17 October 2006
At his monthly press conference, Tony Blair watched presentations about change in the health service from NHS Chief Executive David Nicholson and Chief Medical Officer Sir Liam Donaldson.
Below you can find the transcript of the presentations as well as the PM’s introduction.
- More from the October press conference
- Download Mr Nicholson’s presentation as PDF
- Download Sir Liam’s presentation as PDF
Parts of this transcript may have been edited
PM’s introduction and presentation transcripts
Prime Minister:
Right, hello everyone. Now, let me explain how we are going to try to do this. We have got a presentation on the National Health Service which is something we have prepared for quite some time so we are going to do this first and people can ask some questions on it. I will say something and then Liam Donaldson and David Nicholson will come in and say something and then we will be able to throw it open to wider questions and I will answer those. And incidentally for any of the senior correspondents, if you want to ask on both, you can ask on both. If you ask on Health you’re not prevented from asking on other things, of which there are a myriad of possibilities.
Anyway let us first of all, because this is important obviously as a long-term issue for the country. I said back in April that the next year or so - then - was going to be a crunch time for the NHS. Essentially this is when the reform programme is going through, we are right in the middle of it, there are tough and difficult decisions being taken and it is important that people understand the context for it. And what we are trying to do is to get to a situation where the big issue that there was within the National Health Service when we came to office, namely the amount of time that people used to wait to get their operations, to get proper treatment for cancer and cardiac care, where that is genuinely transformed. And we have for 2008 the target that there will be an 18-week maximum wait, but that is in-patient and out-patient combined. In other words, when we came to office there were thousands of people waiting over 18 months just on the in-patient list, but often they waited many months on the out-patient list before they even got on the in-patient list. The concept of the 18-week target is literally door-to-door, from the GP to the operating theatre and effectively that will mean you have booked appointments and an end to waiting, certainly in a traditional sense, within the National Health Service.
Now to do that we need to make changes within the National Health Service. That is the purpose of the reforms both at primary care level in terms of payment by results in the new system operating in the NHS and also in the contestability of services. But it is all about different ways of working because the context in which health care is being delivered is changing. And I would just like to correct, if I may, some of the stuff that there has been of a negative nature in the past few weeks. For example the Health Care Commission Report last week. This was presented as negative. In actual fact, what the Chief Executive of the Health Care Commission said was there have been real improvements in the NHS, waiting times continue to fall, particularly in Accident and Emergency, for cancer treatment and access to chest pain clinics. This is having a real effect on survival rates from cancer, heart failure and stroke, which are our biggest killers. What they have done, however, is apply a much more rigorous set of standards to judging whether hospitals are succeeding or not. So it is not that the Health Care Commission was saying the NHS is getting worse. On the contrary they say it is getting better, but it has got to get even better still. And I think that is important to point out.
Yesterday there were stories about cancelled operations. Cancelled operations are 25% fewer than 4 years ago. There have been claims that there are some 20,000 jobs or people who have had their jobs lost within the NHS. Actually when you look at what is happening and track those stories down around the NHS the actual figures are far fewer. What is in fact happening however is that it is true. Some people are being redeployed to different work within the NHS precisely for the reasons that you are about to hear. In total there are at the moment round about 300,000 more people employed in the NHS today than in 1997, and before everyone says these are all managers, they are not. Actually the vast increase has been in front line staff. And that is something like a 30% uplift in the numbers working for the NHS.
It is the case today that whereas almost 300,000 people were waiting longer than 6 months for in-patient treatment, today it is virtually no-one. Waiting for cataract treatment, for example, has been slashed from 2 years to 3 months and all of this has been delivered within NHS outcomes that mean that there are round about 700,000 more operations today than there were in 1997. Incidentally on productivity as well again it is constantly said that productivity in the NHS is declining. If you include quality of care within the figures i.e. saving lives, improvements in waiting time, improvements in prevention and keeping people out of hospital, then actually productivity has risen in the NHS over the past few years, and this is borne out both by the King’s Fund Report from last December and the NHS Confederation Report from May.
So, what we will present to you today is the picture of an NHS that yes has got tremendous challenges, and indeed so have health care systems right round the world, but one where improvements are being made and where the key driving force behind the changes that are happening in the NHS today is the need to deliver health care in a different way in a changing world, and we have got to hold our nerve and see these changes through particularly over the next few months. It is the next few months that are going to be absolutely critical as to whether this happens or it doesn’t happen.
Now one final thing I just wanted to comment on before handing over to Liam is again another example of where we can get the progress on public services. Somewhat out of kilter is the report today from the PAC that claims that one million pupils are in poorly performing schools. What they are doing is changing the definition of what is a failing school in order to include a whole series of schools that are not failing in the traditional definition but simply are not performing as well as they should be. That is a completely different definition. Actually on any definition that you use, school results are improving. The number of schools in special measures has declined actually by over a half. The number of schools where under one quarter of the pupils are getting 5 good GCSEs has been cut to one sixth of what it was. Only 110 now from over 600 in 1997 and actually in every single part of this system there have been improvements. Does that mean that all the schools are doing well? No. Does it mean that they are improving? Yes. And whereas when we came to office in 1997 there were many London Boroughs with an average of 25% 5 good GCSEs, today there is not a single Borough in London, not one, that has not got a record of over 40% 5 good GCSEs. So what we would say is, there is considerable improvement. It is coming often as a result of reform, because specialist schools and City Academies are improving at an even greater and faster rate, but we need to do far more. So without any more ado. This is an interesting presentation that Liam has got to give to you.
Sir Liam Donaldson:
Good afternoon everybody. To tell the story of modern health care is very much to chronicle a march of progress in medical science and innovation. How it saves lives, how it transforms quality of life, and how it shapes the way that health care services are delivered.
This is a 57 year old film producer, William Patterson. His closest friend died of a heart attack and he then began to worry about his own symptoms that he had had over a number of years of chest pain and minor discomfort in the area of his heart. He went to see his doctor and was also diagnosed with severe coronary heart disease. He had a major blockage in one vessel and normally he would have required major surgery, open heart surgery. But he was lucky enough to meet with the team at St Mary’s hospital who had just started using robots to undertake this form of cardiac surgery and you see there the robotic system in place, the surgeon sitting there at the console, a three-dimensional image of William’s heart. He had his operation. He was out of hospital within 5 days. Those are the tiny scars that he had compared to what an open heart surgery would be, and within 2 weeks he was travelling around Europe with his job. The only down-side was that his 10 year old son wasn’t very happy about the idea of a robot that didn’t have a face and didn’t talk. But William was very happy and he had an excellent outcome of care.
New technology, shortening recovery times for patients, reducing the risks of surgery, reducing the pressure on intensive care and shortening hospital length of stay.
Tracking technology is increasingly being used in different fields to analyse performance of - in the sports field - of individuals and teams. The blue lines on those charts are successful passes in a football game. The red are unsuccessful. The chart on the left shows one of England’s World Cup games without Wayne Rooney and the one on the right shows the team with Wayne Rooney and look at the flow of creativity and opportunity that is being created. So sports coaches are using that sort of technology.
In the health field we are also using tracking technology. On the left you see an inexperienced surgeon whose eyes are in special goggles that track his eye movements. Look at the dispersal of his eye contact with the area that he really needs to concentrate on, the wound where he needs to do a very precise procedure. On the right you see an experienced surgeon who has done many of these operations before, his eye contact honed right down to the area that needs his undivided attention.
So we are using this sort of tracking technology in an era where we want patients to receive the best quality safe care to do what, when I was training as a surgeon 30 years ago, tended to be an apprentice-style form of training, not quite fulfilling the old adage of see one, do one, teach one, but almost. So we use in modern surgical training we are starting to use, and this is the shape of the future, simulators. That is a gall bladder, but it isn’t a real gall bladder. It is a keyhole surgery virtual operation. The surgeon doing it can pull on the gall bladder. It bleeds like a real gall bladder. He can cut it out and it comes away like a real gall bladder. He can look at the complications of surgery and anticipate them in advance. So when the real patient comes to have her gall bladder taken out, it is being taken out by somebody who has practised many times before doing it on a real patient, transforming the way that surgeons hone their technique.
Barbara is a woman who has had diabetes since she was 10 and like a lot of insulin-dependent diabetes she had relied on a daily insulin injection. But she had a lot of complications with her diabetes. It wasn’t well controlled and her quality of life was poor as a result, so as a result of this technology she has a special monitor attached and implanted under her skin which delivers insulin at the time that is required in the right dose and that technology has transformed her quality of life. So that is an example of new technology putting the patient in control and reducing their dependency on hospital care.
So just a few brief conclusions. The NHS is nearly 60 years old as we all know, and during that time as I have shown in my presentation there has been immense medical progress and much of it in the last decade or so. But one thing has remained static. The sacred cow of our Health Care System to be revered and protected at all costs has been the hospital bed, yet in the best health care systems around the world the goal is not the preservation of the status quo. The holy grail is the maintenance of people’s health so that many people never have the need of that hospital bed at all, and when they do need care the highest quality care for patients needs to be delivered, not in one place necessarily of a static or fixed institution but in the place that they need it, and however it is going to be delivered to give them the best possible outcome and all of these changes driven by excellence and innovation in medical science.
Thank you for listening. I am going to hand over now to David Nicholson who is the Chief Executive of the NHS.
Mr David Nicholson:
Thank you Liam. Good afternoon. I am David Nicholson, Chief Executive of the NHS. This is my sixth week in post so hopefully I am getting to grips with some of the issues around and it is a fantastic privilege for me to do this particular job after spending the last 30 years at a variety of levels working in the NHS. And it is a very exciting time to join the NHS. My job in lots of ways is to take the sort of things that Liam has been saying there and to systemise them, so that everybody in the country has the opportunity to access those kinds of services. And it is true, underlying what Liam has just said, we will not do that by polishing the status quo. Lots of people have said, and indeed it was repeated recently, that the NHS is a much loved institution, and it is. But to be frank, we need to get away from being a much loved British institution to a 21st century health care system which meets the needs of patients. So we are going through significant change which is not without its pain in the system generally and you can all see yourselves, in your daily lives, and reading the newspapers and television and the rest of it that there are big changes happening but it is very important to stress that we need to see these changes through for the benefits of our communities and our patients.
And there are two big changes going on at the moment that I want to mention. The first thing is that the whole way in which, the structured way in which care is delivered to patients, is changing. And Liam has mentioned that a little bit and I will talk a little bit about that in future. And the second bit is that we are changing the delivery system. We are trying to reform the system so that we can get much better outcomes for our patients.
In terms of the way the structure of the Service is changing, in terms of service rather than organisation, there are two elements to that. There is the closer to home, community-based shifting resources and expertise from hospital services to community and primary care, and then there is the concentration and centralisation of services around secondary care.
In terms of services closer to home, this is a facility opened recently in Birmingham and this year, every week one of these facilities is opening somewhere in the country, a facility that not only enables a whole set of new services to be provided closer to people’s homes, but it also gives us some opportunities to develop services. One of the issues when the Prime Minister and I visited this place 2 or 3 weeks ago was to look at the partnership between the Ambulance Service and the Health Services to reduce unnecessary hospital admissions for falls. A major issue in relation to admitting elderly, frail patients into hospital is when they fall. Historically what would have happened, they would have called their GP, the ambulance would have been called, the ambulance would have taken them into hospital. Now there is a whole set of services that the paramedics can offer, can access into the social care and health care to keep the patient in their own home and to provide them with the support that they need.
The second area that I would identify in terms of community services is long term conditions. Long term conditions. 40% of households in this country have at least one member who has a long-term condition: diabetes, heart failure, emphysema, asthma, that kind of thing, and the treatment for these and the care of these patients is being revolutionised as we speak. Liam talked about some of them, but you can see the scale of utilisation of health care in this regard. And one of the major issues that we face is that a large proportion of patients in our hospitals suffer from one or more of these long-term conditions. Indeed 5% of our patients are responsible for using 42% of all the in-patient bed days. There are good alternatives for a large proportion of these patients. If we can better control and support their care in the community we can avoid a whole set of admissions into hospital services which is good for the patient and good for the service.
Inside hospitals things are changing. The length of stay is significantly reduced across the NHS as a whole, something like 20% in the last few years and the way in which we use health care in hospitals is changing as well. Approximately 70% of all in-patient elective care is currently now done on a day case basis which is an increase in numbers from 2.5 million 10 years ago, to 4 million today and that can go further, we can do more using this as the sort of technology that Liam has talked about to improve services to patients on a day case basis.
And the second area relates particularly to the concentration of services in hospital and I think Liam really did show quite graphically the way in which we can train our doctors, we can concentrate skills and talents in particular teams and we can improve services to patients. Prostate cancer is a good example of that and the thing that connects these two things together, community care and hospital care, is often the Ambulance Service. It used to be the case many years ago that Ambulance Services essentially were what was euphemistically described at the time as "scoop and run". You picked the patient up and you took them to the nearest hospital as fast as you possibly can. That is radically changing as we sit here today. The big issue is when people get access to definitive care, and increasingly that definitive care is being delivered to their doorstep by highly trained and high skilled paramedics so the treatment can start in and around the patient’s home, not waiting to go to a particular A. & E. department.
It seems to me in terms of all these changes and particularly at this moment we need consistency of purpose. We need clear direction and we need to drive it forward. It is the duty of the NHS to respond to these challenges in a constructive way, but it will take imagination and courage from the clinical leadership and the managerial leadership of the NHS. And what we cannot do is leave our patients and public behind and that is why we are focusing so much attention at the moment in the way in which we communicate with our patients and public.
What we need to do is to move from a situation where the whole of the debate is around how many beds there are, how many beds there aren’t, how many hospitals have been closed, how many hospitals have been saved, to move to one where we can say how can we improve patient safety, how can we improve services and how many lives can we save.
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