Wes Streeting speech to NHS Confederation

Thank you for inviting me to speak here today.

Even if the NHS weren’t in the midst of the worst crisis in its history, which it objectively is, and even if the public finances weren’t in a terrible mess, which they are, my argument is that we would still need to be talking about how we build an NHS that’s fit for the future – equipped to deal with the health needs and epidemiology of the Britain of 2048, not 1948.

But the depth of the crisis in our NHS and the state of the economy makes the conversation about change and modernisation even more urgent and vital.

You don’t need an extended diagnosis of the morbid symptoms from me. You are faced with the consequences of a crisis everyday. Instead, I want to use this time to offer some light at the end of the tunnel.

Today, I want to talk about some of the amazing opportunities available to the NHS now and in the coming years.

The revolution that is taking place in medical science, technology, and data that has the potential to transform our healthcare.

There is no reason why we should not be leading the rest of the world in this field.

But too often it feels as if the NHS is stuck in the analogue age.

There are a number of reasons for this, but the main one is failure from the top. A government that cannot effectively reform the health service because it is unwilling, unable, and too distracted.

The chaos in the Conservative Party makes plans for long-term change impossible. I have faced four different Health Secretaries in the past year alone, although to be fair, two of them have been Steve Barclay.

And how can NHS leaders stabilise the system and build a path to a better future, when you are constantly firefighting or dealing with instability, uncertainty and bad political leadership?

The junior doctors’ strike this week is likely to be one of the most disruptive in the history of the NHS.

More than half a million patients have already seen their operations or appointments cancelled as a result of industrial action.

Waiting lists that should be falling by now continue to rise.

Yet the Government continues its disastrous approach of refusing to negotiate with NHS staff.

Rishi Sunak's approach has failed. It may suit the Conservatives to blame rising waiting lists on strikes, but it doesn’t suit the NHS and it doesn’t suit patients. So my message to the Prime Minister is: take responsibility, get around the table with junior doctors yourself, and negotiate.

If Rishi Sunak can spare an hour to negotiate with Boris Johnson over the honours list, he can sit down with junior doctors and negotiate an end to these strikes.

And yes, this is partly about pay. I know for junior doctors this is about progression, too. That is why the NHS workforce plan needs publishing urgently. But I was struck last week by comments from Tom Roques, the Vice President of the Royal College of Radiologists. He said the single change that would help most to retain doctors is better IT. For every patient he sees, he has to enter seven passwords just to get the information he needs. Every time. He said the technology on his phone makes his life easier, but IT at work makes his life more complicated.

Our health service is being held back by creaking, outdated technology. You know it, frontline staff know it, patients know it. It is time for an upgrade.

In 2018, the Conservatives banned the purchasing of new fax machines. Five years on, 600 of these slow, inefficient machines are still in use across dozens of trusts.

In 2013, the then-Health Secretary pledged to make the NHS paperless by 2018. Four years later, he admitted he was, and I quote, “quite relieved that most people seem to have forgotten that I made that promise.” Jeremy Hunt’s reward was promotion to Foreign Secretary, and today we can all rest easy knowing that this expert in failure is only in charge of the Treasury. Meanwhile, hours of staff’s time is wasted, patients experience worse care, and taxpayers’ money is effectively chucked down the drain. I’ll give an example: Zubir Ahmed, Labour’s candidate in Glasgow South West, a surgeon, told me an all-too-familiar story about his frustration of accessing a PDF file with his patients’ notes, only to find they’d be scanned in the wrong order, which meant he had to print them out and reorganise them to get the information he needed. Multiple the time lost by him and others and it’s not hard to see the volume of lost time. Staff time and public money, both of which are in short supply. 

And as Labour’s research reveals today, almost 80% of trusts are still running on pagers, with 80,000 of them in use across England. This is technology that is so obsolete, there is only one supplier of pagers left. A new pager today costs up to £400. At last count, 1 in 10 that are still in use across the world is owned by the NHS. I’m sorry, but this is not what an NHS fit for the future looks like.

So, it’s a bit rich for Rishi Sunak to promise to make Britain a world leader in AI, when he can’t even axe the fax or purge the pager.

These failures may sound trivial, but this is the low-hanging fruit. If they can’t do the basics, what chance is there to seize the opportunities that exist today, but aren’t being taken? New technologies available right now, but not on the NHS. The coming years will see innovations that will change the face of healthcare, but how long will it be before patients here see the benefits?

There are now tools which can map radiation therapy onto cancer cells, avoiding organs more precisely than a radiologist working alone. And it does it in seconds, rather than the hour it takes a doctor. This is the standard technology used across the United States. But just one in three radiotherapy planning centres in England use this technology.

There are between 1 and 2 million mammograms done across the UK each year. 96% will not find cancer. But those women are currently left in the dark for weeks, or even months, waiting for the results. Why the hold up? Because two clinicians are required to check them, and there is a workforce crisis. But AI can rule out cancer-free scans in seconds, getting patients their results faster and freeing up clinicians to focus on the tests displaying abnormalities.  This has been rolled out across Hungary since 2021, but not across the NHS.

AI can help interpret chest X-rays, saving 15% of a radiologists’ workload. When combined with interpretation by a consultant radiologist, it can reduce missed lung cancer cases by 60%. Yet to be fully adopted by the NHS.

I’ve said before that the future of the health service must see more care taking place in the community, reducing the burden on hospitals, and allowing patients to receive healthcare from the comfort of their own home. But slow adoption of technology is working against that. At-home tests for kidney disease that use smartphone apps can cut down on unnecessary trips to the GP and hospital, while helping to detect problems earlier. So why are they available to only half of NHS patients?

Clinical trials can now identify ideal candidates using genomics. But trials can’t recruit enough people to take part. Not because patients aren’t willing to help develop new treatments- we saw during the pandemic that the will is there, when more than half a million people signed up to the vaccines trials registry. It’s because companies running trials can’t access basic data, like how old patients are, or whether they are still alive. They have to work up agreements with each trust, rather than a single agreement with the whole of the NHS. Patients are missing out on new medicines, life sciences is losing investment, and the NHS loses revenue.

There is a huge cost of inaction.

Yes, the workforce crisis in the NHS can be tackled by getting more people in. That’s why Labour is committed to double medical school places, and train 10,000 more nurses and midwives, paid for by abolishing the non-dom tax status, as well as focusing on workforce planning.

But that will take years. The technology that exists today can instantly free up staff, make their working lives more bearable so they stay in the service, and deliver better, faster care for patients at the same time.

The IPPR estimates that automation could be worth £12.5 billion to the NHS, in staff time freed up and better productivity. At a time when the cupboard is bare, because the Conservatives crashed the economy, this is a lifeline the health service cannot afford to miss.

Of course there are those who argue that it’s the NHS itself that is outdated. That the values of a universal public service, free at the point of use, its past its sell-by date. The irony is that, as a universal, single-payer service, it ought to be the best placed healthcare system in the world to take advantage of changing technology and medicines.

One that can give the life sciences sector access to a diverse and large population to trial new treatments and technologies. One that ought to be able to negotiate a good deal on price with a good offer to purchase at scale in return. One that should give our patients access to cutting edge breakthroughs in treatment and care. 

Clement Attlee and Aneurin Bevan would have had no idea when they built the NHS 75 years ago. But the values on which they built it – universal healthcare, free at the point of need, publicly funded – are more relevant today than they were in 1945. And they give the NHS a huge advantage. The problem is, they would also recognise too much of the NHS today. Nye Bevan said the NHS always needs to be changing, improving. But over the past 13 years, it has stalled.

Why? Because the Conservatives can never effectively reform the NHS. They opposed its creation because it was built on values that they simply do not share. Just look at what they say once they’re out the door- both Matt Hancock and Sajid Javid called for patients to be charged for appointments, months after leaving the Department of Health.

In office, the Conservatives are paralysed by fear, because they know the public will never support a health service built on their values. So the story of every Conservative government is the same. Managed decline and neglect of the NHS. The health service left to wither on the vine. Necessary reforms ducked.

As ever, it will be left to a Labour government to renew the health service and make it fit for the future. Just as only Nixon could go to China, only Labour can reform the NHS.

In his speech last month, Keir Starmer made it the mission of the next Labour government to build an NHS fit for the future. He committed us to shifting the health service out of the analogue age and into the digital.

Here’s how we will do it.

A single front door for innovators. No more shopping products or trials to each and every NHS trust. Where they can help, we will hold the door open and usher you through.

In procurement, the NHS should identify the goods and services that should be purchased at scale and buy them at the discount rate. We will cut out unnecessary bureaucracy, to stop new technology being constantly re-evaluated for years while the world moves on.

In clinical trials, every trust will operate through a standard system, so the number of contracts needed is minimised, and the administrative burden is eased for all involved.

And we will make proper use of the NHS app.

I was blown away when I visited a medical technology conference in Israel last year. They are 10 years ahead of us. Ambulances use cameras and mobile phone apps to speak to patients and improve response times. Tracking of ambulances means that patients are greeted on arrival at hospital by the appropriate healthcare professional.

When I showed the NHS app to people at the conference, they laughed.

It’s got 30 million users. Time to use it properly.

Every patient should be able to see their medical records through the app.

Patients should be able to use it to book appointments, order repeat prescriptions, and link to appropriate self-referral routes.

When patients reach an age at which they should be screened or need a check up, the app should ping them.

If you’re eligible for a clinical trial, the app should tell you, and you should be able to enrol through it.

That’s what we can do centrally. But I know we will not see the change that’s needed, unless it is the mission of NHS leaders too.

Too often I hear that it is easier to say no to change in the NHS than it is to say yes.

That really worries me.

To make it fit for the future, the NHS will have to change. The change will have to be deep and fundamental. Not a few more doctors and nurses here, a bit more funding there. Serious reform and modernisation. A different way of delivering care for patients. Out of the hospital and into the community. From a service focused on treating sickness, to one that prevents ill-health. From analogue to digital.

Throughout its history, the NHS always changed, adapted and pioneered. It is rooted in the DNA of the NHS. And look at what can be achieved when the NHS says yes to change:

• The first mass immunisation programme in 1958, virtually eradicating polio and diphtheria
• 1968, the first heart transplant
• 1978, the first test tube baby, bringing hope to childless couples
• 1998, the introduction of NHS Direct – healthcare advice available to all 24/7 for the first time
• 2000, NHS walk-in centres
• 2009, free health checks for over 40s
• 2010, a British pensioner, Kenneth Crocker, became the world’s first patient to have heart surgery using a fully remote-controlled robotic arm.
• 2019, The world’s first gene therapy operation for common cause of sight loss, carried out by researchers in Oxford.

This isn’t about changing the principles the NHS was built upon. Rather, it must change to protect those principles and to deliver for patients once again.

When I talk about the need for reform, I can sometimes hear shivers running down a million spines in the NHS.

You've had Andrew Lansley, whose 2012 Act has left much of the health service with post-traumatic stress disorder triggered by the word ‘reform.'

You didn’t just get through the pandemic, you got our country through the pandemic, for which we owe you a debt of gratitude.

You're chronically understaffed, burnt out, and struggling just to keep the show on the road.

I do understand the reaction that says ‘Please, not more.’

But the risk of failing to modernise is that the service will be left to wither on the vine.

The NHS fails to secure the advantages of AI and new medicines for its patients, but private healthcare does. The two-tier system that is emerging in our country today grows, the gap between public and private widens, and the NHS becomes the poor man’s service. That is the future we must avoid.

Instead, we can secure the benefits of the technological revolution for the many, not just the few who can afford to pay.

The prize for modernisation is huge.

Those junior doctors out there on the picket lines today have never worked in an NHS performing at its best, but many of you have.

You know what’s possible, because you delivered it. Working with a Labour government to deliver the shortest waiting times and highest patient satisfaction in the NHS’s history. 

You did it before, we can do it again. And despite the obvious challenges, far greater than they were in 1997, if we get this right, working together, to put the NHS at the forefront of the revolution in life sciences and medical technology unfolding before our eyes, we can say confidently as the NHS celebrates its 75^thanniversary that the best is yet to come. 

Thank you