Sir Hugh Taylor: Right shall we make a start. Welcome everybody; David and I were just remarking that this is an ever-bigger turnout than the one we got for Tony Blair; so that’s impressive. Something must be going on.
Well the people have spoken, and after I think one of the most interesting weeks in our democratic history actually, all of us have been transfixed, haven’t we, by the twists and turns of the election itself and then the subsequent negotiations process. But we now have a government in place and a Secretary of State, which is great. And I think Andrew we were just hearing that the ministerial appointments probably are starting this afternoon. So we’ll, I think, know who the rest of the ministerial team will be fairly shortly.
But the main point of this afternoon is for me to introduce you to the new Secretary of State. What we’ll do is - Andrew will say a word or two in a moment and then we’ll open it up for some questions and answers. We’ve got some questions which were input in advance and we’ll pick up some of those, and we’ll - but there’ll also be an opportunity to ask questions from the floor.
So without further ado, what I’d like to do is on your behalf extend our congratulations again to our new Secretary of State Andrew Lansley, and ask him to say a few words to us, Andrew?
Andrew Lansley: Thank you very much, thank you Hugh, thanks David.
Hugh, thank you very much and thank you, David, too for the opportunity to be with you. I suppose I should say to David Cameron - thank you for the opportunity. But actually, I’m really grateful to have the chance to talk to you here, to you up there and indeed, through those cameras, to talk to staff in Quarry House and elsewhere.
And I do want, I hope, that although I may be introducing myself today, to some of you perhaps I’m not somebody who’s entirely new. We may have met in some cases; you no doubt over the years that I was Shadow Secretary of State for six and a half years, many of you have had to put up with many of the questions, FOI requests, debates and all the other things that are the meat and drink of opposition. Suffice it to say, I know that you are able to respond to all those requests extremely well.
Can I also just say from my point of view, what not all of you will know, some may, for me there is a certain poignancy in being made a minister in a government, having I think last - it was 23 years ago ceased to be a civil servant. I was a civil servant back then; I’m older than most of you. And because I was a civil servant back then, I know just want an important it is in the life of the Civil Service for there to be a change of government.
It always makes a difference where this is a change of minister; sometimes it almost seems like a change of government. But actually for a civil servant one of the central opportunities, I don’t think it’s a test, it’s an opportunity to demonstrate the professionalism of what you do, is to show that you can move from one administration to the other at the behest of the electorate, and deliver just as professional, just as efficient, just as successful a support to a new government as that which you provided in the past.
I know that because I’ve been there. Although I suppose technically speaking, I wrote once upon a time back in 1983 the briefing for an incoming Labour government. And if you remember your political history I didn’t really think it was going to happen. At least this time round we’ve asked you to do the briefing and the preparation for an incoming government, and it has happened. And so I don’t think it was at all any wasted effort.
It isn’t the government perhaps many of you quite expected; it is a new kind of government. I think from your point of view though, I think you should think, because this is how we are thinking, this is not a coalition government; this is a government; this is your government; this is the United Kingdom government.
We have brought together two political parties, with different manifestos in some respects, but in many other respects very similar ideas about how the government should run. And interestingly, where health was concerned, the Liberal Democrats and we in the Conservative Party often had very similar ideas about what we wanted to achieve. And in particular in the agreement that was published the day before yesterday it was set out that one of the central questions that needed to be resolved between the parties was - our manifesto said that there would be an increase in real terms for the National Health Service each year through the parliament. The Liberal Democrat manifesto did not say that, but we have agreed that that is indeed going to be the basis of an agreement for this government.
Now that is very important. I’m not going to go on at length about this because there will be many opportunities for it. But it is important I think for the National Health Service, and indeed us throughout the Department of Health, to recognise that is - in the context of the financial crisis that this country faces - a very substantial degree of protection. But it’s protection for a purpose. It is so that we can meet what we know are very substantial and increasing demands upon health and social care in this country, and do so with an expectation that we can maintain and improve the quality of what we do.
Now from my point of view, I want to set out just very briefly for you what I think are the key priorities for us as a department. Firstly, within the National Health Service it is for us to make real that this is a service which is centred upon, and responds to, the needs and the wishes of patients. It’s not something we’ve ignored in the past; it’s something we’ve often said in the past, but it is not yet something we have achieved.
I want us to feel that compared to healthcare systems all around the world we are one which has the best information for patients, the greatest opportunities for patients to use that information to make judgements about what treatment should be provided, by whom it should be provided and confidence that if anything they need to ask, or goes wrong, that they get the best possible response to that.
Secondly, I want us to be a service that is - and a government that is focused on the outcomes, on the results, not on the inputs and processes. I know processes are important, I know inputs are important. But what matters are the results. And right across the NHS and as you know and you do the same, I’ve talked to people in hospitals and surgeries and clinics right across the country and time and again they are say they are very frustrated by the way in which they are focused on the process rather than able simply to work to the result and the outcome. We’ve got to make the focus on the outcomes and the results.
And I think that is absolutely consistent with so much of the work, which I know you are doing, and you need to do, which is to deliver quality; to think about what does quality mean, what is the fitness for purpose of this? What is the basis on which we can say that we’ve looked at the evidence and we’ve looked at the result and this is the best way of achieving this? That has to be the basis on which we drive towards outcomes, linking quality to outcomes.
And even in things like the Qualities and Outcomes Framework for General Practitioners, too much of that is still focused on inputs and processes, and activity and ratios; not - what are we doing that is evidenced based for quality? And what are we achieving in terms of results for patients?
So at every level we must be thinking about how we deliver that quality, whether it’s from commissioning services and identifying what are the quality standards based on the evidence, through to using payment systems in the National Health Service to drive quality and quality improvement as the EQuIP Programme has started to do, right through to the inspection and regulatory regime - that that is focused on quality and results for patients, not just ticking the box on whether the processes have been met.
And then the third thing is - we must empower professionals throughout the Service. There is a tendency for us sometimes to think the Department of Health is the headquarters of the National Health Service, we’re not. We are here to support the National Health Service, the Public Heath Service and social care in this country. We are not here to run it; we are here to support it. And that the headquarters in my view, we have to constantly think - where is the headquarters of these services? It’s actually close to patients.
We are all of us patients here; where do we actually feel that we place our trust? In the doctors and nurses and the clinicians whom we register with at our local practice, whom we go and see, whom we might see if we’re admitted as an emergency. Those are the people in whom we place our trust. We give them literally the opportunity to make life and death decisions about us. Should we not also expect that they are making many of the decisions about the management of our day-to-day care and services as well?
So we must push decisions close to patients, involving patients in those decisions. And make every part of the healthcare service and social care service accountable for the results that are achieved. That is in the National Health Service my driving approach.
I know also if we are going to succeed in having the best healthcare and health outcomes anywhere in the world, we are also going to have to improve our public health services. There are so many challenges that we face on public health. I am determined that we will be seen as a Department of Public Health, I am determined that public health with be a Secretary of State responsibility in the Department. And that that is because increasingly, as we give the NHS greater autonomy day to day for the decisions that the NHS makes, we should be focused, as a government and beyond government with local government and the private sector, at energising a public health effort that improves all of those public health measures and reduces health inequalities; which is why our proposals for a health premium are specifically designed to incentivise for the reduction of those health inequalities across the country.
And also the fifth of our five priorities - my personal five priorities for the Department - is we must reform and put social care on a long term and sustainable basis. A lot of debate before the election about how that should be done. We have set out some clear proposals for that; about prevention, earlier intervention, about personalisation, about protection and the opportunity for people to take our voluntary insurance.
But there is more I know we need to do to deliver greater effectiveness in social care, plus also to give people the opportunity to contribute in partnership. Because the final of my Ps is partnership, between individuals making their own contributions and we as taxpayers and the state making a contribution.
All of that is in the context from my point of view that - as a government - we are committed to the principles that underlie the National Health Service and which extend into social care; that there is a social solidarity involved in us making collective provision so that the weakest and the most vulnerable in society know that when they have the greatest need we will be there to support them.
Now we have to therefore make sure that in times that are financially extremely difficult, we use all our resources to the best possible effect to make that happen. Nothing is wasted; everything is devoted towards the frontline benefit of care for patients and support for care users.
It doesn’t mean there isn’t a role for administration; there isn’t a role for management. But actually you know, and many of you are maybe people I’ve spoken to about this, good management is not a measure of how many managers, or how much is spent. Good management is a measure of what is achieved. And throughout the Department and beyond the Department into health and social care, we must be looking now to apply the same kind of disciplines that are being applied across the public services and in the private sector - which is to do more for less; to achieve reducing cost of what we do day by day and year by year, knowing that for us in the Department of Health there is a real opportunity there. Because every penny we save will be a penny available for reinvestment to meet demands and to improve the quality and the outcomes we achieve.
Now I’ve been Shadow Secretary of State for six and a half years; I don’t expect to be Secretary of State maybe for six and a half years. But this is a government that has committed itself to an agreement with - for a parliament that lasts five years. I would be delighted if at the end of five years we were able to gather back here today and I could say to you - in a sense it doesn’t really matter if I’m not Secretary of State any more because we’ve put in place long term, sustainable, stable reform for health and social care and for public health, which now doesn’t need politicians to be constantly trying to reinvent what should be the strategy. There have been too many changes of strategy, even within a single government.
In opposition my task was to try and establish a strategy in opposition that we can articulate rapidly in government, that we can implement in a consistent and a coherent way, that in the space of a parliament puts health and social care in this country onto a long term sustainable basis that is going to move us from where we are now to the point where we achieve health outcomes as good as anywhere in the world. That is my ambition.
I am looking forward tremendously to working with all of you to make that happen, and not only you here in Skipton House, but also at Quarry House in Leeds and elsewhere. And I do want to - literally I mean this, I want to get to know you in making this happen. Because in a way you are some of the people I’ve had the least access to over the last six and a half years. I visited 200 and something hospitals across the country, but I don’t get to visit you all the time.
I do remember, Hugh I won’t embarrass, it wasn’t you, you weren’t Permanent Secretary and it’s ministers who did this, but I remember years ago saying I wanted to visit Quarry House in Leeds. And the ministers said, no thank you, because why should the opposition be visiting Quarry House in Leeds.
Well I’m not in opposition anymore and so I am looking to visiting Quarry House in Leeds. In fact I’ll be with you in Leeds tomorrow. Because I know if I and my colleagues who will be appointed this afternoon as ministers of this department achieve anything, it will be because we are able to work with you and with a relationship with you to make these things happen. And I am very much looking forward to achieving that. Thank you all very much.
Sir Hugh Taylor: Andrew, thank you very much. Now this is beyond my pay grade really; I’m hopeless at all this. But I’m going to try and shuffle some questions together. And to give him warning I’m going to come to Adam Joyce first, who I hope is here somewhere. Oh you’re on the front row, Adam, brilliant. But just a little bit of warning. And then Gwen Nightingale, who I hope is here too in Skipton. And Carolyn Heaney; Carolyn are you up in Leeds?
Male: Yes she is.
Sir Hugh Taylor: Yes great. So we’ll go in that order. First couple of questions, Secretary of State, are about coalition. So, Adam, do you want to ask your question? Perhaps you could just say who you are and where you work.
Adam Joyce: Yes. Adam Joyce, I’m in the NHS Communications Team. I just wanted to ask given that we have a coalition government, and I understand your point that it is one government, but does this mean we are likely to see some Liberal Democrat policies reflected in the health mix? And also, how long do you think it will take until we have clarity about the key health policies?
Andrew Lansley: Thank you, Adam. The - I don’t know who the ministerial team will be yet. I await the final decisions. As you say Hugh they are above my pay grade. As one team, we will be working on the basis of what is effectively a coalition agreement. I suppose the best analogy is to say - what we are used to is the idea that a government is elected on a manifesto. Since there is not one manifesto for this government, we are effectively creating the equivalent, a programme for a parliament. It won’t answer all the questions, but I think it will give us a basis upon which we are going to, as a ministerial team, implement that programme.
The initial coalition agreement published yesterday only addressed issues specifically to us in this Department, on the basis of the overall financial envelope. And it did so, from my point of view, happily on the basis of what was in our manifesto.
There will be other issues, but actually unless I have - I don’t think I have missed, I have looked with great care at everything that was said by the Liberal Democrats during the election and in their manifesto, and I think there is an enormous degree of coherence between what they said and we said. I went through some of that. I hope that means therefore that we’re not looking to have a long process of trying to establish what the strategic purpose is.
The departmental priorities, I see absolutely no reason why they should not be what I’ve just described: a patient centred service focused on outcomes, where the service is accountable - empowered and accountable for the results that are achieved; with a strengthened public health service and a department and government focused on public health; and with a long-term sustainable reform of social care. I don’t think any of my Liberal Democrat colleagues would depart from that for one minute. There may be individual issues, but I don’t think they will impede us setting out the strategic direction in weeks rather than months.
Sir Hugh Taylor: Thanks, Andrew. Actually, Gwen, your question was related. Do you want to follow through on that?
Gwen Nightingale: Thanks, yes it was. You’ve set out quite considered, detailed plans in the Conservative manifesto and previous policy documents. And I was just wondering if you envisage that some of the detail of those might change in light of the coalition arrangements?
Andrew Lansley: Yes, thank you, Gwen. I don’t think that in the main we’re looking to see major differences arising from that. There were some things in the Liberal Democrat manifesto and policy documents that differ from what we said in detail. I mean for example where social care is concerned, if you think back to the Green Paper, there were three options essentially, the partnership option, voluntary insurance and a compulsory levy. The Liberal Democrat proposal essentially was that they favoured the partnership option, but they wanted there to be a commission to examine the long-term financing of social care.
From my point of view, I’ve always said we are not in favour of compulsory levy; we are in favour of a voluntary insurance option but also with a partnership component. I don’t think it is a stretch to say for us to start thinking now about how we can combine the concept of the partnership between the individual and the state, plus voluntary insurance mechanisms, could be the basis for thinking about what that long-term reform looks like. But I’m very happy with my colleagues to see how we go about that process. And there may be advantage, as the Liberal Democrats recommended, of seeking to derive some idea about what is sustainable for the long term by asking for some independent work to be done on that.
But I think that’s actually - when you look at a lot of other things which we might come to talk about, on things like the reduction of the regulatory burdens on the health service and the bureaucratic burden, the whole top down target culture and how that impacts on the Health Service, the need to focus on greater devolved decision making in the National Health Service, all of those things, actually I think Norman Lamb and I were talking in much the same kind of terms.
Sir Hugh Taylor: Thanks. I think Alistair, you’re MC up in Leeds, I think we’ve got a question from Carolyn Heaney. Carolyn, would you through Alistair like to ask your question?
Alistair: Yeah, you can hear me?
Sir Hugh Taylor: Yeah.
Alistair: Good afternoon from the Leeds side, very pleased that Secretary of State is paying a visit tomorrow; that went down really well here. We’ve got a packed room, a very good turnout in the sort of current climate so - and we have an overspill. But I’ll pass you on to Carolyn.
Carolyn Heaney: Okay, thanks. I don’t know whether you can actually see me but I wanted to ask you a question about the Prime Minister’s vision for a big society. I in my role, which has been to promote the role of voluntary organisations and voluntary action in health and social care, I can see potential synergies between a big society agenda and the government’s objectives for health and social care services, and the role that those organisations might play. I wondered if you could share with us your early thoughts on what the vision for a big society means in the context of health and social care, and your priorities for it. And where do you see the most potential for big society to manifest itself?
Andrew Lansley: Carolyn, thank you very much. I look forward to seeing you tomorrow all being well. There’s an awful lot potentially in answer to that. Let me just isolate I think some of the key points. The first is this: if we are going to achieve the kind of big society that we have been advocating, that kind of engagement of families and communities and the voluntary sector and the charitable sector - and indeed the private sector - is going to be instrumental in delivering improved public health outcomes.
That’s why in the public health Green Paper I published back in February we made it clear that not only are we looking for locally owned public health strategies where the Health Service and the local authorities will be working together to bring those strategies to fruition, but that actually the delivery of those public health strategies should increasingly be through voluntary and charitable and independent sector providers. Because there’s many people across, particularly in the charitable sector, who provide many of the pump primed initiatives, particularly in public health, but then find that those are not sustained. And it really undermines charities in the independent sector. What we’ve got to do is to make it clear that if they do succeed, and they show that they are working, because through the health premium we support the results they achieve, they can be confident that turns from a pump primed initiative into long-term support.
So that is - the idea of responsibility and a societal response to our challenges is a major part of what we’re achieving, we need to achieve in public health, not least because if we’re going to do these things, you know and I know some of the really big challenges are about behaviour change. And for government to achieve behaviour change is very difficult to do alone. It’s not just about education, it’s not just about advertising, it’s not even about through Change4Life trying to create a whole framework for thinking about diet and exercise and drinking, and so on. It’s going beyond that to achieving change in communities that is about positive peer pressure in communities in society. And that isn’t going to happen by legislation or by government action alone.
The other thing I’d just mention is within the National Health Service I think we are moving to a world where there will be a plurality of providers, including many NHS organisations, who to all intents and purposes become social enterprises; not part of what they regard as a single organisation, but feeling that they are more self governing organisations. But perhaps on the FT model, with the public as principal members and owners of a foundation trust, but also I hope creating opportunities for there to be employee-owned foundation trusts - effectively mutual organisations across the National Health Service.
So to that extent that also I think is really a shift towards what is much less to do with state control and far more to do with a society response. A big society where actually we’re talking about the people taking more control of the organisations, not only more control of their lives, not only more control as families and communities, but also, as employees and as public servants, taking much more control of the service and the organisations through which we provide service to the public.
Sir Hugh Taylor: Andrew, thank you. I’m going to come now to Steve Norton who’s got a question, and then I’m going to throw it open to the floor in Skipton and then in Quarry. Steve.
Steve Norton: Hello, yes, sorry, my name’s Steve Norton obviously, PCS on the trade union side. Mine’s a probably slightly more controversial question. But I mean, given the nature of the cuts, the 6 billion cuts, etc. across the civil service as such, it’s what tends to get lost in common departments, particularly in the Department of Health is the NHS is one organisation, but we are actually a civil service department of state, as such. So are there any plans, from what you’re saying possibly you’re looking at a smaller department, Department of Public Health. Any plans for any sort of major restructuring of staff as such within the Department of Health?
And also what’s the government’s plans now we’ve got the outcome of the judicial review where PCS has been successful in protecting certain terms and conditions of the Civil Service Compensation Scheme, as such?
Andrew Lansley: Okay thank you very much. First thing I should say - I do claim that I was indeed once upon a time a civil servant and a trade unionist as a member of the FDA. So I entirely - that doesn’t mean I necessarily know the answers to the question about the Civil Service Compensation Scheme. If I may I am literally going to park that with Hugh because that is from my point of view not a subject I know about. It’s not a subject that I would expect in any case to make those decisions. I think they would be made on a Civil Service wide basis by my colleagues in the Treasury and the Cabinet Office rather than by me. So I may - I’m sorry I don’t mean to dodge your question, but I think I better hand it back to Hugh, if I may.
In terms of - you will know, as I have said repeatedly back to last year, that in order for us to achieve a reduction in the bureaucratic burden within the service, we are going to have to reduce the administration cost in the Primary Care Trust, strategic health authorities, arm’s length bodies and the Department, and overall by a third over four years including this year. I make no bones about it; that’s the objective. And one of the reasons is because we need to ensure that we deliver every possible resource to the care of patients and care users; we have to do that.
The fact that we have a commitment to increase the funding of the Department in real terms each year does not absolve us of an absolute responsibility to apply to ourselves all the same disciplines as are being applied right across government and the public services. So the same issues will apply. You know if there are pay restraints, as there clearly will be in 2011/12, they will apply in this department and in the NHS in the same way as they will elsewhere in the public services.
We must - because we must show that the protection we have achieved is not on the basis that we can inflate our costs or fail to reduce our unit costs in the way that the rest of government is going to have to do, but simply because we have the opportunity and the need to use those resources and reinvest them for improvements in quality and outcomes, and to respond to rising demand. It does mean there will be changes.
But let me just - I think positively one thing I would say about changes in the Department. This is - forgive me, I will, in effect, make a criticism of our predecessors. I think one of the things that came repeatedly out of the surveys of staff in the Department of Health was that the Department of Health was increasingly good at delivering on the objectives that were set for it, but that the staff in the Department were often, year after year, unclear about the strategic direction that the Department was trying to pursue. So - and there was confusion about that.
So I am determined that one of the principal things that I can achieve, and as a former Private Secretary to a Cabinet Minister, you know, I’ve been in that place, and I know that the British Civil Service is as good as any organisation anywhere in the world at delivering on a strategic objective set by ministers. I also know that it is very accomplished at filling the vacuum if ministers do not know what they’re trying to do.
So let’s be clear - I am going to be clear about what I’m going to try and do. In the Department I’m going to seek to be clear that firstly we are going to create a more autonomous NHS, where we do not seek day by day, on a political basis, to interfere with decisions. We’re going to ensure that there is a commissioning function in the NHS, and a regulatory structure that is sustainable long-term without politicians constantly trying to interfere with it.
Now that will mean in practice within the Department a more autonomous move towards the NHS Board and obviously their Monitor and CQC - but essentially for the Department towards an NHS Board that is responsible for that function of commissioning services on behalf of patients.
Secondly, there will be a public health service, and as a department for public health, we will be increasingly as time goes on a department for which that is our central function. But we will be doing that day by day, and we will be focused on that. And that will have the effect of bringing in a sense more activity and responsibility into the Department, which is currently out in a more diffused and incoherent fashion.
And then the third part - and I say this as perhaps shouldn’t - as a former civil servant, I think we need to be aware that there is a central function of professional civil servants, which isn’t something that is done by NHS managers, and isn’t done by doctors and nurses - which is the business of understanding and managing policy and legislation, and financial control in a public finance environment. And I am looking for professional civil servants to be responsible for that professional task of supporting ministers in delivering a central Civil Service function.
So to that extent, I’m looking towards a department which is much clearer in the future about not what we’re trying to achieve, but that those who are working in the Department are, effectively, in the NHS Board delivering NHS services with NHS experience, competencies and skills; in the public health service, delivering public health objectives with public health competencies, skills and knowledge; or in the core Civil Service function delivering those things for which professional civil servants are responsible.
Now I know that will involve some reorganisation within the Department - bound to do so - at the same time as we are imposing on ourselves some tough demanding requirements in terms of cost reduction. But I think, if we know where we’re going in terms of objectives, strategy and organisation, it will be much easier for people to understand what is happening and why it’s happening.
Steve: Thank you, Andrew.
Sir Hugh Taylor: Steve, just on the point about the scheme, the honest answer is I don’t know yet because I think at the moment we’re still wait - I think the - effectively the Cabinet Office and co are still deciding whether they’re going to appeal against the judgement and all the rest of it. But as soon as we get any further information on that, we’ll let you know where we’re going on the redundancy scheme.
Let me just throw this open now for any immediate questions from the floor. We’ve got half an hour of time. Yes, one question here. There’s a mic coming your way. And then I’ll take one more there, then a couple in Quarry; then I think we’re going to have to wind up.
William Ramsay, The International Division: Good afternoon, sir. Now obviously quite rightly you’ve focused on the home front, great investment and incentiveness for the NHS. But as I’ve just said, I’m from the International Division, and I’d ask you, sir, what future plans are there, if any, for the overseas healthcare medical benefits, bearing in mind of course they’re statutory payments and the UK has still got to comply with its EEA obligations?
Andrew Lansley: Er - I hesitate because it sounds to me like I might have to ask you for advice on that question.
I would say this, and here you’ll forgive me if this is, as it were, on the basis of knowledge in opposition rather than knowledge in government. But I am acutely aware that, if I recall the statistics broadly correctly, the payments received by us in this country from elsewhere in the European Economic Area, for health services provided to their citizens, rose by something like from 30 something million to about £50 million over the last six or seven years. Our payments to other EEA countries for healthcare services provided to our citizens elsewhere in Europe went from about 250 million to something like 600 million. There is a rapidly rising profile of our expenditure on the healthcare benefits to UK citizens in other countries, not matched - now that may be because objectively, that is simply what’s happening - that very few people from other European countries are coming here, particularly pensioners, to live here and so on.
But I do know, also, because I’ve talked to the National Audit Office and encouraged them in their enquiry into the payments made by us to the Irish Republic for pensioners in Ireland, that we were paying too much. And we were paying too much for a number of years.
So from my point of view, viewed coming into the Department from opposition, it is that we were not paying the amount that it was right for us to pay to Ireland; we were paying, if I recall correctly two or three times as much for a UK pensioner to get healthcare in the Republic of Ireland than we were paying for a UK pensioner to get healthcare in Britain. So to that extent there is a problem, and I acknowledge that I don’t have all the information about what the resolution to those problems are, but I do know that it isn’t just simply - we have to meet our obligations; that actually sometimes we were paying far more than we ought to have been paying, and perhaps not recouping as much as we should have done.
Steve: One more question at the back there, yes.
Herm Aphra (?), Legal Group: It’s good to see you here, Andrew; thank you very much for the clarity of thought in terms of what you intend to do. And I suspect from your presentation that you foresee my colleagues having less gap filling to do because of the clarity of thought you have around health issues.
It’s a platform - the bit of the DH that we work for - very much interested in knowing what you expect from the lawyers of the Department of Health in achieving your agenda. Thank you.
Andrew Lansley: Well, thank you very much. I mean, I must say, as a former civil servant, I think the most exciting thing for a Civil Service, a government department, to be doing is to be at the outset of a new government with a programme and a strategy and objectives, and the real impetus to do it. Because this is nothing about personality; this is just simply about the literal fact that, if you’ve had a government that’s been around - whether it was the Conservatives after 18 years or Labour after 13 years - it peters out, and there is just a substantial and I think significant increase in energy and pace and opportunity at the start of a new government.
And I think this particular characteristic of a government - bringing two parties together with therefore a majority in the House and the opportunity to really push it through - I think might give all of us working together to turn that into real achievement.
Legally, of course, I think there’s a lot we’re going to have to do, because not only do we have to think about the legislative requirements - I actually think we’ve probably been thinking too much in the past about a new bill, a new bill, a new bill, a new bill; too little about looking at what we have in the legislation already, what we have in the regulations. What is it we already have the powers to do? And where sometimes does the structure of how we have legislated in the past become duplicatory and even inconsistent.
And I actually think that process of really cleaning it all up is going to be as important as making sure that we put in place the statutory framework that reflects the structure and objectives that I was describing earlier. And I think, you know, that is clearly where I would hope that the legal teams will be taking a leading role in that.
Steve: Andrew, thank you. One last question, Alistair from Leeds. Quick one.
Alistair: Okay, anybody got a question? No questions? One question. We’re just getting a mic here, Hugh.
David Hubbard: Hello. Andrew, you described some structural - potential structural changes to the Department which might involve the creation of a Department for Public Health, an NHS Board and economic regulator to add to the NHS Information Centre that we already have. So this could be caricatured as four Department of Healths with their own Chief Executives, Directors of Finance, websites, stationery, switchboards and so on.
So I was just wondering how that was consistent with less bureaucracy and more efficiency?
Andrew Lansley: I wouldn’t characterise it like that. I would say - we already in the Department we have a Permanent Secretary who leads the professional Civil Service; we have a Chief Executive who leads the NHS; we have a Chief Medical Officer who leads the public health activity. So to that extent, I don’t think I’m creating something new, any more than creating an economic regulator by the development of the functions of Monitor is creating something new.
The point, however, is to be clear about the respective functions; is for there not to be so much overlap, so much duplication, so much uncertainty about who is in charge of what.
From my point of view, I want to be clear about what we are trying to achieve ministerially as a government, but also to create, I hope, through that strategy, for you and for everybody in the National Health Service, a much clearer strategy and structure for the delivery of your objectives.
Now I actually think, if we start to go through that process, particularly - you’ll understand that I won’t go into detail - when you start to look at the range of arms length bodies and intermediary bodies across the health, public health and social care services, then I think you would all acknowledge, as I think, that they are too many, too confused, lack coherence, need to be related to a strategic structure. That is what we’re going to have to do. Doesn’t mean we simply cut and so on, because the objective is not to cut things; the objective is to reinvest for a much more coherent and effective service measured by its results.
And if we can make the whole of the administration cohere to a strategy, I think that would actually make an enormous difference in the reduction of bureaucracy.
Hugh, will you forgive me. I do - I’m supposed to go to the Palace, and you’re supposed never to be late at the Palace.
Sir Hugh Taylor: Andrew, thank you ever so much for that. It’s really good. What you’ve done is set out a really clear agenda, and as you’ve rightly said, that’s the most important thing for us. And I think I can speak on behalf of us all if I say that what we will do is get behind you - that’s what our role is here - to get behind the ministerial team and to give you our full support, and that’s what we’ll certainly be doing. Thank you very much for coming and doing this today. Thank you.
Sir Hugh Taylor: Thanks very much. I won’t keep folk. What I just would like to say by way of closing is that the Secretary of State has set out a very clear agenda. Remember those five big themes, those five big priorities. If you like, they become our new departmental objectives - patient led NHS; emphasis on outcomes; a system which is more autonomous and accountable, particularly in the NHS; a new public health delivery system; a new focus on a stable future on long-term care. Five interesting and I think very helpful priorities on which we have to focus.
Over the next couple of days I hope we’ll be able to give you clarification on the full ministerial team. I think there’s a strong possibility that we may have one of the Liberal Democrat team in the Department in one of the ministerial posts, which will be interesting. A new world for us, this.
And over the first two or three weeks we need to give ministers a bit of time to bed in, to have one or two key strategic meetings. We’ve already had a meeting - Dave and I had a meeting with the Secretary of State yesterday and today. The lawyers were there - talking a bit about how the legislative programme, what will be in the Queen’s Speech on health issues, and so on. But we need a little bit of time to do that.
So we have set a process in train. Your Senior Civil Service colleagues will know all about it. Just to make sure we don’t absolutely deluge new ministers with a load of stuff on day one. So I know you’re all bursting to get your own submissions forward and move stuff on, but we just need to make sure we do that in a controlled way.
We’ll also be trying to signal out to you as quickly as we can a bit about the key messages - you’ve already heard some of them today - and a bit about how the new ministerial team wants to work and how the different ministers will be approaching their tasks. So stay tuned in to all that.
The other thing I think it’s just right that I should say is that the Secretary of State’s been very clear, as I think we knew he would be, about his expectations of us as a department in terms of our leadership of a different system, and also about the need to reduce the total cost of the Department, its arms length bodies, the management stuff in PCTs and SHAs. What he said today is consistent with what the Conservatives said in their manifesto.
David and I have already had a discussion with him, in which we’ve offered him our view that we need to see that programme in the round as a whole; that we don’t want to do this just by salami slicing away at individual bits of the organisation. I think he’s very sympathetic to that perspective. That won’t mean that we won’t have to get on with things.
The rest of Whitehall is coping with an immediate programme of £6 billion in-year cuts, and I don’t think we will be immune from the pressure to demonstrate that we’re supporting that efficiency agenda as well. No details on that yet.
As soon as I have any more detailed information to give you about the impact of this on the Department, then I will do that up front. I will not hold any of that stuff back; we’ll communicate it.
I think we can expect tough times, but I think you’ve already seen from the Secretary of State that we’ve got somebody with a very clear idea of where he wants to go; he’s somebody who speaks the language of a government department, which I think is very helpful. And we’ve certainly got, extraordinary though it is, a government which has been formed by coalition and which, potentially anyway, provides stability and a majority government for quite a long period of time. So we’ve got a strong platform with which to work.
I know this is a testing time for the Department, because we’re all just waiting to feel our way into this new situation on the one hand, and slightly apprehensive about what it may mean to us as individuals and teams and groups as we go forward. We’re bound to feel that; I think we’re all feeling that a bit at the moment.
But I’m very confident about the ability of the Department to respond to the challenges which the new administration is laying down. I think we’ve done a good job in preparation, the briefing material which has been prepared I think is of an extremely high standard. And the stuff the Secretary of State’s already seen, I think he’s been quietly impressed with. And he sets quite a high standard in that respect.
So, well done so far. And we’ll try and keep together in terms of communication over the next few days and weeks, as the way in which the government’s going to work evolves. And I hope that we can have another of these sessions before too long, to just touch base and make sure we’re all lined up on the agenda that’s in front of us.
Thank you very much for coming in such big numbers today. I think that was a really good thing to welcome the Secretary of State in that way. And he’ll be in Quarry House tomorrow, which I think is great, and a really good mark of a Secretary of State who wants to engage with the Department.
So thank you all very much for coming, and good luck.
Lansley to slash NHS management costs
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Andrew Lansley's meeting with DH staff