The last few years have brought change and challenge for the NHS.
New structures, tight resources and much-needed scrutiny of recent care scandals have meant that, like many other British institutions, the NHS has been held to account by the public as never before.
But today, as we mark its 65th anniversary, I want to look above the parapet of daily controversy. I want to consider the future of an institution that has perhaps done more to improve people’s lives than any other in our history.
And I want to argue that those people who say the NHS is unable to cope with the challenge of an ageing society, who say the NHS may even have had its day – those people are profoundly wrong. Indeed when you analyse the new challenges we face, the NHS could even steal a march on other healthcare systems and turn heads - just as it did in 1948 - by the scale of its vision and ambition.
Back then we were proud and brave to pioneer the concept of universal coverage.
The noble idea that in a civilised country no matter your class, race, age or financial circumstances you could get the best healthcare. An idea that was followed all over the world, including now the United States.
But it wasn’t enough just to build the world’s fairest health service. We also pioneered the first national vaccination programmes in the 1950s, the first organ transplants in the 1960s, the first IVF baby in the 1970s, the first cancer screening programme in the 1990s. And only last month, another world first using a surgical robot to treat fibroids.
Today, on its 65th birthday, we salute the consultants, doctors, GPs, nurses, healthcare assistants, porters, cleaners, receptionists, managers…1.3 million people who with their commitment and values make our NHS what it is.
No other country in the world would make their health system the centrepiece of its Olympic ceremony - but we did it for a reason: it truly is one of our greatest and proudest achievements.
As we celebrate, we also reflect. The world today is very different to 1948. Not just in Britain, but everywhere, healthcare systems face two enormous and related challenges: financial sustainability and the ageing population.
By 2016, 3 million people will soon have not one, not two, but three long-term conditions. By 2020 more than a million people will have dementia. By 2030 the number of over 80s will have doubled.
The old model was curable illnesses where you went into hospital unwell and came out better. But the bulk of the NHS’s work is no longer removing tonsils or appendixes, changing hips or knees. Most people now leave hospital with long-term conditions which need to be supported and managed at home.
One quarter of the population now has a chronic condition - including 2.3 million with heart disease, 2.8 million with diabetes and 3 million people with chronic obstructive pulmonary disease.
They all need radically different models of care to what the NHS has been used to.
And this has a massive impact on cost.
Yet because of the economic downturn no political party is able to commit to funding these additional costs with additional resources, creating extraordinary pressure on frontline staff.
We must recognise that our doctors and nurses have never worked harder – indeed in just the last three years they are delivering an additional 400,000 operations and helping an additional one million people in A&E every single year.
And part of their challenge is not just the ageing population, but also vastly higher expectations of a public who expect 24/7 access to highly personalised healthcare.
If we simply respond to those challenges with more of the same – more ministerial targets, greater pressure for volume, cranking up the sausage machine to go faster and faster – we will fail.
Because over-zealous focus on ministerial targets, corporate objectives and volume measurements was what led directly to the tragedy of Mid-Staffs.
The litmus test for the NHS in the next 65 years will be not just how many people it treats, but how well it treats people. Whether it meets fresh challenges with humanity and decency. Whether it truly makes quality of care as important as quality of treatment; whether it treats every patient as the only patient; and whether - whatever the pressures - older people are always treated with the dignity and respect we would want for our own parents and grandparents.
Nowhere in the world has resolved this. But we can deliver it with our NHS. And today I want to outline the 3 pillars that will get us there.
Out of hospital care
First, we need to radically improve out of hospital care. Too many people end up in hospital not by design, but simply because they don’t get the care they need elsewhere.
What is the most common phrase you’ll hear on any hospital ward? When can I go home?
And for many patients, home is where they need to be – but with the support that will keep them in better health and out of hospital. Without that support, their health worsens and the cost of their care increases.
Anyone who has to care for an older relative will be familiar with the circular conversations with the hospital, the nursing home, the GP practice, the council. Each means well, but too often they only take responsibility for their own fraction of the problem.
Where lots of different people are involved in a person’s care, everyone is responsible. But it can mean no one is responsible.
Integrated, coordinated out of hospital care is something where the NHS, with our tradition of family doctors and primary care, could lead the world.
But to do that we need a doctor responsible for vulnerable older people outside hospital just as there is a doctor responsible for them inside hospital.
As a member of the public I would like that to be my GP - but whoever it is they should be named so that patients, families and carers all know where the buck stops. So today I can announce that in the consultation on the changes to the NHS Mandate for 2014, published today, we are asking NHS England to ensure there is a named clinician responsible for every vulnerable older person whether or not they are in hospital.
This will form a central part of the Vulnerable Older People Plan being published later this year. It will be a key part of the integrated care plans that local authorities and CCGs are putting together to access the £3 billion health and social care fund announced by the Chancellor in the spending review last week.
And it will be a key plank to ensure sustainability of the NHS going forward, by ensuring that where appropriate people are supported at home rather than in hospital.
Of course our immediate focus, rightly, is on our most vulnerable. But this should be only the starting point of a much broader transformation in out of hospital care – one which will help every single NHS patient.
For those with long-term conditions who are independent, the ability to manage your condition yourself – self-care – is vital to enhancing quality of life. Those people need access to clinicians quickly when they need it – but also much more support in resolving their own problems, something where telehealth and telemedicine has a major role to play.
But even for those without long-term conditions, the normally healthy and well, we need to see a transformation in the provision of primary care.
With almost half the population set to be obese by 2030, we need much greater support and encouragement to get people to actively manage their cholesterol, calorie intake and exercise.
And much more knowledge – by the public as well as professionals – to ensure early diagnosis when problems occur.
Most of all, we need the right financial incentives to change it from a National Sickness Service to a National Health Service, where everyone in the system is rewarded for keeping us well and not simply treating us when we are not. A new role, a new vision and a new ambition for primary care – essential for patients, and vital for the sustainability of the NHS.
If a radical transformation of primary care is the first pillar, the second is for the NHS to embrace the technology revolution. We live in a world where four out of five people do their banking online. Three out of every four airline tickets were bought online last year.
And there are now more mobile phones than people in Great Britain. Yet this revolution has barely touched the NHS. A & E departments cannot access GP notes, so give medicine without knowing people’s medication history.
Ambulances pick up the frail elderly without knowing whether or not they are diabetic or have dementia. Some hospitals have 16 different IT systems – so if someone in A & E needs a blood test, all their information has to be re-entered on a completely different system.
Last year 41 people had the wrong prosthetic put in their body. Seventy people had the wrong part of their body operated on. 161 people had items like swabs or tools left inside them after an operation. Yet we know with proper information to hand, many of these tragedies can be avoided.
So we cannot go fast enough in bringing the NHS into the digital age. Which is why I have said I want the NHS to go paperless by 2018 at the latest, with online prescriptions and GP appointments by 2015.
The challenge is big – but so is the opportunity. Deliver this and we will be the first country in the world to have electronic health records for an entire population. Integrated care will become a reality as doctors are able – with permission – to access someone’s medical history from any part of the system.
A truly extraordinary transformation in patient safety and patient care. But also a massive improvement in productivity. Budget airlines only exist because of the savings made possible with technology. Skype has slashed the cost of international phone calls. Ebay and Amazon mean shops no longer need bricks and mortar to start trading.
Every pound spent in the NHS is precious – and technology will help each one go further, allowing more people to benefit from more treatment. The choice is not whether to invest in computers or frontline staff. It is whether we harness the technology revolution to allow us to invest in more frontline staff, better equipped, more knowledgeable and with more time for patients.
So the first pillar is a transformation in out of hospital care; the second is technology; and the third and final pillar is to harness our extraordinary traditions in science. The UK has a long track record as a world leader in medical science.
We didn’t stop when Watson and Crick unlocked the secrets of DNA in 1953. Since then our scientists and doctors have worked together to pioneer the world’s first hip replacement and the world’s first combined heart, lung and liver transplant.
They established the link between smoking and lung disease as well as many other world firsts. And it goes on: last week, we announced we will be the first country in the world to make new IVF techniques available to women who risk passing on mitochondrial diseases to their children, something I hope will happen right here at Evelina.
In December, the prime minister announced that he wants Britain to be the first country in the world to sequence the personal DNA code – or genome - of up to 100,000 patients within five years.
If we really want this to be the century of personalised care, then we must radically improve our understanding of disease and how to design treatments better tailored to individual patients.
Combine the information from those genomes with the information in digital medical records – all done with proper consent – and you have a remarkable treasure trove about the make up of diseases, with huge clues as to how to treat patients better.
Genome sequencing is already helping to identify the best treatments for some cancer patients. But it can also transform life chances for others, such as the one in 17 children born with an inherited condition, who could be diagnosed in weeks not months.
By 2015, the aim is to put the UK at the forefront of the genome revolution worldwide, with whole genome sequencing linked to patient diagnosis, treatment and care.
So on the 65th anniversary of the NHS I am pleased to launch a new organisation, Genomics England. Led by Sir John Chisholm, it will provide the investment and leadership necessary to sequence genomes at scale and pace, driving down costs as it drives up the investment in a totally new sphere of science.
The result will be pioneering scientific research hand in hand with commercial investment. The birth of a world-beating life sciences industry right here in the UK. Creating jobs and prosperity, yes. But also unlocking the key to more sustainable healthcare.
And helping us, through the universal availability of new treatments, to ensure the NHS stays true in this century to the values that underpinned its founding in the last one.
The story of the NHS is the story of British talent, British ambition and most of all British values.
It is Europe’s biggest employer. The fifth largest in the world. No organisation anywhere has more staff dedicated to the noblest ambition anyone can have: to be there for us at our most vulnerable, when we or our loved ones are struck down with disease.
But if the NHS is a story about our values, it is also a story about our ambition. The ambition of men and women from every corner of the UK, who, even when faced with the impossible, in medical science, in post-war austerity, with the pressures of an ageing population, have risen to those challenges and exceeded expectations of what is possible.
Today we recognise their achievement. But we humbly tell the watching world, you ain’t seen nothing yet.