Secretary of State for Health and Social Care's address to IPPR
Secretary of State for Health and Social Care, Wes Streeting, spoke at the Institute for Public Policy Research (IPPR)'s State of Health and Care Conference 2024.
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Thanks very much for inviting me here today.
A lot changes from opposition to government. I’ve gone from an office of 7 staff to a department of 3,500. People insist on calling me by my title, rather than my name. The most frustrating change, and I am sure that I won’t be the first to have said this, has been the pace - or lack of it - at which the Whitehall machine works.
So, for Ara [Lord Darzi] to have published 2 reports in the past 2 weeks, both over 100 pages long, packed with expert analysis and huge amounts of data, the first of which he wrote in just 2 months, is really putting the British state to shame. Especially on the first of those reports he put together in just over 2 months. He’s on a one-man mission to solve our country’s productivity.
The Darzi investigation into the NHS and the final report from the IPPR’s Commission on Health and Prosperity, complement each other. Taken together, alongside the Office for Budget Responsibility’s fiscal risks and sustainability report, they depict a perfect storm of rising pressures on the NHS, growing numbers dropping out of the workforce and spiralling costs to the public purse, at a time when there is already a £22 billion black hole in the public finances.
This is what we’re up against. I’ve been in the Department of Health and Social Care for 2 months, and day after day I’m shown graph after graph with all the lines going in the wrong direction.
Recognising this is criticised by some for being ‘gloomy.’ It’s not actually, it’s something this country hasn’t been used to for a long time - it’s honesty.
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This government has resolved to be honest about the problems facing our country and serious about solving them.
You saw both in Keir’s speech last week - honesty about the state of our NHS and a serious agenda for turning it around. As the Prime Minister set out in his speech, continuing with the status quo isn’t an option. Sticking plasters won’t cut it. We’re going to have to make big changes, many of which will come up against loud opposition. So don’t be surprised that we’re making the case for change at the same time.
If anyone was in any doubt about the scale of the challenges before the NHS, then the Darzi investigation published last week made it abundantly clear.
I asked Ara for hard truths, warts and all. He delivered. And then some. He has given a raw and honest diagnosis:
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the promise that the NHS will be there for us when we need it has been broken for almost a decade
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100,000 infants, aged 0 to 2, were left waiting more than 6 hours to be seen in A&E last year
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cancer is more likely to be a death sentence for NHS patients than patients in other countries
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50 years of progress on cardiovascular disease is going into reverse
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patients have never been more dissatisfied with the service they receive
The report is equally damning on the causes.
First, a decade of underinvestment.
Which left the NHS 15 years behind the private sector on technology.
With fewer diagnostic scanners per patient than almost every comparable country, including Belgium, Italy and Greece.
And mental health patients treated in Victorian cells, infested with vermin, where 17 men are forced to share 2 showers. In 2024.
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As the report states and I quote:
It took a scorched earth approach to health reform…. the effects of which are still being felt to this day.
Just imagine, if all the time, effort and billions of pounds wasted on dissolving and reconstituting management structures had instead been invested in services for patients.
Clearly, the NHS would not be in the mess it finds itself in today.
Third, coronavirus.
The damage caused by the pandemic has been plain to see.
But what we didn’t know until the Darzi report, is that the pandemic hit the NHS harder than any other comparable healthcare system in the world.
Patients in this country saw far more operations and routine care cancelled than anywhere else.
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That’s why the backlog ballooned to 7.6 million today.
Fourth, the failure to reform.
A 17% increase in staff working in hospitals, which didn’t lead to better outcomes for patients, but a huge fall in productivity.
Staff put into the wrong place, without the tools to do the job.
Instead of treating patients, too many are trying to find them beds, find somewhere to discharge patients or dealing with slow, creaking, outdated IT.
An enormous waste of talent and money, when so many other parts of the NHS were crying out for investment.
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Activity-based funding was ditched in favour of block contracts. Incentives to reform and modernise ways of working have been stripped out. Translated into plain English, too many parts of the NHS are now paid for effort, not for outcomes. That has to change. And we’ll be saying more about that in the coming months.
Some of the most shocking findings in the Darzi investigation weren’t about the sickness in our National Health Service, but the sickness in our nation.
Children are sicker today than the generation a decade ago. Adults are living longer, but falling into ill-health earlier in life. And as this report from the IPPR puts it, we are in danger of literally becoming the sick man of Europe.
The result is a rising tide of pressures on the NHS.
I’ve said it before but I don’t think the message has yet got through: if we don’t act now, ever increasing demands for healthcare threaten to overwhelm and bankrupt the NHS.
Our sick society is also holding back our economy.
A drop in productivity due to ill-health has cost our economy £25 billion since 2018.
900,000 more people are off work than would have been on pre-pandemic trends. That’s more people than Tesco, Sainsbury’s and Asda employ put together.
Fail to act, and by the end of this parliament 4.3 million people could be off work sick. Millions of people left behind, the welfare bill ballooning and growth hampered.
To build a healthy economy, we need a healthier society.
To achieve that, we need reform of the health service and public health reform too.
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Reform has always had opponents, often vocal and powerful opponents. But believe me when I say the Prime Minister and I will face down that opposition, because it is in the interest of patients, the health service and taxpayers in this country.
It really is reform or die and we choose reform.
As the Prime Minister said last week, radical surgery is required. We will publish a 10-year plan early next year that will set out how we deliver 3 big shifts in the focus of the NHS:
- from analogue to digital
- hospital to community
- sickness to prevention
And what gives me confidence that this can be done is the innovations already taking place in our health service and our country today, pointing the way to a better future.
At the Royal Free Hospital in London, the hospital which treated my kidney cancer, new PET scanners work 4 times faster than standard. Patients are seen days, not weeks after being referred, cutting delays in diagnosis that can be the difference between life and death.
Think of the number of lives that could change, if rolled out across the country. That is why we are committed to putting an AI-enabled scanner in every hospital - freeing up valuable staff hours and getting patients diagnosed much faster.
In the south-east of England, virtual wards have led to 9,000 fewer hospital admissions per year. Patients living with long-term conditions like heart failure are cared for from the comfort of their own home, freeing up vital hospital beds and saving more than £10 million.
Our commitment to invest in more district nurses will make sure more patients across the country can get the treatment they need without having to step out the front door.
Better for patients and less expensive for the taxpayer.
As the Prime Minister said last week, by marrying our country’s leading scientific minds, with the care and compassion of the NHS, the fruits of the revolution taking place today in life sciences can be secured for NHS patients. That public-private partnership will be fundamental to the reform agenda.
Take multiple sclerosis patients. Right now, many are treated through a 4-hour blood infusion - a long and difficult ordeal.
Soon, thousands will be offered an injection that takes just 10 minutes. Just imagine the difference this will make. The hours returned to patients to live their lives. And the thousands of hours of clinicians’ time freed up for the millions of other patients stuck on waiting lists.
And when it comes to prevention, the healthy society we need to build won’t just come from the action we’re taking as a government, to ban junk food ads, pass the tobacco and vapes bill or introduce health checks in workplaces and on high streets.
Nor will it only come from the reforms we will make so the NHS can reach patients sooner, diagnose earlier and treat them faster.
In May, we saw the first NHS patient to be treated with a personalised cancer vaccine at University Hospitals Birmingham.
These vaccines could prevent cancers from returning after surgery, sparing thousands of patients and their families the torture of recurrence.
That’s why I am determined to rid my department and the NHS of any cultural sniffiness about dealing with the private sector, make the NHS the best partner in the world for the life sciences sector and make sure NHS patients can enjoy the benefits. That is what Keir Starmer’s mission-driven government is all about. It’s about mobilising the public sector with business, the voluntary sector and civil society to achieve big lasting change for our country.
In doing so, we won’t just be building a healthy society, but playing our part in contributing to the government’s number one mission - economic growth.
So in conclusion - we’ve hit the ground running in the last 2 months, bringing an end to the junior doctors strike which had lasted 18 months, cost patients 1.5 million cancelled operations and appointments and cost taxpayers a staggering £1.7 billion.
And we’ve begun to fix the front door to the NHS, with an additional 1,000 GPs hired by the end of the year, beginning to reverse the decline in primary care of the past 14 years.
It’s 76 days since the general election and 76 years since the founding of the NHS. There are no quick fixes for an institution of this size and age. [Political content has been removed]
None of this is easy and it will take time.
There will be more arguments to be won along the way, against the ideologues who do not believe the NHS should have any relationship with the private sector and the modern-day luddites who resist greater use of technology in the health service.
This government will never be afraid to take on the arguments and take the difficult decisions to deliver the change that the British people voted for.
If we see this through, the prize is huge. A healthy nation, where fewer lives are lost to the biggest killers and fewer people are forced out of work through preventable disease.
A healthy, growing, prosperous, economy with the proceeds of that wealth shared across our country. An NHS there for us when we need it once again - recovered, reformed, sustainable for the long-term. That’s what we will do.
Thank you very much.