Jeremy Hunt: supporting the NHS to make continuous improvement

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  • Posted:Wednesday 26 November 2014

Jeremy Hunt, Secretary of State for Health, sets out his plan to achieve personalised, 21st century health care for the NHS.

See the transcript from Jeremy Hunt's speech below.

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I’m setting out a plan to achieve personalised 21st century health care for the whole NHS. From next spring you will have online access to a summary of your own GP record and access to the full coded medical records by 2016. From next April you’ll be able to book GP appointments online and order repeat prescriptions without having to go into your local surgery. From 2016 NHS England have said that you’ll also have access to trusted NHS health apps. Technology also unlocks personalised cures for illnesses. We know that diseases like cancer and dementia are not single diseases but infinitely complex variations on a theme, but in health care it’s not just personalised care and personalised cures that technology unlocks, it’s also a revolution in prevention. If you are a vulnerable older person being cared for by Airedale Hospital in Yorkshire you may well be given a big red button. This sits on your armchair and to use it there’s only one thing you need to do and that’s to make sure your TV is switched on, then if you press the button any time day or night a nurse will appear on your TV screen to ask how you are. 

Too often, though, the NHS has lagged behind other countries in offering access to these kinds of products, even though the NHS itself is the winner if costs are contained by preventing illness. This won’t change until health care is commissioned holistically so that the budget holder who pays for innovative prevention sees the financial benefits.  

So today I can announce that as part of a step towards becoming accountable care organisations all CCGs will be asked by NHS England, with support from HSCIC, to collect and analyse expenditure on a per patient basis. CCGs will then, as co-commissioners of primary and specialist care with NHS England, and co-commissioners of social care and potentially public health with local authorities, be able to pinpoint more clearly where there is the greatest potential to improve patient outcomes by reducing avoidable costs through more innovative use of preventative measures.

But alongside personalisation and prevention there is a third P, the protection of personal medical data. If we lose the confidence of the public that their data is safe none of these things will be possible. I am today announcing the establishing of a new national data guardian to be the patient’s champion when it comes to the security of personal medical information, and I’m delighted that Dame Fiona Caldicott, who’s done so much outstanding work in this area, has agreed to be the first national data guardian for health and care. She’s agreed that it will be her responsibility to raise concerns publicly about improper data use.

A more personalised service that helps people stay healthier isn’t just what people want, it also reduces cost. True financial sustainability means rethinking how we spend money, not just day to day but more fundamentally. Just as in 2009 Sir David Nicholson set up the Nicholson Challenge to save £20 billion this Parliament, so the forward view sets up a £22 billion challenge for the next Parliament. As the forward view makes clear, long term pay freezes are unlikely to be viable if the NHS is to retain the staff it needs. So today I want to outline 10 savings challenges, challenges which between them could save been £7-£10 billion a year by 2020.

The first challenge is Safer Care. A report by Frontier Economics bringing together the available evidence suggested that the total cost of preventable harm in the NHS may be between £1-2.5 billion.  

One of the areas identified by the Frontier Report forms the second challenge, ensuring the safe, effective and optimal use of medicines. Last week the Academy of Royal Medical Colleges estimated that adverse drug reactions resulted in costs of £466 million through additional bed days, so poor use of medicines is connected to the third challenge, the £300 million waste each year in primary care from unused drugs, half of which could be avoided according to a study by the University of York and the School of Pharmacy.

The fourth challenge is procurement. The NHS spends almost £15 billion each year on medical equipment, devices, office supplies and facilities, and the NAO found variation of up to 183% in the prices paid by trusts for the 100 most commonly ordered products, so we’ve established the procurement efficiency programme led by Lord Carter which aims to deliver savings of at least £1.5 billion from the NHS procurement budget from next year.

My fifth challenge is agency staffing. The amount being spent by trusts on agency fees has gone beyond a sensible response to new staffing levels required by Francis and become an unacceptable waste of money, so we’re supporting trusts by publishing a new toolkit to help reduce spend on agency staff and we’ll bring down these costs further by working with providers to improve their processes and challenge agencies that are ripping off the NHS and taxpayers.

The sixth challenge is on surplus land and estates.  There’s huge potential for that land to be used for better NHS primary care facilities or indeed housing and schools, whilst at the same time reducing NHS overheads and generating cash for reinvestment in NHS services.

The seventh challenge – there are only 10 – is to ensure that visitors and migrants pay a fair contribution to our NHS. Independent research from Prederi suggests that up to £500 million could be recovered from visitors and temporary migrants accessing NHS services. To do this we’re providing financial incentives to trusts to promote the identification of people who should be paying for their health care. 

The eighth challenge is back office costs. The health system is on track to reduce its admin costs by a third over the course of this Parliament which will save £1.5 billion.

The ninth challenge is to come up with more solutions ourselves by reducing the £500 million plus we spend a year on management consultants.  It’s our doctors, our nurses, our health care assistants and our managers who will create a sustainable NHS.

And the final challenge is a personal priority of mine: making better use of IT to free up time for frontline staff.  A study by the Health & Social Care Information Centre found that 66 per cent of a junior clinician’s time is spent finding, accessing and updating patient notes compared to just 24 per cent on patient contact, and that’s why I want all clinicians in primary, urgent and emergency care to be operating without the use of paper records by 2018.

Now taken together, these changes could save a significant part of the forward view’s £22 billion, and combined with local innovation we can surely find the rest.

I want to build on the consensus around the forward view to develop a compact around both the amount and the way that we embrace innovation and efficiency to deliver the savings needed, and I’d like to finish on a note of optimism because we aren’t alone as a country in facing these challenges, but if we implement this plan that I’ve outlined this afternoon we will be the first country in the world to do so across an entire health economy. An NHS that turns heads across the world as it blazes a trail for 21st Century health care.

Thank you very much.


john kapp

director SECTCo,
Social Enterprise Complementary Therapy Company
Comment date
08 December 2014
I don't know whether Jeremy made this joke at your conbference, but he opened at the NHS Alliance conference last Thurs with: Speaking to the NHS is like in a cemetry. Everyone's underground, and nobody's listening. This is my experience of 14 years as a patient representative, see papers on section 9 of www,

Veronica Burton

qualified neonatal intensive care and paediatric nurse,
Comment date
08 February 2015
Not enough nurses because of the Francis Report? Jeremy Hunt surely knows that the problem originates with the rush for foundation status, for which hospitals were obliged to break even. A popular ploy was to reduce the number of nurses they employed. This in turn led to a reduction in nurse training places, in response to an apparent fall in demand, with repercussions for years in advance - like now.
As for agency staff, can you blame nurses for turning to a way of earning a wage worthy of their skills, expertise, experience and dedication? In a response from the Health Department to a letter I wrote, 'appreciation' was expressed that people would be 'disappointed' at the government's refusal to honour the NHS Pay Review Body' findings. Separated by nearly a page it answered my point that MP's were happy to take a 10% raise in their pay, by suggesting I write to the Independent Parliamentary Standards Authority, which has awarded this pay rise. I have not done so as I know what the answer will be. Much as MP's would, of course, like to refuse their rise, in solidarity with grossly underpaid workers whose dedication has been treated with contempt for decades, they are just not in a position to refuse their rise. After all, it's been awarded by their pay body.

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