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Thanks very much for inviting me here today.

A lot changes from opposition to government. Ive gone from an office of seven staff to a department of 3,500. People insist on calling me by my title, rather than my name. The most frustrating change, and I am sure that I wont be the first to have said this, has been the pace or lack of it - at which the Whitehall machine works.

So for Ara to have published two reports in the past two weeks, both over a hundred pages long, packed with expert analysis and huge amounts of data, the first of which he wrote in just two months, is really putting the British state to shame. Especially on the first of those reports he put together in just over two months. Hes on a one-man mission to solve our countrys productivity.

The Darzi investigation into the NHS and the final report from the IPPRs Health and Prosperity Commission complement each other. Taken together, alongside the OBRs Fiscal Risks and Sustainability report, they depict a perfect storm of rising pressures on the NHS, growing numbers dropping out of the workforce, and spiralling costs to the public purse, at a time when there is already a 22 billion black hole in the public finances.

This is what were up against. Ive been in the Department of Health and Social Care for two months, and day after day Im shown graph after graph with all the lines going in the wrong direction.

Recognising this is criticised by some for being gloomy. Its not actually, its something this country hasnt been used to for a long time- its honesty.

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This government has resolved to be honest about the problems facing our country, and serious about solving them.

You saw both in Keirs speech last week- honesty about the state of our NHS, and a serious agenda for turning it around. As the Prime Minister set out in his speech, continuing with the status quo isnt an option. Sticking plasters wont cut it. Were going to have to make big changes, many of which will come up against loud opposition. So dont be surprised that were making the case for change at the same time.

If anyone was in any doubt about the scale of the challenges before the NHS, then the Darzi investigation published last week made it abundantly clear.

I asked Ara for hard truths, warts and all. He delivered. And then some. He has given a raw and honest diagnosis:

• The promise that the NHS will be there for us when we need it has been broken for almost a decade

• 100,000 infants, aged 0-2, were left waiting more than six hours to be seen in A&E last year

• Cancer is more likely to be a death sentence for NHS patients than patients in other countries

• Fifty years of progress on cardiovascular disease is going into reverse

• And patients have never been more dissatisfied with the service they receive

The report is equally damning on the causes.

First, a decade of underinvestment

which left the NHS 15 years behind the private sector on technology

with fewer diagnostic scanners per patient than almost every comparable country, including Belgium, Italy, and Greece

and mental health patients treated in Victorian cells, infested with vermin, where 17 men are forced to share two showers. In 2024.

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As the report states and I quote:

It took a scorched earth approach to health reform. the effects of which are still being felt to this day.

Just imagine, if all the time, effort, and billions of pounds wasted on dissolving and reconstituting management structures had instead been invested in services for patients.

Clearly, the NHS would not be in the mess it finds itself in today.

Third, Coronavirus.

The damage caused by the pandemic has been plain to see.

But what we didnt know until the Darzi report, is that the pandemic hit the NHS harder than any other comparable healthcare system in the world.

Patients in this country saw far more operations and routine care cancelled than anywhere else.

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Thats why the backlog ballooned to 7.6 million today.

Fourth, the failure to reform.

A 17% increase in staff working in hospitals, which didnt lead to better outcomes for patients, but a huge fall in productivity.

Staff put into the wrong place, without the tools to do the job.

Instead of treating patients, too many are trying to find them beds, find somewhere to discharge patients, or dealing with slow, creaking, outdated IT.

An enormous waste of talent and money, when so many other parts of the NHS were crying out for investment.

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Activity-based funding was ditched in favour of block contracts. Incentives to reform and modernise ways of working have been stripped out. Translated into plain English, too many parts of the NHS are now paid for effort, not for outcomes. That has to change. And well be saying more about that in the coming months.

Some of the most shocking findings in the Darzi investigation werent about the sickness in our National Health Service, but the sickness in our nation.

Children are sicker today than the generation a decade ago. Adults are living longer, but falling into ill-health earlier in life. And as this report from the IPPR puts it, we are in danger of literally becoming the sick man of Europe.

The result is a rising tide of pressures on the NHS.

Ive said it before but I dont think the message has yet got through: if we dont act now, ever increasing demands for healthcare threaten to overwhelm and bankrupt the NHS.

Our sick society is also holding back our economy.

• A drop in productivity due to ill-health has cost our economy 25 billion since 2018

• 900,000 more people are off work than would have been on pre-pandemic trends.?Thats more people than Tesco, Sainsburys, and Asda employ put together.?

• Fail to act, and by the end of this parliament 4.3 million people could be off work sick. Millions of people left behind, the welfare bill ballooning, and growthhampered.??

To build a healthy economy, we need a healthier society.

To achieve that, we need reform of the health service, and public health reform too.

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Reform has always had opponents, often vocal and powerful opponents. But believe me when I say the Prime Minister and I will face down that opposition, because it is in the interest of patients, the health service, and taxpayers in this country.

It really is reform or die, and we choose reform.

As the Prime Minister said last week, radical surgery is required. We will publish a ten-year plan early next year that will set out how we deliver three big shifts in the focus of the NHS:

• From Analogue to digital

• Hospital to community

• And sickness to prevention

And what gives me confidence that this can be done is the innovations already taking place in our health service and our country today, pointing the way to a better future.

At the Royal Free Hospital in London, the hospital which treated my kidney cancer, new PET scanners work four times faster than standard.?Patients are seen days, not weeks after being referred, cutting delays in diagnosis that can be the difference between life and death.

Think of the number of lives that could change, if rolled out across the country. That is why we are committed to putting an AI-enabled scanner in every hospital- freeing up valuable staff hours and getting patients diagnosed much faster.

In the South-East of England, virtual wards have led to 9,000 fewer hospital admissions per year.?Patients living with long term-conditions like heart failure are cared for from the comfort of their own home, freeing up vital hospital beds and saving more than ten million pounds.

Our commitment to invest in more district nurses will make sure more patients across the country can get the treatment they need without having to step out the front door.

Better for patients, and less expensive for the taxpayer.

As the Prime Minister said last week, by marrying our countrys leading scientific minds, with the care and compassion of the NHS, the fruits of the revolution taking place today in life sciences can be secured for NHS patients. That public-private partnership will be fundamental to the reform agenda.

Take MS patients.?Right now, many are treated through a four-hour blood infusion a long and difficult ordeal.?

Soon, thousands will be offered an injection that takes just ten minutes.?Just imagine the difference this will make.?The hours returned to patients to live their lives. And the thousands of hours of clinicians time freed up for the millions of other patients stuck on waiting lists.

And when it comes to prevention, the healthy society we need to build wont just come from the action were taking as a government, to ban junk food ads, pass the tobacco and vapes bill, or introduce health checks in workplaces and on high streets.

Nor will it only come from the reforms we will make so the NHS can reach patients sooner, diagnose earlier, and treat them faster.

In May, we saw the first NHS patient to be treated with a personalised cancer vaccine at University Hospitals Birmingham.??

These vaccines could prevent cancers from

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