The Rt. Hon. Sir John Major KG CH

Prime Minister of Great Britain and Northern Ireland 1990-1997

1991Prime Minister (1990-1997)

Mr Major’s Speech to the Nursing Standard / BUPA Nursing Awards – 17 September 1991

Below is the text of Mr Major’s speech to the Nursing Standard/BUPA Nursing Awards dinner, held at the Marriott Hotel in London on 17th September 1991.


Madam President, I am delighted to be with you this evening. These awards are very important. Important because they are the result of joint enterprise between the RCN, BUPA and Nursing Standard. There is scope for much more joint enterprise in many areas of health policy. And I hope and expect to see more.

But important also because they recognise the service ethos which is at the heart of health care. I know already that the award winners all have one thing in common. They are all nurses, midwives or health visitors who are engaged in clinical practice. They have all been nominated for their work in improving the quality of care which they deliver to their patients.

The delivery of care to patients is at the heart of nursing practice: and nursing practice is at the heart of our Health Service. The NHS is the largest employer in the country. And within it, nurses, midwives and health visitors form the largest professional group. So this is a good occasion for me to set out some objectives for the Service.

In our country, the National Health Service is almost universally respected. The NHS offers peace of mind to millions of people. I am determined that it will thrive and grow as a truly National Service available to all our citizens. That is what it has done for the past twelve years.

The facts speak for themselves. More patients have been treated. New treatments have been developed. More staff have been available. Since 1979 expenditure on the NHS has grown at 3 per cent a year over and above inflation: a cumulative increase of 50 per cent in real resources devoted to health care.

But money is not everything. It is how we use that money that is so important. None of that progress in patient care could have been achieved without the commitment of the skilled professionals who work in the health service. Each and every day there are hundreds of thousands of cases of professional, dedicated, and successful health care.

Of course, things go wrong from time to time. But everyone here, all of us, are committed to preventing and to solving those problems. The more we work together the more successful we will be. The purpose of tonight’s awards is to recognise individual effort to provide better care. Such effort epitomises all that is best in the National Health Service.

I have good reason to be personally committed to the NHS. When I was seriously injured it was the NHS that treated me. When my parents were in their final illness, it was the NHS that cared for them. When my children were born it was the NHS that delivered them. In this I share the experience of millions.

This government is quite clear about its health policy and the future of the NHS. That policy is founded on ten important principles.

First, the needs of the patient must be paramount in running the NHS.

Second, health care is free at the point of use in hospitals and in doctors’ surgeries. And it will remain so.

Third, we will continue to offer free prescription charges, so that only those who can afford to do so will make a contribution to the cost of medicines.

Fourth, the Government’s priority will be to see the NHS is not just maintained, but improved. Extra resources will continue to be provided for the NHS year after year within the limits the economy can afford.

Fifth, all money – and I do mean all the money – that is saved by increased efficiency in hospitals will be ploughed back into patient care and not handed back to the Treasury.

Sixth, the reforms we have introduced in the Health Service will continue to be directed towards improving care for patients, and ensuring that more responsibility for health care is handed down to local levels. That is why we created NHS Trusts and GP Fundholders. To give more responsibility to hospitals and GPs in deciding how best to meet local needs. And let me stress a fundamental truth about NHS Trusts. They are, and will remain an integral part of the National Health Service available to all. None will be privatised now or in the future.

Seventh, as we have underlined in our Citizen’s Charter, every patient must be treated with proper respect and dignity at all times. And they must receive proper information about all aspects of their illness, treatments and care.

Eighth, not only must the treatment offered by the NHS be clinically good. The NHS must offer patients certainty about the maximum time they may have to wait for inpatient or out-patient treatment.

Ninth, families have the right to make private provision if they choose. Doctors and nurses have the right to practise privately. No free society should try to deny either right. As the Soviet Union and Eastern Europe begin to hope and plan for private health care, it is inconceivable that anyone in the UK should still oppose it. And, as it grows, there should be more constructive co-operation between the private and public sectors in health.

Finally – and I place particular importance on this – nurses, doctors and all the staff who work so hard and with such skill deserve our support. I can assure you that they can count on mine and the wholehearted backing of this Government in the years ahead.

Those ten principles will guide the way ahead for our policies on health. There will be many challenges. There may be setbacks. Meeting the ever-growing demand for health care is a daunting task, not only for Britain, but for every other country as well.

But let us be clear why we face such challenges. They are the challenges of success. They came about because:

– More people live longer.

– Technical advance makes new treatments possible.

– New techniques have been developed by professionals in health care.

– New discoveries have been made by scientists involved in pharmaceutical and diagnostic research.

Of course, it is reasonable to point to the case for growing resources. That is a legitimate matter for debate, though I regret it is all too often turned into a political football. But the growing pressure for more resources comes not because health care is failing, but because it is advancing – at a greater pace than ever before. And is advancing because of the success of the Service.

In Britain we now spend over 30 billion pounds a year on the health service. More than on Defence. More than on Education. And as a Government we have a duty to ensure that taxpayers’ money is spent effectively. That is true for all public services. But what really matters for NHS spending is getting the best service from the resources available – for the patients and for the community as a whole. And that is what our reforms in the NHS are intended to bring about.

I know that carrying through these changes has meant some heart-searching, much hard work, and has needed lasting commitment from all those involved. But the benefits are increasingly to be seen. With the principal reforms now in place we can lift our sights to the common goal of all these changes – a better Health Service.

For I am quite clear where the NHS reforms are taking us.

– We will see further improvements in the health of the nation – some of them quite dramatic, like the vastly improved prospects for children with leukaemia and reduction in measles, mumps and rubella. In 1990 there was not one death from acute measles – the first year without a death since records began.

– We will see costs brought down and waste reduced within the NHS. And waste reduced means funds gained for the Service. I say again that every penny saved will stay in the NHS to provide more and better care.

– We will see people working in the NHS with more confidence in the services they are delivering.

– And we will see the public at large placing even more value on the NHS. Not just out of affectionate habit, but because it is getting better and better and is responding more directly to their needs.

Madam President, in July, I launched our Citizen’s Charter. want that Charter and its principles to be a driving force in every part of the public service in the 1990s. The Citizen’s Charter’s key theme is to make public services more responsive to the needs and the wishes of their users and to raise further overall quality. Nowhere are these objectives more important than in health.

The NHS reforms are already taking us a good way towards achieving the improvements set out in the Citizen’s Charter. In future those responsible for spending public money will be able to set new and demanding standards for those providing services to patients.

We will be building on the reforms when we publish the Patient’s Charter soon. The Charter will set out in detail what people can expect of the NHS. It will also spell out what Health Authorities and providers are expected to do to ensure that these expectations are met. And what people can do to secure redress if they are not met.

For example:

– you can expect your District Health Authority to publish details of all the services it provides, together with an indication of the standards of quality it expects to maintain;

– as soon as you are put on a waiting list, the hospital will write to let you know how their guaranteed waiting times affect you;

– you can expect a named nurse or midwife to be responsible for your care from start to finish;

– if things go wrong, the Patient’s Charter will tell you how to register a complaint about GP or hospital treatment.

I am delighted to find from your manifesto for health that the Royal College of Nursing is thinking on very similar lines.

You have argued for:

– the right for all citizens to have access to good quality services;

– the need for services to be matched more clearly to need;

– the need to empower consumers, for example by providing information on the range of services available locally in language people can understand;

– the need to inform patients about their diagnosis and to secure their consent to treatment and participation in research programmes;

– the need for patients to be informed of the likely waiting time for treatment and given a guarantee that their wait will not exceed a stated maximum.

It gives me great confidence to know that the driving force for delivery of service in the NHS does not need persuasion of the merits of the Charter approach. It is already your approach. This makes it much more likely that things will happen.

It is, at last, becoming properly recognised that nursing as a profession is a key complement to medicine. Highly trained nurses are now the deliverers of care to cancer patients, to diabetics and to many others. In a number of areas nurses are running their own clinics. Nursing is becoming more specialised as nurses develop and extend their roles in both physical and psychological care. All these changes must make for the more effective use both of their skills – and those of doctors. Most important of all, it benefits patients and improves the choice available to them. I thoroughly welcome such developments and look forward to seeing them grow.

Previous winners of these awards have provided us with examples of how nurses have pushed further their traditional role. They were innovators who had developed, for example:

– new skills in counselling and support;

– a programme of higher quality care for elderly patients with mental illness problems;

– new arrangements for parent support and communications; and

– a highly effective nurse-led service for those suffering from leg ulcers.

Just a few examples of nurses carving out a new, improved and distinct role for themselves and raising the quality of care which patients receive. I know that when we hear the achievements of tonight’s winners there will be more excellent examples.

For its part, the Government has reaffirmed its commitment to the development of nursing practice. William Waldegrave announced at the RCN Congress in May that he was making £3.2m available over the next five years for the development of Nursing Development Units and the concept of patient centred nursing care. I know that Ann Poole here is working closely with the Kings Fund, the NHS and professional organisations to develop this initiative.

Madam President, Christine Hancock was kind enough to attend my seminar at Chequers where we discussed the then proposed health strategy. As all of you will know, we published the consultative document “The Health of the Nation” in June.

That document was widely welcomed. The strategy seeks to strike a much better balance between prevention, treatment and rehabilitation. By setting national and local targets, I am confident the strategy will help tackle some of the main health problems of our time, for example reducing the amount of heart disease and cancers.

But if the strategy is to succeed we need your help. The initiative is directed towards improving health in the widest sense. Not just through better diagnosis and treatments in doctors surgeries and in hospitals, but through preventive measures and more effective rehabilitation. Nurses, midwives and health visitors are also uniquely well-placed to get these messages across. That is why you must be involved in the planning of the strategy. The Department of Health is consulting widely on this initiative until the end of October. I hope that each of you will make your views known.

So far, I have spoken mainly of the National Health Service of which we are all rightly proud. However, we must not overlook the important contribution which the independent health care sector makes in giving people a choice about how their health care needs are met. Moreover, in recent years we have seen many examples of co-operation and collaboration between the sectors, including some in the field of nurse education. These initiatives flourish through joint commitment. I am delighted with your achievements to date and urge you to continue your efforts.

I believe that there is much more scope for collaborative ventures between the private health sector and the NHS. Although it is not a new development, the reforms will make this easier. For example, for some time the private sector has been an important supplier of elderly care to the NHS. Such developments provide choice to those buying services, and help to sustain standards. They ensure that we get the best possible value for every pound of taxpayers money spent on health care.

Madam President, this evening we must thank BUPA and the Nursing Standard for sponsoring and organising these nursing awards. The Nursing Standard is not only run by nurses, it is owned by them through the Royal College.

I understand that the College is celebrating its 75th anniversary this year. I congratulate you, your predecessors, and officers and members of the College, on the many successes which the organisation has had through the past 75 years. You have an enviable reputation as a College and I have no doubt that will grow further in the future.

This evening I have touched on a wide range of nursing issues in my remarks. But the main theme has been that nurses, midwives and health visitors are at the very heart of health care. They have more direct contact with patients and with their families than any other health profession. Their responsibility for the well-being of the patient and family is critical. Their role in health care is quite unique. No one forgets the nurse who looked after them in hospital; the midwife who delivered their first child; the health visitor who checked mother and child thereafter. I would like to say thank you to all who work so hard and with such skill in the NHS and private sector. I wish you well for the future.