Rt Hon Alan Johnson MP plenary

Rt hon Alan Johnson MP.

Thank you very much Ed. I could refute that story in the Guardian but I won't take that time in this speech. It is a joy, in this quiet time in political life, to see Ed Stourton so late in the day. I don't think I have ever seen him in the afternoon. But I really wanted to come to this conference because I think it is tremendously important. I know you have had David Nicholson, Clare Chapman and me delivering speeches over the last few days and it is obvious that you needed to have John McCarthy with his stories of surviving physical and mental torture with this list of speakers. But with more changes in the health service being led locally by staff these gatherings have assumed an increased importance and this conference couldn't have come at a better time. Last week Lord Darzi published his interim report setting out our shared vision for a clinically-led, locally driven NHS. This week the chancellor published the comprehensive spending review providing the funds to begin to implement that vision.

The NHS is cherished like no other institution in this country. Conceived during a time of conflict it is a testament to what can be achieved through social solidarity. And now, as we transform the service to provide for demographic change we need that sense of solidarity more than ever. Extra staff and investment has led to improved patient outcomes as Wanless recommended in his recent report. Mortality rates are down 17% in the latest figures and cardiovascular are down 35%. More than a million extra operations take place every year, waiting listing are down while satisfaction levels are up. The media gave a lot of coverage last week to a highly questionable report by something called the Power House which ranked the NHS 17th in Europe. Let me give you a quote: "results of this analysis contain information quality problems, and should be treated with great care" that wasn't me saying that. It was the authors of this report. Nevertheless it got huge coverage, more than the press used by the commonwealth fund an American organisation that is hugely respected for it's analysis which ranked the NHS first in comparison with five other developed countries, the US, Canada, New Zealand and Australia.

First on quality and equity and first on value for money. Although health outcomes are improving, as you know better than I, morale across the service has declined. Staff feel that they don't get the praise they deserve for the jobs that they do. They feel change has been done to them rather than with them and they think much of that change has been ideologically driven.

The level of dissatisfaction is, as again you know better than I do, a huge problem. With 1.3 million staff the NHS is the biggest employer in the world, surpassed only by the Chinese red army and the Indian railways. It is imperative that any organisation of this size possesses clarity of its purpose, of its development and staff feel they are genuine partners based on mutual trust. Through the social partnership forum, government, employers, unions are developing, such a partnership as well as a commitment that neither side should spring surprises on the other.

Government is seeking to move away from the old top down monolithic model of management of the past and putting power in the hands of patients and practitioners. Trade unions are readily acknowledging that the status now is not an option with the health service external pressures. And employers are putting an enhanced premium on HR policy and staff engagement.

In the past, the reward for devoted dedicated public service was too often shabby conditions, poor pay and no training. A research project in the 1950s revealed how a male nurse had to request permission from a matron to get married. Now this was a very progressive hospital obviously to employ mail nurses in the 50s, but the nurse recalls that the matron, and I quote, "showed little interest in me but was very concerned about my wife to be. Had I enough money to keep her, was there somewhere for her to live, were we thinking of starting a family?"

Now I come from a trade union background myself and you might be interested to know that we did an analysis of the reasons why people were dismissed in the Post Office between 1926 and 1936. Now this just reminded me, we found someone dismissed - I kid you not - someone dismissed for unclean habits. Someone dismissed for a scandal caused by the behaviour of their wife. But my favourite, my absolute favourite - the Post Office was the civil service at the time - someone was sacked for marrying a drunk without official permission. The rule was clearly that if you get official permission that is fine.

Now, happily today there is a much more enlightened approach to management with a less intrusive and more practical kind of managerial support.

Pay is up in real terms, the normal pension age has been retained at 60 for existing staff following the recommendation of the NHS Pension Scheme review, chaired by one AA Johnson. Employers are increasingly involving staff in decisions concerning the future. Such involvement by employees in matters which effect them is not just good communications policy, important though that is, it makes excellent business sense as well. A better informed staff will be more motivated. Greater motivation means better performance, better performance means improved patient outcomes and broader skills means greater flexibility. All crucial components in our vision for the National Health Service.

Now we must give you the power to deliver improvement, managed locally with strong support from government. We have tripled investment over the last ten years and this investment has been matched by new ways of working, from practice-based commissioning to NHS Direct and Foundation hospitals.

The comprehensive spending review locked in all of these increases and added real terms growth of 4% a year. With new technology, rising aspirations and shifting demographics this is crucial but it has to be combined with improvement in productivity to ensure better value for money for the taxpayer. The CSR includes a tough 3% a year efficiency for all government departments, including health. This will release 8 billion pounds a year for use on better patient care by 2011 it is very important to get this message across. The efficiency savings don't go to savings or Treasury, they stay within the Department of Health. Improving community-based services so that people with long term conditions can receive greater support locally, could bring savings of around 5 hundred million pounds a year. Intervene with preventative action when someone is at risk of illness rather than too late, (inaudible) heart disease or lung cancer. Spreading new technologies and best practice more widely across the health service could lead to savings of 1.5 billion pounds a year, including procurement it could save billions of pounds a year and introducing MRSA, all admissions which are funded for in the CSR, we can reduce the risk of being hit with huge costs later on.

We will not realise our vision of a more efficient health service unless we release the full potential of those who work within it and this puts you centre stage. HR isn't an optional extra for the organisation. It is not something to get around to when there is time. It is an absolute necessity which should be at the heart of the organisation strategy, delivering growth innovation and lasting success.

It is about creating the right working environment, and encouraging more employees to climb the career ladder so that they reach their potential, ensuring employees are working smarter not harder, getting the right people with the right skills in the right place.

I believe there are two major challenges. First ensuring that the NHS recruits and retains the best staff. Since 1997, 80,000 more nurses, 36,000 more doctors, have been recruited into the health service. All strategic health authorities have set up talent pools for newly qualified graduates and we have documented the numbers for medical students. Now the challenge is to make sure that these high qualify recruits are motivated not just to enter the NHS but to stay. Staff want to feel respected, equipped with the time, training and resources that they need to do their job properly. They need supportive managers and opportunities for progression. They want to feel good about working for the NHS.

But staff surveys reveal that job satisfaction and morale is declining across the NHS.

It is a real concern and it is leading to higher attrition rates for instance in radiography. We are working to address these problems through the social partnership forum, which is a new and precious development, but one of the best ways to encourage people to stay in the service is by demonstrating that they can progress in the service. Skills for health and skills for care are looking across the health and social care sectors to identify long term training needs. We are hoping to develop a new academy in social care under the expert hand of Chris Humphries, the Director General of City and Guilds.

The knowledge and skills framework plays a key role in skills development but it is not being rolled out across the service as widely as it should be. It is an integral part of Agenda for Change and the new pay system and it must be fully implemented by all NHS organisations.

Through the social partnership, we are looking at how we can improve its take up. When budgets are under pressure, training is still depressingly too often the first thing to be sacrificed. This might provide short term relief but the long term consequences can be disastrous. Instead of cutting training we should improve the way we focus training so it works for the organisation by improving the flexibility of the work fours.

Secondly, we must promote a culture of innovation across the NHS. The health service has always been a fundamentally radical organisation in conception and development and has traditionally been quick to embrace new medicines. Since 1948, the introduction of ? and measles vaccine, ultrasound, MRI and cat scan, heart surgery and artificial hip or knees it is a myth that the NHS is slow to embrace change. However where the NHS has not always been very nifty has been in the adoption of changes in working practice. This has entered our remit to raise productivity and improve patient outcomes to help embed a culture of innovation across the NHS. We will create a new health innovation council backed by 100 million pounds jointly funded with the Wellcome Trust to identify barriers to change ensuring a rapid flow of ideas across the health service in practices, products and processes from conception through development to adoption.

Innovation must be the lifeblood of the NHS that we are creating for the future. The Darzi Next Stage Review aims to take the NHS from good to great. World class in all aspects instead of just some. You can mandate good, but greatness can only be unleashed it will improve impossibly for the nation to attain as perforations for the health service unless local managers are able to unleash the potential of NHS staff.

This places pressure on all of you. I recognise that. But I do know that it is a challenge that you relish and that you will meet and be working together we can actually work in the interest of a high quality accessible integrated health care service, focused on prevention cherished by the public, in which staff feel developed and empowered. Thank you for everything you are doing towards achieving that goal.

EDWARD STOURTON: Thank you very much indeed for that. I am going to hold you for a couple of questions first if that is alright.

Rt Hon ALAN JOHNSON: As long as they are health.

EDWARD STOURTON: I don't want to get bogged down in this morning's headlines and I know you had an interview with Mr. Humphries before you came but there was a lot of concern expressed about what happened in Maidstone here during the panel session and I suspect people would like to hear from you what lessons you draw from that incident.

Rt Hon ALAN JOHNSON: We draw the lesson that the Healthcare Commission report draws our attention to. There are around four or five specific recommendations from government. One of which is that C-difficile should be recognised as an illness in itself. Another is that doctors should be better trained in terms of death certificates to recognise the reasons behind that and there is another whole series of issues in those five recommendations for us that relate to current guidance that is out there that we might need to bolster that and clarify that.

I mean the exchange with your colleague this morning, the splendid Mr. Humphries and the media today is to make sure people understand in an organisation of the size of the NHS, there is always the likelihood of incidents like this occurring somewhere.

But for anybody to assume that Maidstone and Tunbridge is the norm throughout the NHS is wrong. People will have arguments and we might hear about targets and about meeting central government direction and there is a perfectly good debate to have on that but if you read the report, and I have asked David Nicholson to circulate that report to every single trust to every chief executive, to every medical officer, to every nursing officer in the country so you can see for yourself the catalogue of failures that happened in that trust. It is inexcusable in terms of the leadership of that trust to allow that to happen, from basic things like not washing hands and allowing zimmer frames to be passed between infected and non-infected patients. Practically all of the guidance points to a catalogue of errors that happened in that trust. It is not indicative what is happening across the NHS as a whole.

EDWARD STOURTON: But in terms of people here everybody in this room would say we can't imagine being caught up in something like that. We would hate it to happen in our hospital. What should they watch for what can they do to make sure something like that never happens?

Rt Hon ALAN JOHNSON: Read the report and follow what the Health Commission details as to where this started and all the different failings. And it has to come down, management do a great job in the NHS and they don't get the credit that they deserve but here were real failures from consultants, from nursing staff as well, right the way through. And you know there will be a few people trying to say oh this is because there was a lot of pressure on that trust. At that time. here is a lot of pressure throughout the system there is always pressure in the NHS. None of that excuses the kind of things that happened there. The kind of conditions that patients were placed in, put into dirty beds. For anyone out here who is working day in and day out to avoid hospital-acquired infections gaining hold they will see if they read that report the kind of things not to do. And I think that is going to be a good contribution if you like, that you just look at what happened at Maidstone and Tunbridge Wells, you shake your head, you wonder how that was allowed to happen for so long and you make absolutely sure that won't happen in your trust or the hospitals you are responsible for.

EDWARD STOURTON: Low job satisfaction and low moral that has been a theme in the last three days and one thing that has been said is part of the responsibility for that lies with the rhetoric of politicians who talk endlessly about reform with the implication that the job is not being done properly by the people who are doing it at the moment and the message they take away from that being they are not properly valued. You got good press in some regard from some of the speakers, do you accept there is some merit to that case?

Rt Hon ALAN JOHNSON: I do accept some merit there. Not to criticise my predecessor.

EDWARD STOURTON: Of course not, perish the thought.

Rt Hon ALAN JOHNSON: No, really. It am fortunate to come into this position after you have all been through a horrific time. We had to balance the books in PCTs, we had to move from deficit to surplus otherwise there is no way we could convince the public the amount of money they are putting into the NHS is money well spent and the public have huge sympathy for greater investment in the NHS. That might be different if they thought financial practices weren't robust, so that process was very difficult and some of the stuff that helped to get waiting times down did involve introducing the independent sector in lots of places. So lots of reforms happening (independent sector) this gap between perception and reality and the way the staff who were basically behind the NHS plan - there is great support for the plan back in 2000 - suddenly through it all we lost that somewhere along the journey. Some was the famous Nigel Crisp letter, some was about - I think - a feeling suddenly this is ideologically driven. Speeches didn't talk about patient care and the importance of that as the crucial reason why we are involved in the health service. They spoke about, you know, markets and choice and contestability. These do not turn staff on to say this is why we come into work and are happy to be in the NHS. So there is a need to actually make sure that the language is connecting not just with the staff but also with the public who basically couldn't give a damn about practice-based commissioning and payment by results, but they care about whether we are improving patient care.

EDWARD STOURTON: Well in that regard what about productivity because you are entering a period where you are getting increases but not of the levels of funding that you had and to keep that support from the public you have to convince the public that the extra money that they are putting in is actually not going in to your salaries, but actually showing through patient care.

Rt Hon ALAN JOHNSON: Two things, first of all the Wanless report for the King's Fund a couple of weeks ago - of course in 2002 he was commissioned by government to say how much we need to spend. Five years on he was saying what had happened to that money. Now he said there is notable, was his words, improvements in healthcare outcomes, the government's direction is right. Wanless said lots of good stuff. What was picked out was this comment about productivity.

EDWARD STOURTON: Naturally, I mean...

Rt Hon ALAN JOHNSON: Yes I am not blaming you for that Ed. As always you can't go through and just pick out the negative bits without mentioning the positive bits as well. That is how you get a balanced view. What did Wandless say about that:: he accepted it is notoriously difficult in measuring productivity to actually account for quality. What we want is quality of care, people allowed and empowered to spend more time with their patients, GPs, now the contract in 2004 often gets criticized but it has led to GPs spending more time with their patients because there is a quality element, incentivising them, that did not exist before the contract.

Now the National Audit Office and others have found it difficult and have said they find it difficult to put an element of quality into productivity. You can read the figures that say we have an 8% increase in productivity, you can read them another way to show there is a 7% decrease this depends on how you measure quality. The other thing is Wanless was looking at the situation of necessity before we move from deficit to surplus where there has been a lot of productivity improvements engaged in that and also the other thing as I mentioned in my speech there is 3% efficiency target on us and all government that will lead to increases in productivity I but it has to be increases in productivity that actually take into account more time being spent with the patient so we improve patient care.

EDWARD STOURTON: That is hugely important for this audience because in the pub and families and so forth they will be under pressure that all our money is going into the service - it is going to you and the people we work for and we aren't seeing the benefit.

Rt Hon ALAN JOHNSON: I don't think it is.

EDWARD STOURTON: Maybe our perception is wrong but I suspect they have put that to them.

Rt Hon ALAN JOHNSON: I think the public think two things. We need more staff in the NHS and nobody does analysis of the situation before 97 and thinks that we had enough doctors and nurses, porters, we had to bring in more staff and I think the public support that. And I think the public support people in the NHS being well paid. They think that doctors and nurses should be better paid then they were. When you get some reports that suggest all the money has been gobbled up on paying and conditions, labour costs are 80 per cent of the cost of the NHS, actually that is not a bad equation as to where that money went. But you know, what the public want to know about is are their hospitals safe, are they going to get decent patient care and we have got to return the debate to those issues which are at the forefront of their minds.

EDWARD STOURTON: I have been hogging the questions, let me through it open to the hall and give you a chance to say some of the things that have been on your minds over the past few days.