The NHS is the country’s most precious creation. We are all immensely proud of the NHS and the people who make it what it is—a service that last year delivered half a million more outpatient appointments, nearly 1 million more A and E attendances and 1.5 million more diagnostic tests than the year this Government came into office; and it is doing so while meeting waiting time targets, reducing hospital-acquired infections and virtually eliminating mixed-sex wards. The essence of the NHS is its values: universal and comprehensive health care that is free and based on need and not the ability to pay.
Today I am proud to publish the first ever mandate to the NHS Commissioning Board. From now on, Ministers will set the priorities for the NHS, but for the first time, local doctors and clinical staff will have the operational freedom to implement those priorities using their own judgment as to the best way to improve health outcomes for the people they look after. That independence comes with a responsibility to work with colleagues in local authorities and beyond, to engage with local communities to create a genuinely integrated system across health and social care that is built around the needs of individual people.
The mandate makes clear my responsibility, as Secretary of State for Health, to uphold and defend the enduring values that make the NHS part of what it is to be British. It also sets out my priorities for the NHS Commissioning Board over the next two years and beyond, linked closely to the NHS outcomes framework, the latest version of which I am also publishing today.
The priorities set out in the mandate closely reflect the four key priorities I have identified to Parliament as my own. Let me take each of them in turn. My first priority is to reduce avoidable mortality rates for the major killer diseases, where despite increases in life expectancy our survival rates are still below the European average in too many areas. If our mortality rates were level with the best in Europe, we could save as many as 20,000 lives every year—20,000 personal tragedies that could be avoided, but are not. It cannot be right that we are below average for cancer survival rates, that for respiratory diseases we are the worst in the EU 15, or that our performance on liver disease is getting worse, not better. Today I call on the NHS Commissioning Board, working with Public Health England, local government, clinical commissioning groups and others, to begin a concerted effort to bring down avoidable mortality rates in this country.
The mandate asks the board to make measurable progress to improve early diagnosis, giving more people quicker access to the right drugs and treatment where they need it; to reduce the wide and unacceptable variation between different parts of the country, both in terms of inequality of health outcomes and variability of performance by NHS trusts; and to support a renewed focus on prevention, working with local authority partners to help people quit smoking, drink less, eat better and exercise more.
My second priority is to build a health and care system where the quality of a person’s care is valued as highly as the quality of their treatment. When we place ourselves in the hands of others, we should be confident that we will be treated well, our dignity respected and that that will be the case regardless of our age or mental state, or whether we are in a hospital, a care home or our own home. For most people, most of the time, that is already the case, but too often it is not. The appalling revelations from places such as Mid Staffs and Winterbourne View bring home the desperate need for change. We must go beyond the enforcement of minimum standards. We must raise our game so that the NHS is recognised globally for its commitment to the highest standards of care for all, just as it is recognised for its commitment to the highest standards of treatment for all.
The mandate asks the NHS Commissioning Board to ensure that GP-led commissioning groups work with others so that vulnerable people, particularly those with dementia, learning disabilities and autism, receive safe, appropriate, high-quality care. It also asks the board to improve standards of care during pregnancy and in the early years of children’s lives. This will include offering women the greatest possible choice over how they give birth, giving every woman a named midwife who will be responsible for them both before and after the birth, to reduce the incidence and impact of post-natal depression through early diagnosis and better intervention and support.
The mandate asks the board to measure and understand how people really feel about their care through the new friends and family test, asking patients whether they would recommend the care they receive to their friends or family. The test will cover hospital and maternity services in 2013, with other parts of the NHS following soon after. The mandate also asks the board to drive up standards of care by championing a transparency revolution within the NHS. This will make us the first country in the world to publish comparative information on performance throughout the health-care system, including on clinical commissioning groups, local councils, providers of care and consultant-led teams. Mental health, long the poor relation, must have parity with physical health. The mandate asks the board to make clear progress in rectifying that, particularly by looking at waiting times and rolling out the programme of improved access to psychological therapies.
My third priority is to improve dramatically care for the third of people in England who live with a long-term condition such as asthma, diabetes or epilepsy. As a group, they account for more than half of GP appointments and nearly three quarters of hospital admissions. That has a huge impact on the individuals concerned—an impact that can be compounded by the way in which they are dealt with by the NHS. We need to do better.
The mandate therefore asks the board to help those who rely heavily on the NHS by harnessing the power of the technology revolution. Labour’s NHS IT projects failed, wasting billions, but we must not allow that failure to blind us to how technology can transform treatment and care throughout the system. I am today asking the board to ensure, by 2015, that all NHS patients in England can access their GP records online; that, in at least parts of the country, those records are integrated with other medical records across the health and social care system, so that a single record can follow a patient seamlessly from ambulance to hospital, to GP clinic and to their own home; and that everyone can book GP appointments and order repeat prescriptions online, as well as contact their GP by e-mail. I am also asking that significant progress be made towards ensuring that 3 million people with long-term conditions benefit from telehealth and telecare by 2017.
With respect to people with long-term conditions, the mandate also asks the board to ensure, by 2015, that more people have the knowledge and skills to control their own care, and that carers have the information and advice that they need about the support that is available to them, including respite care.
My final priority is care for older people, specifically those with dementia. Already, one in three people over the age of 65 lives with dementia. Shockingly, even though the right medicines can make a huge difference to people’s quality of life and that of their families, we diagnose fewer than half of those with the condition. I want the diagnosis, treatment and care for people with dementia to be world-leading. The mandate therefore asks the NHS Commissioning Board to make significant progress in improving dementia diagnosis rates and to ensure that the best treatment and care is available to everyone, wherever they live. We also want hospitals, and indeed all NHS organisations, to make significant progress in becoming dementia-aware and dementia-friendly environments.
The mandate covers other important areas of NHS performance, including research, partnership working, the armed forces covenant and better health services for those in prison, especially at the point when they are integrated back into the community. The mandate also sets the NHS Commissioning Board’s annual revenue budget, which for 2013-14 will be £95.6 billion, with a capital budget of £200 million. An important objective for the board is therefore to ensure good financial management, as well as unprecedented and sustainable improvements in value for money across the NHS.
We are the first country in the world to set out our ambitions for our health service in a short, concise document that is centred around patients. Its clarity and brevity will help bring accountability, transparency and stability to the NHS. The last Government sent endless instructions to strategic health authorities and primary care trusts, constantly bombarding them with new targets, new directions and new priorities, and drowning the NHS in red tape and bureaucracy. In stark contrast, the mandate is just 28 pages long. It signals the end of top-down political micro-management of the NHS—an approach that failed to get the best treatment for patients and the best value for taxpayers. The mandate demands much closer integration between secondary and primary care, and between the NHS and social care. It requires a new style of leadership from the NHS, with local doctors and nurses free to innovate in the way that they commission care. I look to the board to develop their leadership skills so that they can do that. The mandate will make it easier for Ministers to hold the health and care system to account, and easier for Parliament to hold Ministers to account for their stewardship of the system. It is a historic step for the NHS, and I commend the statement to the House.