not their medical ones? Why can you order your groceries at home but not your prescription? Why can you book a hotel but not a GP appointment?

In Denmark people can already access their hospital records online. In Sweden and US ordering prescriptions online is becoming routine – so why can’t we?

The big Labour disaster with the NHS IT contracts must not stop us trying to crack this. Which means no to top-down, bureaucratic procurement – but yes to more information, faster response and the better service from technology.

The Prime Minister and I announced on Saturday a £100m fund to help nurses use technology to reduce form-filling and increase patient time. It is a good start – but we need to do much more.

Let me finish by saying this.

The Conservative Party is and always has been the party of aspiration.

To people up and down this country, health is an aspiration perhaps even more important than a good school for the children and financial security for the family.

Which is why as a party we care so much about health and the NHS which provides it.

No one will fight harder than us to give children the best and healthiest start to their lives.

That sounds good. What is happening to Sure Start centres?

No one will fight harder than us to give families the best healthcare modern technology can deliver.

And no one will fight harder than us to make sure older people, whatever challenges they face, are treated with dignity, compassion and respect.

So we salute our GPs, our doctors, our nurses and our professionals who make the NHS the pride of Britain.

And we promise to match their dedication with our commitment – to work night and day to build a health service true to its core values but ambitious for the future, and giving every family in the country the confidence and security that comes from receiving the best healthcare in the world.

Thank you.