Renewing NHS Cover_FINAL 16/12/05 11:13 am Page 1 renewing the NHS The Smith Institute The Smith Institute is an independent think tank that has been set up to look at issues which flow from the changing relationship between social values and economic imperatives. If you would like to know more about the Smith Institute please write to: renewing theNHS renewing A series of four seminars held between The Director The Smith Institute October 2002 and January 2003 3rd Floor 52 Grosvenor Gardens Edited by Tony Pilch London SW1W 0AW Telephone +44 (0)20 7823 4240 Fax +44 (0)20 7823 4823 Email [email protected] Website www.smith-institute.org.uk Designed and produced by Owen & Owen 2003 THE SMITH INSTITUTE renewing the NHS A series of four seminars held between October 2002 and January 2003 Edited by Tony Pilch Published by the Smith Institute ISBN 1 902488 60 1 © The Smith Institute 2005 THE SMITH INSTITUTE Contents Preface By Wilf Stevenson, Director, Smith Institute 4 Seminar 1. Enduring values Introduction by Wilf Stevenson 6 Welcome by Carolyn Quinn, 7 Presenter, BBC Radio 4 Presentation by Derek Wanless, 8 Author, Securing our Future Health: Taking a Long-Term View Presentation by Julia Neuberger, 14 Chief Executive, the King’s Fund Presentation by Andy Burnham MP, 21 Member, House of Commons Health Select Committee Presentation by Dr Evan Harris MP, 23 Principal Liberal Democrat Health Spokesman Presentation by Michael McManus, 26 Former Special Adviser; Conservative candidate for Watford in 2001 Discussion 28 Seminar 2. Delivering a modern health service Introduction by Wilf Stevenson 48 Presentation by Hazel Blears MP, 49 Parliamentary Under-Secretary of State (Public Health), Department of Health Presentation by Bill Thomas, 55 Managing Director, EDS, UK and Ireland Discussion 66 2 THE SMITH INSTITUTE Seminar 3. Towards a new definition of public health Introduction by Wilf Stevenson 86 Presentation by Professor Siân Griffiths OBE, 87 President, Faculty of Public Health Medicine Presentation by Dame Deirdre Hine, 92 Chairman, Commission for Health Improvement Discussion 97 Seminar 4. Real choice Introduction by Wilf Stevenson 120 Welcome by Carolyn Quinn, 121 Presenter, BBC Radio 4 Presentation by Sir Graeme Catto, 122 President, General Medical Council Presentation by Harry Cayton, 127 Director, Patient Experience and Public Involvement, Department of Health Discussion 132 3 THE SMITH INSTITUTE Preface Wilf Stevenson Director, Smith Institute The Smith Institute has been set up to look at the issues that flow from the changing relationship between social values and economic imperatives. This booklet is based on a series of four seminars that took place between October 2002 and January 2003. We have tried to reflect the debates that followed. Inevitably, in transferring a live event into print, some of the colour and texture of the original debate may have been lost. We hope, however, that those who attended the seminars will recognise much of what is included here, and that those who read this booklet will respond to the flow of issues and ideas that emerged during each event. 4 THE SMITH INSTITUTE Seminar 1 Enduring values A seminar held on Thursday 31st October 2002 Edited by Tony Pilch 5 THE SMITH INSTITUTE Introduction Wilf Stevenson We got interested in health about two years ago and this is our second series of seminars. You may have seen that we have published a pamphlet already, which records a series of debates that we held about this time last year – a very lively series of discussions on the big issues that were coming to the fore at that time. We have been working closely and most enjoyably with our original partners in this scheme, the King’s Fund and the General Medical Council, and we are also now working with the Industry Forum. Their support has been crucial to two years of seminars, and financial support from Pfizer, EDS and MSD has been essential as we have done a series of fringe events during the recent party political conference season. Today our starting point is the recent Wanless Report and we are really, really delighted that the author is here with us. The proposition we want to test is that the enduring values of the NHS, or what are more accurately described in the NHS Plan as its basic principles, are now settled and really beyond recall within the parliamentary process for the foreseeable future. I am delighted that Carolyn Quinn has agreed to chair the seminar. 6 THE SMITH INSTITUTE Welcome Carolyn Quinn Presenter, BBC Radio 4 Thanks to the Smith Institute for inviting us all here. Yesterday in the House of Commons as everyone was leaving the chamber after Prime Minister’s Questions, the former Conservative cabinet minister Peter Lilley brought forward a back-bench bill calling for patients to be allowed to choose the hospital in which they receive treatment. This was quite timely considering our thesis today, as we are discussing the values of the NHS and pondering questions of choice and access. Should we assume that the NHS is an unassailable constant that simply needs improvement and modernisation from within? Or are wholesale reform, different methods of funding and choice the only sustainable ways forward for British healthcare? Our first speaker today is Derek Wanless, who was commissioned by the Chancellor to report on the long-term needs of the NHS. Let’s hand over to him now and hear his views on what it means to have a National Health Service and the common values and principles that underpin it. 7 THE SMITH INSTITUTE Derek Wanless Author, Securing our Future Health: Taking a Long-Term View Thank you very much indeed, Carolyn. Like Wilf, I am delighted to see so many people here today, because, although the purposes of the Wanless Report were many, there was one great objective, namely to help the UK eventually to have a better health service than it otherwise would have. But there was also the intermediate objective, which was to stimulate debate and try to build consensus, or at the very least make clear what the differences were. The question of values was important to us when we started off our work, and we had to address it. We had a very short time in which to do the report, so we took a very simple approach. We decided to draw together all the information we could find from around the UK and around the world to help us in the task the Chancellor had given us. We then fed our provisional conclusions into an interim report, in which we set out a vision based on that research. If people generally validated that vision, we felt, then we could safely use it for our final report, making it the basis on which the projected costs would arise. The starting point, in terms of values, was to take into account the great deal of work that had already been done in the National Health Service 2000 Plan, in which ten core principles had been set out. There had been much debate about them, indeed quite a bit of consensus-building around them. Many of them were old, but some were set out in a relatively new form, and let’s remind ourselves just to start this set of seminars what exactly they said: • That the NHS will provide a universal service for all based on clinical need, not ability to pay; • It will provide a comprehensive range of services; • It will shape its services around the needs and preferences of individual patients, their families and their carers; • It will respond to the different needs of different populations; 8 THE SMITH INSTITUTE • It will work continuously to improve the quality of services and to minimise errors; • It will support and value its staff; • It will use public funds solely on NHS patients; • It will work together with others to ensure a seamless service for patients; • It will help keep people healthy and work to reduce health inequalities; • It will respect the confidentiality of individual patients and provide open access to information about services, treatment and performance. In our review we assumed that these were the principles that would apply over the next 20 years. When we set out our vision for 2020, however, and when we looked at the different scenarios that we put together to try and help us to do a range of costings, we needed to delve rather more deeply than that. We recognised that there were gaps and, potentially, some inconsistencies in what was there. In the event, we got very little back about values or principles from our consultation after the interim report. We got much more on specific points that people wanted to raise about the detail of what we had set out. Of course the trouble with values and principles is that, if they are too general, or if nobody would ever dream of saying the reverse, then they don’t really help to build consensus. For example, if any organisation sets out an intention to “support and value its staff”, I know of no organisation that would be in open disagreement with that. What’s so important is not just what’s there, but also what’s not there. There is no mention, for example, of the buildings, the technologies or the other resources that are applied and the ways in which they are applied. So the problem with values like that is not that people don’t believe them or try to live them; it’s that they don’t go into enough depth, enough detail, to help people work out what they mean and how to implement them.