Thank you, Dame Sheila QuinnMadam President, for a delightful dinner. I am not sure we have stuck to the DHSS guidelines on healthy eating. But the Norman FowlerSecretary of State seemed to be enjoying himself along with the rest of us. And he looks robust enough to me.
It is both a pleasure and a privilege to be with you tonight. The Royal College of Nursing is the oldest, the largest, and the most prestigious of the nursing professional organisations. [end p1] It was founded in 1916, and granted its Royal Charter in 1928.
It has flourished ever since. Over the last five years alone, the membership has more than doubled, to nearly a quarter of a million. The membership is drawn not only from the National Health Service, but also from the private sector and from all other areas of the profession. [end p2]
We in the Government and you in the nursing profession share a deep commitment to the National Health Service—a commitment which transcends temporary disagreements, and [end p3] provides a source of strength for the future.
The Royal College of Nursing upholds the highest professional standards of patient care—standards which meant that the College did not strike in 1982 when so many others in the health service did. It is that professional integrity which gives the College and its Members their high standing in the community.
It is an integrity which we in the Government stand ready to honour. We set up the Nurses Pay Review Board in [end p4] recognition of your professional approach and your sense of duty to patients; and it will not have escaped this audience that last year we decided to accept its recommendations.
Finance
Your commitment to patients is expressed in direct human care. The Government's commitment is more often expressed in terms of money. Money is not my favourite measure of health care, because patients are more important. But money is a measure of a sort, even though it does not measure what the Health Service does, only what it costs. [end p5]
Twenty-five years ago, when I first entered politics, the National Health Service cost less than one-third of the total yield from income tax. Now it costs nearly a half.
On the day I assumed office as Prime Minister, expenditure on the health service amounted to £11 a week for every family with two children in the country. Now that figure is £23 a week.
After taking inflation into account, we are spending more in real terms on the health service than we did when we came to power in 1979. [end p6] 20 per cent more. The grand total is approaching £17 billion. And still there are demands for new, more sophisticated treatments. So fast is the pace of research, we have to run hard just to keep up.
We are now providing treatments which didn't exist a few years ago: — hip replacement operations have become a standard treatment for arthritic disease. — the number of patients receiving treatment for kidney failure rose by two-thirds between 1978 and 1982. [end p7] — the number of coronary by-pass operations doubled over the same period.
Research evidence suggests that the health of our people compares well with most other countries, including some that are a lot richer than we are.
The NHS remains a service to be proud of. But: “All social services have to be paid for in one way or another, from what is produced by the people of Britain. We cannot create a scheme which gives the nation as a whole more than we put into it” . [end p8]
That was Clement Attlee speaking the day before the NHS came into being. His argument is as true now as it was then.
You can't distribute wealth until it has been created.
Flourishing public services depend upon a profitable private sector.
You can't have care without enterprise [end p9]
Good Management
All of us who work in the public sector—and Prime Ministers do as well, you know—owe it to our fellow citizens—as well as to ourselves—to make the best possible use of the resources they provide. That is why good management is so important.
We want a health service which runs smoothly, quietly and efficiently, so that doctors and nurses can concentrate on providing care for patients.
Too often what is known as consensus management is not management at all. [end p10]
It is simply an excuse for lack of leadership, delay in taking decisions, or just not taking them at all.
That was the theme of Roy Griffiths ' report. And a very crisp clear report it was too—not like some I have had to read in my time. Roy Griffiths should know—he comes from a company which is second to none in its service to the consumer. As he said: [end p11]
“If Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the people in charge” .
Now, at last, she would find the person she was looking for. His name is Victor Paige, and I am delighted that he is here with us this evening. We welcome him—and may I give him notice that I for one am expecting great things of him! [end p12]
We want to free the local manager—and whether nurse, doctor or administrator by training, it is good managers we are looking for now—to deliver better value for money, because we know that money wasted is money that could often be spent on patient care.
£10,000 thrown away on bad purchases could have paid for a heart transplant operation.
Nor is it just in the hospital service that this principle applies. We are also looking to get better value for money from the Family Practitioner Service—especially the drugs bill. [end p13] That's what the limited list proposal is about. We will not be put off when there are real and sensible savings to be made. But we will consult, and are consulting, with the professions and the appropriate specialists to make sure the list is complete and that patients will still be able to get all the treatment they need.
That is the most crucial point—to protect the interests of patients. [end p14] What Norman Fowler and Kenneth Clarke are doing is exactly what we would expect any well-run company to do—making sure that they get the right supplies at the right price. [end p15]
Peroration
Madam President, last year the National Health Service treated more patients than ever before in its history. Although it did so with fewer staff than in 1983, the health service still employs around a million people, compared to half a million twenty-five years ago.
What is all this activity for? We in the Government, and you in the Royal College have a clear answer. It is to enable as many people as possible to enjoy good health, so that they can fulfil [end p16] their potential as individuals and look after themselves and their families in a free society.
It was Izaak Walton who said: “Look to your health; and if you have it, praise God, and value it next to a good conscience; for health is the second blessing that we mortals are capable of” . [end p17]
Madam President
Izaak Walton was surely very perceptive to link a clear conscience and good health so closely together. The question I now face is: can I with a clear conscience ask you, a gathering of nurses, to rise and drink an alcoholic toast to good health—the health of the nursing profession; the health of our caring services? I think, on reflection, that I can. It was the great Apostle Paul who wrote to Timothy—
“Take a little wine for thy stomach's sake”
and so, though I cannot take his advice too far—chateau bottled wine could prove even dearer than proprietary drugs—I can, in good conscience, [end p18] and with great pleasure, ask you to rise and drink the toast— “The Royal College of Nursing” .