00:00When it comes to the condition of the NHS today, the Darzi diagnosis is clear.
00:05The NHS has not been able to meet its most important promises to patients
00:09since 2015. A&E waits are causing thousands of avoidable deaths, 50 years
00:15of progress on cardiovascular disease has gone into reverse, 345,000 people are
00:20waiting more than a year for mental health treatment, that's more than the
00:24entire population of Leicester. And as the performance of the NHS has
00:28deteriorated, so has the health of the nation. Adults are falling into ill
00:33health earlier in life and children are less healthy today than a decade ago.
00:38ARA's conclusion was that the state of the health service is heartbreaking and
00:43I'm yet to hear anyone seriously contest this analysis which was entirely based
00:48on the data. Of course that didn't mean my conservative predecessor didn't try
00:53but she was left resorting to pointing out Lord Darzi was shock horror, a Labour
00:59minister in an attempt to discredit the author and his work, conveniently
01:03forgetting, impolitely I might add forgetting, he did work for conservative
01:07led governments too, not to mention three decades of experience as one of our
01:11country's top surgeons. It's not just the Conservatives, there are others who
01:15argue that pointing out the state of the service is demoralizing for staff and
01:20risks deterring patients from accessing care. Well in my experience, not just as
01:26a patient, but in the last three years talking to frontline staff and NHS
01:30leaders, most people appreciate the honesty and recognise that the biggest
01:35barrier to patients accessing care is long waiting times. And as I've argued
01:39before, a culture that puts sparing political blushes or protecting the
01:44reputation of the NHS above protecting the interests of patients is one that
01:49stifles inconvenient truths being spoken to power, that silences
01:53whistleblowers and that ultimately puts patient safety at risk. Now in the last
01:58few years I've come to know many of you in this room and the last four months
02:03I've toured the country talking to leaders and frontline staff, so I think I
02:08know you well enough to know that you share my view that honesty is the best
02:11policy, that you agree with the Darzi diagnosis and that you share my optimism
02:16that the NHS is broken but not beaten. Every day there are outstanding episodes
02:22of care being delivered by dedicated people working with some of the best
02:26science in the world. As Arrow put it, the NHS is in critical condition but its
02:31vital signs are strong. Our collective challenge is to take the NHS from the
02:36worst crisis in its history, put it back on its feet and make it fit for the
02:41future. The budget was important, the Chancellor gave us the investment we
02:46need to arrest the decline, begin fixing the foundations and start turning the
02:51service around. The NHS was the standout winner, we're delivering the largest
02:56health capital budget since Labour was last in power and the biggest cash
03:01uplift in day-to-day spending of any government department. There have been
03:07two predictable reactions to this. The first says that the NHS is getting too
03:13much money, that this is a black hole that consumes ever-increasing amounts of
03:17taxpayers cash and that the NHS will complain that it's never enough. So right
03:23on cue some NHS leaders popped up in the newspapers, aided and abetted by the
03:28health think tanks to complain that this isn't enough. Well one of the luxuries of
03:32leading a think tank is that you don't have to engage with the choices and
03:36trade-offs that government does. The Chancellor had to raise more than 40
03:42billion pounds to plug not just the 22 billion pounds hole we walked into in
03:46July but also to fix the foundations so that our economy and our public services
03:51can recover from years of mismanaged decline. When the Chancellor announced
03:57the settlement for my department she joked about how unpopular it would make
04:01me around the cabinet table and the truth is at the cabinet meeting in which
04:05she set out the contents of her budget I did feel uncomfortable. Not because I
04:10was worried about the opinions of the people in the room because they support
04:13the NHS and the investment but because I am worried about the jobs they have to
04:19do. As I look around the cabinet table I see a Justice Secretary who inherited
04:25overflowing prisons, a Work and Pension Secretary who inherited more than 4
04:29million children living in poverty, a Defence Secretary charged with securing
04:33our nation at a time when there is a ground war in Europe as well as constant
04:38and emerging threats of cyber warfare in a more dangerous and unpredictable world.
04:42So every penny of extra investment that goes into the NHS was a penny that
04:48didn't go towards child poverty reduction or extra prison places or
04:52bolstering our armed forces and more than that every penny that's spent on
04:56treating sickness is a penny that doesn't go on preventing illness and you
05:01know as well as I do that around only 20% of the nation's health is affected
05:05by the NHS. The rest is dictated by the poverty that we live in, the damp on our
05:11walls, the food we eat, the air we breathe and so on. So you can't pretend to care
05:16about the social determinants of ill health if you only ever ask for more
05:20money for the NHS. So then the argument goes we must do both and of course that's
05:26right but the choices and trade-offs aren't just about spending money but
05:30raising it. The tax burden in this country is at record levels. We chose
05:35rightly in my view not to hit working people in their pay slips. The extra
05:41investment in the NHS as well as other public services meant asking employers
05:45and the wealthiest to pay more and you'll have seen in the past few weeks
05:49that there are those who disagree with the Chancellor's decisions and that's
05:53the nature of tough choices. We stand by our decision to prioritise the health
05:58service. Healthy businesses depend on a healthy workforce and a strong economy
06:02depends on a strong NHS. But if you want to know where the average taxpayer
06:06stands on NHS spending it's quite straightforward. They welcome the
06:11investment but they worry it won't be spent wisely. They agree with a central
06:17argument we made at the last general election that investment must be matched
06:21with reform. We entered government with the public finances and the public
06:26services in a far worse state than they were when Labour last went from
06:31opposition to government. Tight fiscal constraints mean that reform needs to do
06:36a lot more heavy lifting. But even if we'd inherited the strong economy and
06:41public services we saw at the height of new Labour we would still need to reform
06:46our public services because we're standing in the foothills of a
06:50scientific and technological revolution that is changing the world around us.
06:53Citizens are used to choice, voice, ease and convenience at the touch of a button.
06:58We expect everything faster. Unless our public services are modernised to meet
07:03the needs of our people they'll become increasingly redundant and irrelevant to
07:07people's lives, unable to meet their needs. The failure to reform the state to
07:11meet the needs of the people is one of the fertilisers of populism we see
07:15across liberal democracies. The other is a failure to ease the pain in their
07:21pockets. So we need to address both with NHS reform that delivers better
07:26outcomes for patients and better value for taxpayers' money. By now you'll be
07:31familiar with the three big shifts that will underpin our 10-year plan for
07:35health from hospital to community, from analogue to digital, from sickness to
07:39prevention. These shifts are not radical new ideas but delivering them truly would
07:45be. They're necessary to tackle the challenges of our growing ageing society,
07:50rising levels of chronic disease and rising cost pressures, as well as to
07:55seize the opportunities of a scientific revolution in which AI, machine learning,
08:00genomics and data offer us the chance to transform our system of healthcare to
08:05one that can not only diagnose earlier and more accurately and treat more
08:09quickly and effectively but also predict and prevent illness. But we're not waiting
08:15for the 10-year plan in May to get cracking with reform. Over the last few
08:20years I've regularly heard the criticism of the top-down nature of the
08:24NHS. It can be a difficult criticism for those at the top to hear. But for the
08:29last four months I found myself at the top of the system, at the peak of the
08:34mountain of accountability.
Comments