In less than two years, the National Institute for Clinical Excellence has become an integral and respected part of the NHS. That in part is due to the vital work it has already done; it is in no small part also due to the efforts of Mike Rawlins, Andrew Dillon and all the people who have contributed to NICE's efforts. I want to start by thanking them today.
Through NICE, for the first time the NHS - patients, clinicians, and managers - now have a single authoritative source of clear advice about which treatments work best for which patients.
NICE is part and parcel of an agenda designed to raise standards in the NHS, and thereby nurture both professional and public confidence in the National Health Service. NICE has already begun to eradicate the lottery in care which has been so corrosive of that confidence in the past.
It epitomises the philosophy which lies at the heart of the NHS: care based on patients' clinical need, not their ability to pay or where they happen to live. NICE is part of the broader momentum of change now sweeping through the health service. A momentum intended to focus growing NHS resources on delivering better, faster care for patients.
NICE is already proving its worth for patients and, by doing so, proving its critics wrong.
When I spoke at this conference last year, I said I wanted NICE to be the health service's equivalent of the Monetary Policy Committee of the Bank of England independent, hard-nosed, authoritative, evidence-based. It has been all this and more.
In its first full year of operation NICE has produced guidance to the NHS on topics as diverse as coronary artery stents and advanced hearing aids. Following NICE appraisals on taxanes for breast and ovarian cancer we estimate that an extra 5,000 women a year will be treated with effective anti-cancer drugs who otherwise would not have benefited.
It has not all been a one way street though. NICE has been tasked with the toughest of decisions: sorting the wheat from the chaff in NHS treatments. By doing that it is protecting patients from low value or obsolete treatments, and so freeing up more room for the faster uptake of effective new treatments.
The overall balance sheet is pretty clear.
Nick Timmins, a perceptive commentator on the NHS, wrote a fortnight ago in the Financial Times,
So far the view that NICE is there purely to ration is hard to sustain. Its first 15 significant decisions have saved the NHS about £70 million. However its recommendations for wider use of some treatments has boosted NHS spending by at least £205million Many thousands of patients should now be receiving potentially life saving treatments they were previously denied.
Nick Timmins is right. In the work it has done, in the work it has yet to do, step-by-step, NICE is ending the lottery of care in the health service.
And right the way across the NHS, step-by-step real change is happening. The NHS today is a service in transition.
Progress is under way: 10,000 more nurses and almost 5,000 more doctors. The numbers waiting for outpatients appointments and in-patient treatments falling simultaneously for the first time. New waiting time targets for cancer delivering faster care for thousands of patients. Fast track chest pain clinics and more heart operations bringing about long overdue improvements in cardiac services. Every accident and emergency department that needs it and 1,000 GPs surgeries being modernised. The biggest hospital building programme in the history of the NHS underway.
So progress in the NHS but nowhere yet near reaching its true potential. The fundamentals of the NHS are sound its principles, its fairness, the commitment of its staff. But there is a long way to go before we match the aspirations of government, staff or patients for the NHS our country needs.
But to read some of our newspapers you'd think there was no progress at all. I know bad health stories make good newspaper copy. I know some of our papers are openly hostile to the very principles of the health service. That in the end is a matter for them.
For the Government's part, I also know that the distorted picture people read in some of our papers is neither an accurate reflection of the commitment of NHS staff to high quality services for patients nor an accurate description of the high quality of care most patients receive.
So all I ask is that we have some balance in the way the NHS is reported, not just this winter but all year round. The truth is about the NHS the glass is half full not half empty.
There are many things that are wrong in the NHS and many things that go wrong and where they do we are unrelenting in pursuit of putting them right. But for the majority of patients the health service, even with all of its very clear failings, provides good care day-in, day-out.
Good but not yet good enough.
There is no doubt NHS staff are under very real pressure. Too often they are run off their feet and, despite that, services for patients are still too slow, standards are still too variable.
Why? Because for decades funding has been too low. And for decades, all too often staff have had to fight a system designed for the needs of the 1940s rather than the needs of today. So while the NHS is right in principle, for far too many patients it is simply not good enough in practice.
A lack of the right level of investment; a lack of the right sort of reforms. After decades of Whitehall denial, these are the simple facts of NHS life. I believe that today there is a shared understanding between the health service and the Government of what needs putting right in the NHS.
One, increased and sustained investment not just for one year but over a period of years
Two, capacity building to tackle the shortages of nurses, doctors and beds that bedevil NHS care today.
Three, an unrelenting drive to ratchet-up standards and ensure greater equity in provision of treatments and services.
And four, reforms to liberate the talents of staff and to break down boundaries between services in order to streamline care for patients.
Today we have the best opportunity there has ever been to fundamentally redesign the health service around the needs of its patients. After decades of under investment the health service can go for growth again.
For years, the NHS budget rose by an average of just 3% a year, not enough to keep pace with changes in technologies and treatments let alone to modernise care for patients. In the last parliament, the NHS budget grew by even less. In the last year of the previous government's tenure of office it actually fell in real terms.
Let me be candid with you. In this Government's first two years of office, spending on the NHS did not rise as quickly as many had hoped. I know that. And I know the NHS is still feeling the effects.
But the tough choices we took then, are paying off for the NHS now. It is precisely because interest rates and inflation rates are at historic lows, unemployment is down, employment is up and the public finances are back in balance that we are now enjoying twice the historic growth trend in NHS spending.
It is precisely because we have a strong and growing economy, providing the foundations for strong and growing public services, that we can now tackle the legacy of under-investment we can see in our nation's transport infrastructure, school buildings and of course, the NHS.
Our prudence then, is being used with a purpose now: over the five years from 1999 the NHS budget is growing by one half in cash terms. By one third in real terms.
And our purpose is to bring about the fundamental and far-reaching reforms the NHS now needs. The foundations have been laid. The internal market with its focus on finance rather than quality has gone. There is a new emphasis on raising standards through clinical governance, the Commission for Health Improvement, the national service frameworks and of course, the National Institute itself.
Modernisation now needs to take hold in all parts of the NHS. The NHS Plan sets out the essential reforms necessary to transform the way the health service works.
For the first time there will be a system of inspection and accountability for all parts of the NHS. The principle will be national standards combined with far greater local autonomy backed by new money to reward good performance.
For the first time there will be a new consultants contract that gives most money to the doctors working hardest for the NHS. And with medical school places poised to grow by 40% over these few years we all need to recognise the special contribution that research and teaching are making to NHS modernisation.
For the first time nurses and other health professionals will be given the bigger roles their qualifications and expertise deserve. Health and social services will be brought together in one organisation. The NHS and the private sector will work more closely together too for the benefit of NHS patients.
This programme of reform will take time to implement but it can deliver the goods for patients. To make the NHS faster and more convenient for patients. To get waiting times down for treatment. To bring about dramatic improvements in cancer, heart, elderly and mental health services. In short - to get more of the best sort of treatments to more patients more quickly and more fairly.
NICE is at the heart of this modernisation agenda. It holds the key to delivering major improvements in services and treatments to the maximum number of patients. In an era of quite unprecedented expansion in the health service, NICE can now focus these extra resources available to the NHS in a full frontal assault on the lottery of care. That does not mean that tough choices can be avoided about how priorities are set in the NHS.
Last year I think I became the first serving health secretary to use the "R" word. I talked about rationing at this conference. The truth is that there isn't a health care system in the world public or private that doesn't have to make those choices. That is true. The crucial issue is about how, not whether, those choices are made. Our choice is for a healthcare system based on need not ability to pay, where resources are focused on those interventions that provide greatest health benefit. These are not purely technical judgements. That is why the NHS Plan signalled that we will be creating a new NICE Citizens Council to advise on the value judgements underpinning these complex decisions.
So of course there will always be limits. But in the future I see no reason why new drug treatments, for example, should not comprise a much higher share of the rising NHS budget. Indeed in the next few years I want to see major advances in the number of NHS patients who are receiving the best, most up-to-date, state-of-the-art, clinically cost effective drugs and treatments.
Before long then, NICE will produce guidance on anti-dementia drugs and those for motor neurone disease. Its work programme for next year includes appraising a range of treatments for their use in all parts of the health service - 13 anti-cancer chemotherapy drugs, alongside new smoking cessation, schizophrenia and arthritis treatments. The guidance will help frontline doctors and nurses in the difficult job of deciding which treatments work best for which patients.
At the same time NICE will also produce clear clinical guidelines to help spearhead the fight against heart disease, asthma and eating disorders as well as new guidance on the use of caesarean sections and healthcare associated infection in both primary and secondary care. The guidelines will reduce variations in standards by helping frontline clinicians and others judge the most appropriate practice for their patients.
There is one further area for NICE to examine. One in seven couples in our country are affected by infertility. Almost 45,000 of them seek treatment every year. The current state of NHS infertility services is a very real cause for concern.
I am publishing on our website today the department's baseline survey of local NHS infertility services. The survey sets out the state of infertility services which we inherited. It shows huge and unacceptable variations in access, funding and provision of infertility services between different parts of the country. Different treatments also have very different success rates.
The lottery of care in infertility services is glaring, obvious and it is unfair. It is causing undue hardship and distress to very many couples. It is high time it was brought to an end.
The Royal College of Obstetricians and Gynaecologists produced three sets of guidelines for the management of infertility treatment. I am now asking NICE to consider and update these guidelines so that the latest knowledge and the best practice is available in all parts of the NHS.
In this way, the National Institute for Clinical Excellence will assist the Government in our determination to ensure that, in the future, couples get fairer, faster access to clinically cost effective and appropriate infertility treatments.
We can do this precisely because of the scale of resources now available to the health service. We can also do it because in NICE there is a means of bringing order to what has until now too often been a chaotic and unfair way for patients to access treatment and care.
I can also announce today that we will introduce explicit monitoring so that we know that every health authority and NHS trust is taking full and proper account of each NICE appraisal. Monitoring will take place shortly after the publication of each NICE appraisal and then six months later to track progress on implementation. The Commission for Health Improvement will then incorporate successive NICE appraisals into its routine clinical governance monitoring.
A growing NHS is now able to prove its sustainability by showing that its founding values of care being available according to clinical need can withstand the tests which advances in science and technology bring.
The pace of change is becoming ever faster. You can see that in the major changes in surgical technology and drug treatments the NHS has absorbed in the last few years alone. We know that many public and private enterprises are developing new tests for susceptibility to common diseases such as cancer, dementia and heart conditions. The human genome project will have a huge impact on the way illness is understood and health care is provided.
The NHS is uniquely placed to take advantage of these developments. It does not discriminate on the basis of risk. The large and diverse population it serves could provide the numbers needed to help unravel the complex interactions between genes and environment in the causation of disease. We know we will have to invest in better IT systems and electronic patient records in due course to realise the full potential of the new genetics but in the long run there are likely to be cost savings for the NHS through better prevention.
The key point is that an NHS providing care for free and according to need can ensure that the whole population benefits in the fairest of ways from these major advances. The advent of genetic technology - while it will undermine private health insurance by destroying the voluntary risk pool on which it depends - actually makes the case for our country's National Health Service.
More relevant than it has ever been, the NHS is a British institution of which the country can be rightly proud. But it is a British institution which the country must now reform.
I agree with the American philosopher Richard Rorty when he says:
a nation cannot reform itself unless it takes pride in itself unless it has an identity, rejoices in it, reflects upon it and tries to live up to it.
Pride - not in the sense of bellicose nationalism, but as a desire to live up to the country's ideals.
Patriotism not as narrow chauvinism or sectional interest but as a celebration of what is good in Britain today as a foundation for what can be better about Britain tomorrow.
The NHS is part and parcel of the British way of life. One recent opinion survey shows that an overwhelming majority - 80% - of our fellow citizens believe that The NHS is critical to British society and we must do everything to maintain it. That support is true for professional and working families alike, for people young and old, for men as well as for women.
Another survey shows that in answer to the question about which national institution showed Britain in a favourable light 91% answered the NHS. By way of comparison: the House of Commons scored 70%. And the BBC just 68%. No-one mentioned the Daily Mail.
The NHS helps shape and cement our national identity. The post war history of the health service and of our country are intimately connected. The NHS creation was a defining moment in the evolution of Britain as a fairer, more socially just society.
Today its values still hold good. It is a unifying force in our society - used by young and old, rich and poor alike. It embodies the values we hold most dear fairness, compassion, community, opportunity for all. These are the values of our country. They are the values of our health service.
The NHS embodies the very best of what it is to be British. No wonder for all of its very real faults and I am the first to acknowledge them it is still held in such high regard by the British people.
And you only have to look across the Atlantic to see that not every healthcare system so closely embodies the values of the society that it serves. In the USA, the HMOs rank alongside lawyers as the most reviled institutions in the land. There, a profit-driven health system has helped destroy the bond of trust between patients and health providers.
It is not healthcare per se then, but how far healthcare reflects the wider values society holds dear which engenders public trust. And in the case of the NHS it is the symmetry between our country's values and our health service values which helps explain the enormous commitment of its one million staff.
The NHS is a quintessentially British organisation based on quintessentially British values. Those who attack the principles of the NHS attack the gut instincts of the British people. One of the great ironies of the current political debate is watching some politicians attack all things European, while at the same time covertly arguing for the backdoor importation of European-style insurance systems and the abandonment of the British model of healthcare.
The importation of either a US-style private insurance system or a European-style social insurance system would be out of tune with Britain's values and not in Britain's interests. The one would entail endless bureaucracy and massive injustice. The other would load taxes on jobs and competitiveness.
The Bismarckian system of health care may be right for Germany. The NHS is right for Britain.
I am a pro-European who believes Britain should be at the heart of Europe. But on health we should all be Euro-sceptics. Standing up for Britain means standing up for the best of British values and institutions. Standing up for Britain means standing up for the NHS.
But the pride and passion we feel for the NHS must not lead us to be complacent about it. Quite the reverse.
It is precisely because it is so central to our sense of national identity that the NHS has to be saved and preserved. Ironically the best way of doing that is not to leave the NHS as it is but to reform it so it is better able to meet the challenges of the modern age.
In many ways the NHS is not just an emblem for all that is right about Britain it is also an emblem for some of the things that are wrong.
A country renowned world wide for our invention and innovation only then to be stifled by decades of under investment.
A country where the public service ethos is strong but where public services were weakened by the absence of reform.
A country which has led reform around the world but which sometimes finds change difficult to achieve at home.
Just as our country must face the fundamental challenges about how we modernise our constitution and our infrastructure, so we must meet the challenge of reforming the NHS. Reforming it on the firm foundations of its principles and its values. But reforming it nonetheless to meet the challenges of this new consumer age.
Britain and its health service are both now in transition. For both, change is as necessary as sometimes it is difficult. But in both there is real and substantial progress.
NICE is an example of the progress that is being made:
A new institution to make the most of new investment.
A new way of working to end the postcode lottery of care.
New technologies and treatments made available in ways which are most effective.
There were those who questioned our decision to create NICE. I understand that. I hope those people can now see NICE for what it really is: part and parcel of the fundamental reforms our health service needs; proof positive that those reforms offer opportunities rather than threats; that change brings benefits not just costs.
The reforms we are making are for the long term, the long haul, rather than the quick-fix. They will deliver but change does take time.
There is a long, long way to go but, as NICE demonstrates for us today: ours is a service in transition; progress is being made; reform will pay off for patients.
