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Earl Howe's key note speech at QIPP summit

Earl Howe, minister for QIPP, gave the key note speech at the recent QIPP summit.

Earl Howe's key note speech at QIPP summit

Earl Howe speaking at QIPP summit

I am thrilled to be appointed as a minister to the Department of Health. A policy area that I’ve been deeply involved with for a number of years and that I’m passionate about. It’s a delight to inherit Ara Darzi’s portfolio as Minister for Quality. The work that you’re doing is key to the future of the NHS, so it’s a delight to be with you. I begin by confirming a basic principle lest there be any doubt. This government is committed to upholding the values of the NHS. Healthcare that it is available for all, free at the point of delivery and based on need, not the ability to pay. For more than six decades, doctors and nurses, and yes, managers and administrators, have worked very hard to deliver a health service we can all be proud of. Their dedication and expertise is recognised and respected, I believe, the world over. The next thing I’m going to say may surprise you a bit. I also wish to acknowledge the improvements that the previous government has brought about. The investment it made has seen more doctors and nurses, more GP practices and hospitals and has led to some significant improvements in the quality of services the NHS now provides. All that is very good. However, investment alone is not enough. And the increases in funding that we’ve seen have not, I’m afraid to say, been matched by a corresponding improvement in services or, more importantly, health outcomes. Principles of Reform This Government is determined to change this. The Secretary of State has clearly set out our approach to transform the Health Service and there are five planks to this approach: An end to the paternalistic, ‘doctor knows best’ approach of old, now putting the patient central to all decisions about their care. To put it another way, there must be “no decision about me, without me”. Secondly we must resolutely focus attention and resources on what matters most. Not on measuring inputs or processes, although those things do sometimes have a role as proxies. But, with a rigorous, consistent and long-term focus on improving clinical outcomes. The third thing: empowering professionals to be free of the shackles of central government. The NHS may have been showered with money, but it has also, I’m afraid, been drowned in bureaucracy. This government is determined to let NHS staff organise themselves locally as they know best and not to fence them in with centrally imposed targets or diktats. This is bold but we’ve got to do it. The fourth thing is a new focus on public health. None of us can be satisfied in making the sick well when we have the opportunity to prevent people from becoming sick in the first place; one of the Ps in QIPP. It is better for individuals, better for communities and far better for the NHS budget in the end. The fifth and last plank in this approach is we must understand and maximise the connections between healthcare and social care. One of our greatest challenges is how to deal with the rising health and social care costs of an aging population. The Financial Context These are the principles that will underpin our approach towards the NHS. But, if we are to improve health outcomes, if we are to instil a new culture of value and productivity into the NHS, then we must bring these principles to life. We need to fashion a vibrant, creative NHS that really fizzes with ideas of how to improve quality and how to reduce costs. And, it is to the cost side of the equation that I now want to turn. The Prime Minister and the Chancellor have set out clearly the scale of the financial challenge we face as a nation. Most people talk about the size of the deficit, and at £155 billion, it’s easy to see why. But think for a moment about our total debt – currently £903 billion or almost two thirds of the UK’s entire GDP [62.2%] – and, if you think about that, you start to see why we need to take such drastic action. In the autumn, the Spending Review will cut the budgets of the majority of government departments by an average of 25%. The effect that this will have on our whole way of life should not be underestimated. The sobering fact is we have lived beyond our means for far too long and we now need to put our affairs in order. But, the size of the cuts in other departments only serves to underline the significance of the government’s commitment to the NHS. For rather than cuts there will be real terms increases in NHS funding for each year of this Parliament, that’s a tremendous privilege. Of course, we all know that this will not be enough. There may be increases but they will not be large. Certainly not large enough to cope with the rising level of demand from an aging population, better drugs, more effective new treatments and NHS pay and pensions. So, instead of relying on ever more funds flowing from the Treasury, we must look to ourselves to make savings. This practical imperative is what QIPP is all about. The various workstreams are looking at everything from prevention to new models of care for people with long term conditions, new uses for technology, and better value for taxpayers, working at all levels, nationally, regionally and locally. We have the resources, we have the knowledge and we have the ability to give the people of this country a truly first class NHS and to deliver it within our means. Yeovil District Hospital Already there are many examples from around the country, as we can see from the Establishing the Evidence project, of where empowered, innovative professionals are doing exactly this. At the Yeovil District Hospital NHS Foundation Trust, the enhanced recovery programme in elective surgery has improved the quality of care, reduced re-admissions and shortened time spent in hospital from weeks to an average of just five days. They have done this by bringing together everyone involved– surgeons, dieticians, ward staff – to jointly re-design care pathways. If this approach were replicated across the NHS, it could save as many as 200,000 bed days a year. Sandwell Community Healthcare Services And, it is not only hospitals leading the way. There are many excellent examples of community services significantly improving patient care and reducing costs. In Sandwell, the PCT has re-designed its approach to managing dysphagia, an inability to swallow. For many people approaching the end of their lives – those with conditions such as dementia, Parkinson’s or stroke – dysphagia can mean a revolving door in and out of hospital. Sadly, it also means that more people die in hospital rather than in their nursing home. This is not good for patients, for carers or for the NHS. So, in Sandwell, they decided to do something about it. First, they developed a Rapid Response Unit to assess patients within four hours rather than the recommended two days, reducing hospital admissions. And second, they developed an extensive training programme for nursing home staff to help them manage dysphagia in their patients. This made hospital admission one option, not the only option. The effect has been dramatic. In the six months between April and September last year, 75 people avoided being admitted to hospital. Not only does this improve the quality of patients’ lives, it saved the PCT almost a quarter of a million pounds [£225,000]. And. there are many other examples of improved care going hand-in-hand with reduced costs. You can read more about them, and submit your own, on the NHS Evidence website. And here again, we see the commitment of the government is central. For any savings made will not be returned to the Treasury, but be re-invested back into the Health Service. The Moral Imperative With public spending elsewhere being cut so dramatically, I believe that aside from the practical imperative for the NHS to become more productive, there is also a moral imperative. For every penny that remains in the Health Service is an extra penny cut from another department, then that penny had better not be wasted. It had better be working as hard as it possibly can to improve the health of the nation. Because if it is not, then not only is it a tragedy for the Health Service, it is a tragedy for every public service that is being cut further to protect the NHS. It is right that the sick do not pay for the folly of a nation living beyond our means. That we protect the sick and the elderly and help people return to work. But, we must never forget that while we are protected, others are not. And, we have a duty to those others to make sure we exceed the expectations that lie on our shoulders. Conclusion So at the end of today’s proceedings, what should we be saying to ourselves? Despite the obstacles we face, I believe this is an exciting time for the Health Service. We have a real opportunity to transform the NHS, social care and public health. We will set patients free to shape their own care. And we will set professionals free to deliver care in the best way possible. We work best when we work together. There are people here today from the NHS, social care and the voluntary sector. And every one of you has a vital contribution to make. While not for one moment underestimating the difficulty of the road ahead, we should also never forget the opportunity we hold in our hands, the opportunity that QIPP provides. The challenge we face is an extraordinary one. But the Health Service is full of extraordinary people who I know will rise to that challenge. -Ends-