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Andrew Lansley: An open NHS will be a safer, stronger, better NHS

Andrew Lansley MP is Secretary of State for Health.


At the turn of the last century, the US supreme court judge Louis Brandeis argued that ‘sunlight is the best disinfectant’ for any organisation acting in the public interest. A century on, his words continue to resonate with all public services – and particularly so the National Health Service.

The NHS isn’t always the easiest organisation to get answers from. A simple complaint can turn into a long struggle with an arcane bureaucracy. Sensitive decisions about moving or closing units or departments too often take place behind closed doors. The performance of individual doctors is hidden by a lack of published data.

And yet we know that a more open NHS can be a safer, stronger, better NHS. For example, if you have heart surgery in England, you now have a greater chance of survival than almost any other European country – over the last five years, death rates have halved and are now 25 per cent lower than the European average.

How did this happen? Cardiac professionals were open and transparent. They collected analysed and published their outcome data. They admitted weaknesses, shed light on good and bad practice across the NHS and encouraged all cardiac units to improve.

Today’s Health Bill will make this sort of transparency common practice by overhauling the messy and inadequate system of accountability.

First, we’ll reduce political interference, by removing ministers’ discretion to intervene in day-to-day decisions in the NHS.

In effect, I will be the first Health Secretary to gain power only to give it away – to a new independent NHS Commissioning Board, which will oversee the running of the NHS.

Responsibility for shaping local NHS services will move closer to patients and professionals. GP-led consortia will make decisions about patient care and specialist clinicians will take the lead in shaping how hospitals function.

Accountability and control will move out of the obscure network of Primary Care Trusts and Strategic Health Authorities, and into the hands of recognisable, visible members of the community: that is, local GPs, working with local nurses and hospital consultants.

The whole of the NHS will become more responsive to patients’ needs, with increased choice over where you’re treated and by whom, meaning people can vote with their feet if they can receive better care elsewhere.

For those with deeper concerns, new HealthWatch organisations will act as a patient champion locally – ensuring the patient’s voice is no longer lost in the system.

Second, we’ll enhance the role of local authorities in NHS governance.

One of the big accusations made against me is that by handing control to GP consortia means I’m reducing public accountability. In reality, we’re introducing more democratic control over the NHS than ever before.

Councils will get more responsibility for shaping local health services and ensuring other services such as social care work more closely with the NHS – and, for the first time, they will have powers to scrutinise any NHS funded services.

Government ministers, meanwhile, will take responsibility for the things they can and should be responsible for – setting the strategy, establishing the priorities and accounting to Parliament for progress made.

So rather than meddling in NHS business for political gain, the Government will instead publish a mandate for an independent NHS Commissioning Board. And this means a new kind of accountability for me, as Secretary of State.

I will now be required to develop and revise this mandate with input from the general public every year.  This will set out clearly and transparently what is expected of the NHS. Each year, I’ll then report publicly on the performance of the health service in delivering this mandate.

And finally, we will strengthen accountability for outcomes and quality within the NHS. Out will go the old system of politically inspired targets and central diktats. In will come a new focus on outcomes and standards.

A new Outcomes Framework for the NHS, supported by the work that NICE is doing on Quality Standards, will ensure all health services are held to account for what ultimately matters to people – such as how quickly and effectively you recover from surgery.

We will also clear up the confusion about who is accountable for quality standards.  In future, the Care Quality Commission will have sole responsibility for this across all providers.

In short, today’s Bill is a manifesto for opening the NHS up for the public and the profession. By casting sunlight onto one of this country’s greatest institutions, we can improve health services for all.


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