Tue, 27 Apr 2010
“The real question that politicians now have to answer is not: How much do you love the NHS? It’s, how do you protect and improve the NHS at a time like this?," the Liberal Democrat Leader said.
Speaking at the Royal College of Nursing’s conference in Bournemouth today, Nick Clegg said
Thank you so much for inviting me to speak to you today. It is a real honour to be here. You don’t need me to tell you that the job you do is one of the most important jobs there is. You are the lifesavers as well as the shoulders to cry on. You are the healers and well as the comforters.
Politicians have the chance to make a difference once in a while. You make a difference every day, if not twenty or a hundred times a day. You, as nurses and as a profession, have my respect, my admiration, and my utmost commitment to support you and the work you do in our NHS.
The RCN itself, of course, is the largest organisation of its kind in the world, and also, I might add, the best. I met a group of student nurses a few months ago when they came up to Parliament on the RCN bus. And today, I’ve come here to the RCN on the Liberal Democrat campaign bus – the most glaringly bright yellow vehicle you’ve ever seen.
It’s a particular honour to be here because you are leading the way in addressing the challenges in the NHS, setting the example politicians must now follow – something I want to discuss in more detail in a moment. And you are making your voice heard on the political stage, with your Nursing Counts Campaign. You are right to say that NHS services must be protected. That if the axe falls on caring staff, it will cost us all more in the long term. And you are absolutely correct to highlight the importance of public health and specialist nurses, to help us keep people healthier and manage long-term conditions more effectively.
One particular proposal you are making caught my eye: protection for whistleblowers. Just before I was elected leader of the Liberal Democrats I went on a march with a Manchester nurse Karen Reissmann who had spoken out about her concerns over the provision of treatment in her local area and had been summarily sacked. Though I clearly didn’t make much of an impression as she’s now standing for another party.
But there’s a simple principle: nurses need to be able to highlight their concerns without fear and without threat of retribution. You see what is going on: you must speak out, and when you do, you will always have my support.
Whether it’s community nursing to improve public health and reduce demand on the NHS, or specialist nursing, from rheumatology to mental health, to take the burden off consultants, and GP follow-up appointments and improved patient care.
Your skills, initiative and ideas are going to be essential to the changes we make to ensure the NHS services people rely on are protected even now that money is tight. I could tell you about the wonderful nurses in our local surgery, or in our local hospital, who have cared for my three sons on countless occasions.
I could tell you about the nurses who helped my wife Miriam just this weekend when she fractured her elbow. But the truth is the only thing that is remarkable about my experiences in the NHS is how wholly unremarkable they are. I am just one of millions.
Parents turning up at A&E in the middle of the night with a sick child in their arms. People going through months or years of chemotherapy in the battle against cancer. Others finding a route out of depression or addiction with counselling and care. Every experience is different, and yet each is the same.
The NHS is not a faceless institution but the sum total of millions of individual, acts of care and support. The brainchild of a Liberal, Beveridge, the NHS was founded on a series of fundamentally liberal, and fundamentally British values. Fairness. Equity. Solidarity. Those principles endure today. Rightly so.
It is something that perhaps too many of us, too often, take for granted, but which must never change. The NHS is a precious inheritance. It must not be cast aside.
I am wholly committed, head and heart, to keeping our NHS, free to use and paid for by us all. But you and I also know that’s the easy bit to say. The real question that politicians now have to answer is not: How much do you love the NHS?
It’s how do you protect and improve the NHS at a time like this when money is tight.
There will be 3.5m babies born in over the course of the next five years – 100,000 more than in the last five.
How do we guarantee they will be born as safely as babies born today? There will be an extra 1.7m people in need of long term care by 2026.
How do we guarantee they will get the standards of care available today? There are new treatments and new drugs for diseases like cancer being developed every day.
How do we ensure a publicly funded NHS can afford to make world-class treatment available for all? And how do we do any of this when there is less money to go around in all our public services? I believe we can and must protect services and jobs in the NHS. But we can only do so if we face up to the realities of the situation in which we find ourselves.
I could have come here with promises of bags of gold, but you would not have believed me. You live in the real world. You know, we all know that money is now tight. The deficit now stands at £167bn. And we all know that finding bucketloads more money for health at a time when budgets are tight could only come at the cost of other equally essential areas like schools and police.
So you know we have to find ways to help the NHS do more with the money it already has. And you are rightly sceptical, as you said at the weekend, of promises from politicians that do not face up to those basic facts. And do not acknowledge that cuts are not something that might happen in the future but something that is happening, right now.
The Institute for Fiscal Studies this morning assessed the parties’ policies on the deficit and taxation. And concluded that the Liberal Democrats’ plan is the most credible – even if there’s still much more work to do, we have gone further in spelling out how to cut the deficit.
The most fair – we will put money in the pockets of people who need a break by raising the income tax threshold so that no one will pay a penny of income tax on the first £10000 they earn. A proposal which the IFS has specifically said is the best way to encourage people to move off benefits and into work.
The old politics is to make unfunded promises and hit you with surprises after the election. Our way of doing things is to be as open and upfront as possible about the challenges we face and how, together, we can start to fill the black hole in the public finances and deliver fair taxes to millions of people who need a break.
We need a new, different approach to the way money is allocated and used within the NHS.
That is what I want to talk to you about today.
I want to talk about our plans to help the NHS work better with the money it has by devolving power to patients, to local people and to staff like you.
Plans mirrored in many ways by the approach of my Liberal Democrat colleagues in the Welsh Assembly and Scottish Parliament for the Welsh and Scottish NHS – both of which face similar if not greater pressures than the NHS in England.
We will look for efficiency and unnecessary programmes of spending wherever they lie. But because the NHS faces exceptional demographic pressures, savings we identify within the health service will be diverted, penny for penny, pound for pound to areas of the NHS which have been starved of cash, or could be in future years.
Areas like dementia, where demographic pressures are high, cancer, where the costs of treatment are rising, and mental health, which has been a Cinderella service within the NHS for far too long.
Our working assumption is that we will stick to the government plans for NHS funding. That doesn’t mean trying to do the impossible: more with less. It simply means spending money where it is needed, not wasting it elsewhere.
Just think of the mistakes that have marred the impressive record of investment in recent years: A grandiose IT project running years behind schedule and billions over budget. GP and consultant contracts poorly negotiated with no clear benefit for patients. And an endless cycle of botched reorganisations of the endless quangos, boards, trusts and agencies that make up our health services.
An NHS which has more administrators, managers and clerks than it does hospital beds. Government figures show it would take one person 491 years to provide all the data the government agencies demand from health services each year.
Last year filling in those forms cost the country a total of £1bn, enough to pay the salaries of more than 25,000 nurses. Just imagine how different – how much better – our NHS could be if this were changed. My vision for change in the NHS is a liberal one.
It’s about dispersing power – to patients and to clinical staff. You know as well as I do that the NHS is over-centralised and still driven far too heavily by targets and bureaucracy.
And you know, both as people who work in the NHS and as people who use it that patients themselves have too little control, both over their day-to-day care, and over the direction and priorities of the NHS as a whole.
So I want to give more power to local people. More power to staff and more power to patients.
First: local people
In the last 13 years, increases in public spending have been accompanied by the politics of big government. More money has been given – and Liberal Democrats welcomed that decision wholeheartedly. But it was given on the condition that central government got to decide how to spend it.
Central directions, onerous inspections and a myriad of bureaucratic targets. Micromanagement, waste and skewed priorities. These are the hallmarks of a Labour NHS. Liberal Democrats will radically change the way the NHS is run by devolving power to local people. I want to turn remote PCTs that answer to the Secretary of State, into accountable Local Health Boards answerable to the people who use the local NHS.
Two thirds of the members directly elected by local people and the final third indirectly elected representatives from local councils. Let me assure you: this isn’t a proposal for yet another reorganisation of NHS structures. I know – I hear it all the time from everyone I meet who works in the NHS – that you are sick to the back teeth of restructuring. Our proposals will not put you through another pointless cycle of change.
What we want is for the existing structures, Primary Care Trusts, to become democratically accountable. A responsive NHS should have a central structure, of course, but it should not dictate local needs – it should respond to them. The signals shouldn’t always go downwards, in the form of orders, targets, rules and regulations.
The signals should go upwards, from patients, from communities, from doctors, nurses and local managers who have the perspective to understand what is best for individual patients’ needs. But it’s not enough to devolve power to the health board level.
We should go further still. Labour has finally moved towards a set of entitlements for every patient, and I want to see that idea implemented in full.
Under our proposal, where a health service provider fails to deliver those entitlements they will be legally obliged to pay for that treatment in whichever facility can provide it – inside the NHS or outside.
We know this can work because we’ve seen it work in Denmark. Their entitlement system has driven up efficiency standards as state hospitals do everything within their power to avoid paying for treatment elsewhere. It will do the same here. Saving money and improving standards. And then, we need to empower individuals with truly personalised health services.
I welcome the changes the government is making to move in this direction. I want to see more direct payments and individual budgets for people with chronic, long-term conditions - and in mental health services, in particular, where care still lags too far behind. That means allowing health service users the opportunity to take much more control of managing their own care.
By giving real choice to the individual, we can empower that patient and allow them to shape a care package for themselves – a package that suits their individual wants and needs. And nurses, especially specialist nurses, will be right at the heart of delivering those new kinds of care. In the community, in surgeries, in hospitals – you are the people who the NHS will rely on more and more in future years.
The final step to reform is to put more power into the hands of you, the people who serve our NHS. I know this is politically fashionable right now. Even Labour, who took power away from front line staff, is eager to make promises.
The difference I can offer is simple: employee empowerment is a fundamental liberal principle. Liberal Democrats are not fair-weather friends, promising more freedom one day, and threatening more rules the next.
The idea of devolving power away from Whitehall, away from managers, and to the public servants who are the heart and soul of the NHS goes to the core of everything we believe in. We will put front line staff in charge over their ward or unit budgets. A change Nursing Standard has long been campaigning for.
We will allow staff to establish not-for-profit social enterprises or John Lewis-style employee trusts to run services of all kinds within the NHS. We will let diversity and flexibility flourish within our health service.
And we can assure you: this will be a permanent change, not a temporary blip in an otherwise unrelenting stream of centralisation. Nine months ago I launched a consultation exercise called Ask the People in the Know. A website where public servants themselves could submit their ideas for delivering the services they know best - for less. Cutting out the waste that only those on the front line see.
For far too long, governments of both old parties have sought to change things with commissions or reports researched, written and implemented in an office in Whitehall. I wanted to turn that conventional wisdom on its head. Instead of commissioning an expert to spend a year writing a report on inefficiency. I asked the people who already know. We were inundated with responses.
Hundreds of people – dedicated public servants – putting forward their ideas from small changes to procurement regimes to major proposals to abolish duplication between regulatory agencies. I want to ask the same question again today to you.
This weekend the RCN rightly said that unless change happens in our NHS, the savings needed will be delivered by sacking staff who are so desperately needed to deliver care. And that will cost us all more money in the long term.
So how do we make the savings we all acknowledge are needed? From Whitehall, a Liberal Democrat government can cut bureaucracy and streamline quangos. And we will.
We will scrap Strategic Health Authorities, saving £140m a year from management costs. We will help PCTs cut their management and admin costs back – in real terms to what they were in 2005, saving £800m a year. We will decentralise the NHS and cut the central department in half - saving £100m a year. And we will cap NHS chief execs’ pay, so that none earn more than the Prime Minister.
From government, too, we can use pay restraint to keep pay costs under control, and so protect jobs. We will seek pay restraint with fairness. Our proposal is very different from those of the two other parties. I reject the idea from the Conservatives of a blanket pay freeze for all registered nurses.
But I reject, too the idea from Labour that you give a 1% pay rise to everyone, meaning an extra £1000 a year for a chief executive on £100,000, but just £190 extra for a nurse just starting out on his or her career. That is deeply unfair.
We propose a cap on pay rises of £400, so that the little money there is for pay increases is shared fairly.
Going to nurses who need it not consultants and senior managers who are already very comfortably off. Every nurse earning less than £40,000 will be better off under our pay plans than under either of the other parties.
And while I do believe there needs to be reform to public sector pensions we will not remove a penny of entitlements you have already built up, and for which you have worked so hard. So: cuts to central bureaucracy and restraint on pay: these are essential. And the money will be diverted, penny for penny, pound for pound to areas of the NHS which have been starved of cash, or could be in future years. But it is still not enough to protect the services we rely on. We can and must do more.
I was heartened by the report of the NHS Institute which identified £3.6 billion of efficiency savings that could be made if less efficient Trusts performed better. Changes like reducing pre-operative bed days, increasing day surgery rates, and increasing the numbers of patients who turn up for their appointments. The only problem is: I can’t make those things happen. Only you can. So tell us how.
We need to change the way power flows in the NHS. You should be telling us how to run it, not the other way around. Central bureaucrats, hidden behind closed doors, do not know how to cut the fat without cutting into the services people need. You do.
It is only the skills, innovation and ideas of the nursing staff of our health service that can protect it from the cuts you fear. This is a time of real change for the NHS.
Let us make sure it is change in the right direction. The NHS will not survive if we do not, together, take time to listen to the people who count, who work in the NHS, and then deliver savings which make sense.
By turning the NHS on its head, letting power flow up from you to the hospital boards, the local health boards and on, up to Whitehall, I believe we can protect the NHS we all rely on, even at a time when money is increasingly tight. That is the change the NHS needs.
And nurses can and must be at heart of making it happen.