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David Cameron: Speech to the Royal College of Nursing

It's great to be here today. I want to talk to you about the institution that you devote your lives to, and that I owe so much to.

The NHS. I want to explain how our plans for our health service fit into our wider vision for the country...

...the change this will bring...

...and what it means for you and your colleagues in nursing.


Our vision for the country is based on one simple value: responsibility.


Because when you spool back to the source of so many of our problems today, you'll find the same cause: a lack of responsibility.

In our economy, some bankers asked what they could get away with and not what was the right thing to do...

Some individuals racked up debts on credit cards and ignored the inner voice that told them it was wrong...

And the Government borrowed and borrowed as if pay-back day would never come.

There has been a terrible failure of responsibility in our society, where so many fathers leave their families to fend for themselves because they've lost all sense of duty...

...where welfare is too often a lifestyle choice and not a last resort...

...and where neighbours shut the door on problems in their communities, waiting for someone else to sort them out.

We've also seen a denial of responsibility in our public services, where nurses', doctors', teachers' professional judgement is undermined by the tyranny of top-down centralised control.

And of course as everyone can now see, politicians have failed to uphold their responsibilities.

It is the responsibility of those we elect to behave properly.

Not just legally.

Not just within the rules.

But to the highest ethical standards.
People who stand for public office put themselves forward as people who will rule over the rest of us.

When so many of the problems that face our country - like debt, like family breakdown, like crime - are at their heart questions of individual behaviour and personal responsibility...

...then it is not just morally desirable but politically essential that our representatives set a good example.

A lack of responsibility - and a low expectation of responsibility - have led us to our battered economy, our broken society, our beleaguered public services - and our broken politics too.

So our mission is clear: to spread responsibility to every area of national life.

That's what I mean when I say, as I have for many years now, that the modern Conservative Party stands for social responsibility not state control.

We want to bring responsibility to our economy by making the country live within its means, bringing law and order to the financial markets and by building a new economy based on savings and investment not borrowing and debt.

We want to bring responsibility to our society by strengthening and supporting families and transferring real power to neighbourhoods and communities.

Brick by brick we will build a more responsible country...

...where obligation and duty are common currency...

...where everyone understands that life is about 'we', not just 'me'. 


And central to that vision is the NHS.

What clearer expression of responsibility can there be than a country that comes together to look after its hurt, its sick, its frail, its elderly?

What a fantastic fact of British life that the moment you're injured or fall ill, you know that whoever you are, wherever you're from, whatever's wrong, however much you've got in the bank...

...there's a place you can go where people will look after you and do their best to make things right again.

The NHS is an expression of our social responsibility, our shared responsibility.

It's why we all feel so passionately about it.

And this is very personal to me.

My son Ivan spent a lot of time in hospitals, and being cared for at home by NHS staff.

The people who were there for us day in, day out were our local community nurses.

I cannot begin to tell you how important that support was.

Not just for the practical things, like finding a special school, arranging for night care, recommending the right treatment...

...but for the emotional things, too - listening, reassuring, just being there with a friendly face on a difficult day.

They are absolute stars, and what it taught me is this.

When the nursing is good, the care is good.

It is the quality of nursing that determines the quality of care.

I can't imagine the number of lives that the people in this room have touched through their work.

So before I go on I want to say thank you for everything you do.


But those who think my commitment to the NHS is down to some personal attachment alone - they're wrong.

I've been a passionate supporter of our health service since long before my children were born.

And there's another mistake that some people make.

There are those who think we're committed to the NHS just for political reasons.

That we've made some calculation about what people want to hear.

But that's not how I work.

Last Autumn, if we'd asked a focus group whether to back the Government's VAT cut, people would have said yes.

But we said no because we believe that borrowing money to spend on a fiscal stimulus is reckless and wrong when you are already so in debt.

At the last election, our party had a popular position on university tuition fees: we said we'd abolish them.

I changed that position because it wasn't realistic or responsible - so now we have an unpopular position, but the right one.

When we made the environment a political priority, green issues were pretty low down on people's personal priorities - and frankly still are. 

That doesn't put me off because we have an environmental responsibility to future generations, whether it's popular or not with this generation.

And I expect I'll go to my grave being taunted for saying the truth: that if some of our children were shown more love at an early age, they'd be less likely to get caught up in crime.

My point is, we don't take positions based on what's popular, but on what we believe to be right.

When it comes to the NHS, my commitment comes from a deep philosophical belief, a belief in mutual responsibility.

So let me make something clear, in terms that will no doubt disappoint some who dream of replacing the NHS with a different system.

The reason we've ruled out changing the NHS to some kind of insurance-based system is not because I'm afraid of saying things the public won't like.

There's no plan in the back of my mind to soften people up for ditching the NHS a few years after we've won an election.

So those who might be pinning their hopes on a Conservative government, in the end, introducing insurance-based healthcare in Britain: you've got the wrong guy.

It's not going to happen.

Not in one year, not in five years, not ever as long as I'm in charge because I believe in the NHS and I want to improve it for everyone.

So there will be no change to the fundamental principle of a National Health Service free for everyone at the point of use.

Full stop. End of story.


But no change to the principle of the NHS doesn't mean no change within the NHS.

I don't want anyone to mistake my commitment to the NHS system for a commitment to blindly accepting the status quo.

We have plans to improve the NHS because as you know better than most, the NHS needs improvement.

When health inequalities are wider than they were in Victorian times, it's clear we need change.

When more people die each year from hospital infections than road accidents, it's clear we need change.

When we see terrible tragedies like those at Mid-Staffordshire, where it might be that as many as 1,200 people died needlessly, it is starkly clear that the NHS needs change - and we are determined to bring it.

But first I want to tell you what we're not going to do.

There will be no more of those pointless re-organisations that aim for change but instead bring chaos.

Too often Ministers have re-arranged the NHS like they're just shuffling a pack of cards and not the nation's largest employer.

Out went the NHSE and in came the DH.

Then the 28 SHAs became 10 SHAs.

Out went FHSAs and in came PCGs.

Then the PCGs were replaced by PCTs.

The recent history of the NHS reads like a bowl of alphabetty spaghetti.

But it's not funny, it's profoundly disruptive and demoralising.

It reveals an attitude to the NHS that sees it as just a massive bureaucratic machine to be taken apart and put back together again.

That is so wrong.

The NHS is not a machine.

It is all about people.

And the right way to get a better health service is by getting the best out of the people who work in it.


Our plan for doing that is based on our central belief, responsibility.

We need to give people the professional responsibility to get on with the job they signed up for.

In recent years that responsibility has been undermined.

You've had decisions taken away from you, bureaucrats second-guessing your judgements, targets to nanny your every move.

This approach just doesn't make sense.

First because when it comes to care, there is no one-size-fits-all model that can be drawn up in Whitehall.

It wouldn't fit the patient causing trouble on the ward...

...or the pensioner who needs company more than they need medicine...

...or the child in A&E who's covered in strange bruises.

The target and the rulebook can't help you with these things.

The millions of human dramas that pour through the doors of the NHS need different responses, on-the-spot decisions, professional initiative, judgment, discretion.

And the top-down, target-led, untrusting approach doesn't make sense because those who come to work in the NHS are, by their very nature, responsible and compassionate people.

Nurses, doctors, cleaners, therapists, physios, porters - you weren't drawn to your job for the perks or the uniforms, you came in because you wanted to care for people.

The motivation is there, the compassion is there, the skills are there, now you just need to be given the trust and the tools to get on with your job.

So we're going to scrap all those top-down, centralising, interfering targets that undermine your professional responsibility.

But that doesn't mean there won't be any accountability.

We don't have some naïve view that you can put taxpayers' money into the health service and just hope for the best.

But instead of bureaucratic accountability, we want to see democratic accountability.

Instead of being obsessed with processes, we will be obsessed with results: the health outcomes that really matter to people.

What are my chances of living independently if I have a stroke?

How long will my Dad survive if he gets cancer?
What are my chances of surviving from heart disease?
That's what patients care about and that's what you care about as nurses.

So we'll make sure that information is collected and published.

No one in the health service should be frightened of publishing more information and giving patients greater choice.

It's a positive thing because it brings healthcare up to date with the way we live our lives today.

When people find out they've got an illness the first thing they do is look it up online - and they should be able to do the same for treatment too.

And publishing outcomes is also a good thing because it's going to make people healthier.

It's simple - when patients not only have the power to choose where they get treated but also the information  to make an informed choice, then hospitals and GPs that don't provide good care will have to raise their game.

More professional responsibility backed with real accountability is a recipe that's going to save lives - and that's why we're so passionate about it.


We've made the argument about the values we will bring to improve the NHS.

But I know that none of this will mean anything unless we have a nursing workforce that is dedicated, contented and fulfilled.

The sheer range of what nurses do today is incredible.

You have specialist roles from mental health, to accident and emergency, to neo-natal care.

You're doing more research and commissioning work.

You're breaking boundaries.

But with this great expansion has come a misconception.

It's the idea that we're faced with a stark choice about the direction of nursing...

...that we can either continue to professionalise nursing, with more clinical work and greater specialism...

...or we can "go back" to what they call traditional nursing, the bed-making and back rubbing of Florence Nightingale's day.

I think this is nonsense.

Professional skills and basic care aren't mutually exclusive - they strengthen each other.

In any one shift a nurse might take a 12-lead ECG, feed or turn the patients, administer intravenous drugs, supervise cleaning on the ward, do the rounds.

It's this across-the-board involvement that makes nurses so valuable.

So yes - the caring tasks will always be important and yes, with them nursing can rise as a profession.

But for this to happen - and for nurses to exercise real professional responsibility - I believe we need to focus on three areas: training, time and respect.


First, training.

There are two specific areas of concern right now.

In just a couple of years' time, everyone who wants to become a nurse will have to do a degree.

If that helps to raise professional esteem, that's a very good thing.

But there is the danger that all-degree training might put some people off.

The teenager who's got a handful of reasonable GCSEs and just wants to care for people.

The busy mum who hears the word degree, pictures the typical undergraduate and thinks - that's not me.

We need to make very sure that the doors to nursing are open to all.

That's why we're looking at turning the degree from one big course into smaller modules, so it's a steady ramp into nursing and not an intimidating step up...

As well as making training more accessible we've got to make it more practical.

I met a nurse the other day who told me she'd been frustrated on her course.

They did whole modules on theoretical subjects like 'cycles of reflection' and 'followership' when what she was aching to learn was the practical, anatomical stuff.

How the lungs work, how the heart works, how to start it if it stops.

There's no better way to learn about these things than by putting down the textbook and getting practical training with living, breathing human beings.

But too many of today's placements don't give student nurses the practical experience they need.

They're stuck in the role of observer, feeling more like a spare part than a helping hand.

We've got to find a way to make training more practical - not just for the student nurse, but for the qualified nurses who could do with the support.

Because another major challenge facing nurses is time - or rather lack of time.

<h2>TIME </h2>

More time is essential if nurses are to keep on top of those basic caring tasks - the ward round, the bedside chat.

People are quick to criticise nurses for not doing these things, but this is just so unfair.

It's not because they don't care, it's because they don't have time.

A recent RCN poll showed that nurses spend a million hours a week on bureaucracy.

A million hours a week.

So scrapping all those box-ticking targets is going to make a big difference.

And if we're in Government we're going to make sure that each hospital has high-quality admin staff to do all those secretarial jobs that waste your time.

What it comes down to is this.

If we're giving you more professional responsibility we understand that you need more time to make careful judgements and do the job as thoroughly as you want to.

<h2>RESPECT </h2>

And we also understand that you can only exercise that responsibility in an atmosphere of respect.

Yes, you knew this job would be tough at times when you signed up.

But too often nurses have to work in conditions that are confrontational and even frightening.

Last year over 55,000 NHS staff were physically assaulted.

I've heard from nurses who've started their shift in tears, locked in the toilet, overwhelmed by the hostility outside.

It is outrageous that our professionals have to put up with this.

We're going to accept nothing less than a zero tolerance approach to those who attack NHS staff.

That means prosecution as standard practice - with the attack regarded as an aggravated offence.

I want to see this stamped out.

And as well as feeling free from threats of violence, we need nurses to feel free to speak out about their workplace.

One in three nurses has suffered lasting damage to their career for raising a concern with a colleague.

We are going to protect people from intimidation and crack open that closed culture by giving those who want to speak out a contractual right to do so.

Zero tolerance on violence and a clear right to have your voice heard.

This is not just about justice - it's about sending out a powerful signal that these are our dedicated professionals, they do a difficult and crucial job and they must be treated with respect.


Because we will never forget - a strong staff of nurses is the heartbeat of any hospital, any clinic, any surgery.

It is the patience and care of nurses that nurses patients back to health.

And if we're in government, you have my word that we will do everything we can to support you in that...

...just as we will support our NHS.

It's been called a kind of secular religion, and I don't think that's far from the truth.

We have faith in it.

We believe it shows the best of the British spirit.

We belong to it together.

And together, let's make it even better.

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