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Access to NHS Services

Part of Opposition Day — [15th Allotted Day] – in the House of Commons at 5:18 pm on 3rd July 2007.

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health 5:18 pm, 3rd July 2007

I am willing to consider the hon. Gentleman's particular case. Such developments should occur only where there is a capacity problem. If the hon. Gentleman contacts me, I will look at the case.

There is no question but that developments in recent years have damaged staff morale, with deficits in some health trusts placing unwanted additional strain on hard-working NHS employees. As we move to the next phase of the NHS transformation, there should be a much greater focus not on top-down reforms but on stimulating change among patients and practitioners. I want to maximise local autonomy for the doctors, consultants, nurses and managers who actually do the job, day in and day out. The policy framework that we set will be right only if the views of staff and patients are properly incorporated.

A modern NHS must move from a public sector monopoly to a truly patient-led public service. That means doing more than changing the relationship between Ministers and senior managers; it means transforming the entire relationship between the NHS and the public and creating a system that is publicly accountable locally, as well as through the elected Government. My predecessors have already taken significant steps towards creating an independent, self-improving NHS, steadily removing power from the hands of politicians and transferring it to clinicians. In 1999, we created the National Institute for Health and Clinical Excellence to give clinical guidance on what the NHS should and should not do. We also established the Commission for Health Improvement, which is now the Healthcare Commission and is soon to merge with the other independent regulatory bodies that we have created. There are now 67 foundation trusts independent of Whitehall, accountable to their members and making their own decisions on how best to serve their patients.

That increased transparency and independence has brought undoubted improvements, but it has also had a short-term effect on confidence, revealing what was previously hidden. That has made our lives in Government more difficult because transparency always does, and that is no bad thing, but we were right to introduce these changes. In the internet age, transparent information is not only a powerful spur to improvement but a part of what the public expect. Patients need staff to take the time to explain the condition and the treatment options. Citizens need to know what is going on and to be properly involved in collective decisions.

However, it would be foolish to pretend that we have not also introduced more centralisation—more top-down direction and more command and control. We introduced national targets to eradicate the unacceptably long waiting lists. Without those targets, the NHS would not have seen the transformation of services that I described earlier. However, the treatment needed for the NHS then, when the whole system was in intensive care, is not the same as the treatment that it needs now, when it is well on the road to recovery. Of course targets have their limits. With targets, there is always a risk that Governments end up improving only the health care standards that they can measure. Targets can also have adverse effects if they are not properly researched and informed; and the top-down performance management that goes with them leads the NHS to look up to Whitehall rather than outwards to its patients and local communities. That is why we are determined to move away from targets as we transform the NHS from a top-down bureaucracy to a bottom-up, self-improving organisation with power in the hands of patients, their advocates, crucially GPs and other primary care staff, and of course staff themselves.

The heart of the NHS will always depend on effective collaboration by professionals around the needs of patients. That is why we placed a duty of collaboration on all providers in the NHS family. In future, a key measure of the quality of care given by every provider will be not only performance but the partnership established with the rest of the health service. With more than 600 organisations in the NHS, we need to ensure that each patient has a clear path to follow so that they can obtain the right treatment at the right place and time. Primary care trusts have already been given the authority and finance to develop and commission services around local needs, meeting national quality standards without being locked into historical practice.