Alan Milburn: The NHS needs cultural change

From a speech by the Health Secretary to the Social Market Foundation

Money alone cannot deliver the modern, responsive health services our nation needs. The NHS has cultural barriers to progress that must be overcome if it is to reach its full potential. That can only be achieved through reform. For half a century, uniformity of provision has not guaranteed equality of outcome. Too often, the poorest services are in the poorest communities. The hard fact is that for 50 years it has been poorer people who have lost out from poorly provided public services.

The route to patient choice lies not through more healthcare charges but through big cultural changes. The cultural changes which redesign services around the needs of patients so that they are able to make choices about where and when and by whom they are treated. And so that NHS patients can make that choice free of charge, within the NHS.

So it is right to be bold on reform. But boldness is not an end. It is a means to an end. It should be about making health services more responsive so they can provide more opportunities for the communities they serve. That is the purpose of our reform programme in general and NHS Foundation Trusts in particular.

To meet that challenge, we've got to move on from the one-size-fits-all, take-it-or-leave-it, top-down health service of the 1940s towards an NHS which embraces devolution, diversity and choice – precisely so that its services can be more responsive to the way the world is today. Unless we do so, more and more of the public will simply walk away from public services, eroding the national consensus that supports them.