GovWire

Ive come along today to lay down some direction.

Not just to make the case for reform, which Ive done before, but to spell out how well do it and what I need you to do with me for us to collectively succeed.

When it comes to the condition of the NHS today, the Darzi diagnosis is clear:

• The NHS has not been able to meet its most important promises to patients since 2015
• A&E waits are causing thousands of avoidable deaths
• 50 years of progress on cardiovascular disease has gone into reverse
• 345,000 people are waiting more than a year for mental health treatment thats more than the entire population of Leicester
• As the performance of the NHS has deteriorated, so has the health of the nation
• Adults are falling into ill-health earlier in life
• And children are less health today than a decade ago
• Aras conclusion was that the state of the health service is heartbreaking

And Im yet to hear anyone seriously contest this analysis, which was entirely based on the data.

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In my experience, not just as a patient,but in the last three years talking to front line staff and NHS leaders most people appreciate the honesty and recognise that the biggest barrier to patients accessing care is long waiting times.

As Ive argued before, a culture that puts sparing political blushes or protecting the reputation of the NHS above protecting the interests of patients is one that stifles inconvenient truths being spoken to power, that silences whistleblowers, and that ultimately puts patient safety at risk.

In the last few years Ive come to know many of you in this room and in the last four months Ive toured the country talking to leaders and frontline staff, so I think I know you well enough to know that you share my view that honesty is the best policy, you agree with the Darzi diagnosis and that you share my optimism that the NHS is broken, but not beaten. Every day there are outstanding episodes of care being delivered, by dedicated people working with some of the best science in the world. As Ara put it: the NHS is in critical condition, but its vital signs are strong.

Our collective challenge is to take the NHS from the worst crisis in its history, put it back on its feet, and make it fit for the future.

The Budget was important. The Chancellor gave us the investment we need to arrest the decline, begin fixing the foundations and start turning the service around.

The NHS was the standout winner. Were the biggest cash uplift in day-to-day spending of any government department.

There have been two predictable reactions to this: the first says that the NHS is getting too much money. That this is a black hole that consumes ever-increasing amounts of taxpayers cash and that the NHS will complain it is never enough.

So right on cue, some NHS leaders popped up in the newspapers, aided and abetted by the health think tanks, to complain that this isnt enough.

One of the luxuries of leading a thinktank is that you dont have to engage with the choices and trade-offs that government does.

The Chancellor had to raise more than 40 billion to plug not just the 22 billion black hole we walked into in July and to fix the foundations so that our economy and our public services can recover.

When the Chancellor announced the settlement for my department, she joked about how unpopular it would make me around the cabinet table.

The truth is, at the cabinet meeting in which she set out the contents of her Budget, I did feel uncomfortable.

Not because I was worried about the opinions of the people in the room because they support the NHS and the investment but because I am worried about the jobs they have to do. As I look around that Cabinet table I see a Justice Secretary who inherited overflowing prisons. A Work and Pensions Secretary who inherited more than 4 million children living in poverty. A Defence Secretary charged with securing our nation, at a time when there is a ground war in Europe, as well as the constant threat of cyber warfare in a more dangerous and unpredictable world.

Every penny of extra investment that goes into the NHS was a penny that didnt go towards child poverty reduction, extra prison places, or bolstering our armed forces.

More than that, every penny spent on treating sickness is a penny that doesnt go on preventing illness. You know as well as I do, that around only 20% of the nations health is affected by the NHS. The rest is dictated by the poverty we live in, the damp on our walls, the food we eat, the air we breathe and so on.

So, you cant pretend to care about the social determinants of ill-health if you only ever ask for more money for the NHS.

So then, the argument goes, we must do both.

Of course thats right, but the choices and trade-offs arent just about spending money but raising it. The tax burden in this country is at record levels. We chose, rightly in my view, not to hit working people in their payslips. The extra investment in the NHS, as well as other public services, meant asking employers and the wealthiest to pay more.

You will have seen in the past few weeks, that there are those who disagree with the Chancellors decisions. Thats the nature of tough choices.

We stand by our decision to prioritise the health service: healthy businesses depend on a healthy workforce, and a strong economy depends on a strong NHS.

But if you want to know where the average taxpayer stands on NHS spending its quite straightforward: they welcome the investment, but they worry it wont be spent wisely.

They agree with the central argument we made at the last general election that investment must be matched with reform.

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Tight fiscal constraints mean that reform needs to do a lot more heavy lifting.

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We would still need to reform our public services because we are in the foothills of a scientific and technological revolution that is changing the world around us.

Citizens are used to choice, voice, ease and convenience at the touch of a button. We expect everything faster.

Unless our public services are modernised to meet the needs of our people, theyll become increasingly redundant and irrelevant to peoples lives, unable to meet their needs.

The failure to reform the state to meet the needs of the people is one of the fertilisers of populism we see across liberal democracies. The other is failure to ease the pain in their pockets. We need to address both with NHS reform that delivers better outcomes for patients and better value for taxpayers money.

By now you will be familiar with the three big shifts that will underpin our 10 year plan for health:

• From hospital to community
• From analogue to digital
• From sickness to prevention

These shifts are not radical new ideas,but delivering them truly would be.

Theyre necessary to tackle the challenges of our growing ageing society, rising levels of chronic disease and rising cost pressures; as well as to seize the opportunities of a scientific revolution in which AI, machine learning, genomics and data offer us the chance to transform our system of healthcare to one that can not only diagnosis earlier and more accurately and treat more quickly and effectively, but also predict and prevent illness.

But were not waiting for the 10 Year Plan in May to get cracking with reform.

Over the last few years, Ive regularly heard the criticism of the top-down nature of the NHS. It can be a difficult criticism for those at the top to hear, but for the last four months Ive found myself at the top of the system at the peak of the mountain of accountability and I not only recognise the criticism, I agree with it.

The NHS in 2024 is more hierarchical than almost any other organisation I can think of. Even our Armed Forces, as the Messenger Review argued, is less locked into centralised into command and control.

Those of you who have studied the birth of the NHS will know that there were vigorous debates within the Attlee Government about how the new NHS should be organised. Given the vital role that a strong state and central planning had played in Britains success in the Second World War it was perhaps inevitable that Nye Bevans centralised model won the day, albeit with concessions to the doctors to overcome opposition from the BMA. But Herbert Morrison and others in the Labour movement had argued strongly for a municipally based model, with power and control exercised locally.

Attlee and Bevan could scarcely have imagined in 1948 that the single payer system they created would make the NHS ideally placed to seize the opportunities of data, genomics, AI and machine learning. The N, the national, in NHS is important. It should be the guarantee that patients everywhere are treated according to the same values and the same standards.

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The framework Im setting out today is based on triple devolution: with power shifting out of the centre to ICBs, to providers and, crucially, to patients. I want to lead an NHS where power is moved from the centre to the local and from the local to the citizen. Morrison meets Bevan.

It starts with clarity. The centre should be deciding strategy, policy and clear objectives for the system to deliver on beha

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