"The Choice: Investment in the Health Service"
This is the second in a series of speeches I am making about the choices facing Britain. Before I come to the main issue I want to address today - nursing in the NHS - I want to set it all in a wider context.
When we came to office we identified these key weaknesses in Britain.
1. Chronic instability in our economy, boom and bust, periods of growth then followed by recession that had given us high interest rates, a doubled national debt, high unemployment, with business and Government often unable to plan ahead financially.
2. Chronic under-investment in our public services, like schools, hospitals, police and transport.
3. Chronic social division, with one in five non-pensioner homes having no-one working within them, and four million children and 2 million pensioners living in poverty.
These weaknesses were fundamental. They required long-term solutions. They involved and still involve tough choices. One of the most frustrating aspects of modern politics is that you seldom get the chance, even as Prime Minister, to engage the public in a serious and detailed conversation about the choices you face. Yet understanding these choices and calling them the right way, is of the essence. Because each one is a fork in the road, in the journey of renewal of Britain. The right turning will take us further along the road. The wrong one leaves us stranded. So the choices of direction are vital. They are long-term and they are hard.
If we want a better NHS and more nurses in it, better paid nurses, we need to have the money to pay for it. We can only get the money if the economy is strong. And the economy can only become strong if we take the decisions necessary to strengthen it. We have to earn before we can spend, in public life just as in our household expenses as individuals.
So back in May 1997 we took two fundamental choices. We gave the Bank of England independence in setting interest rates. We set tough new spending rules which meant we could get out of serious debt, and couldn't go back in it again. Together they have revolutionised British economic management. Politics can't be played with interest rates. Governments can't spend what they can't afford. The aim was to give such confidence on economic management to markets and business that we would avoid the boom and bust of the past. Today, we are now the fourth biggest economy in the world. Inflation is the lowest in Europe. Interest rates that used to average ten per cent, average six per cent. Employment is the highest, unemployment the lowest for over 20 years. We have paid off a vast amount of national debt. But it all came from a choice.
We made another choice. Through the New Deal, the Minimum Wage and the Working Families' Tax Credit, and special help to people being made redundant, we put one million people into work and made it pay, so saving vast sums in benefit. So more people are working, paying taxes not being paid benefit, and the Treasury is in surplus.
But it all came at a price. It meant two, nearly three, tough years on public spending and some unpopular decisions like keeping the fuel duty escalator, to cut down the borrowing requirement. It meant that we didn't start really to invest in the NHS in the way we wanted until this year. So you were working flat-out and often still are in an NHS that was under-funded.
But as a result of the tough decisions, when we did start to invest, we could do it in a way that lasts. We now have a four year programme of investment which will grow NHS spending by a third more. Not feast then famine but steady, sustainable growth over a number of years. Why? Because it is built on the foundation of a strong economy.
Likewise we are investing massively and sustainably in education, transport, science and technology. All this investment is vital. I said the British economy was strengthening. But it is not as strong as it can be. We need to raise productivity. To do that we need to raise skills, to develop our most important national resource: people. This investment is the best guarantee of future prosperity for all.
However, again, it represents another turning in the road, another choice of direction. We did what we responsibly could to help motorists and hauliers on Wednesday, but we did it in a way that did not put at risk either economic stability - which helps businesses and our mortgages - or our programme of investment. That too is a choice. We have chosen the path of investment. And I say to the fuel protesters and others: we understand your concerns, we are happy to carry on in dialogue with you, but we have done as much as we responsibly can. We cannot and will not reverse the choices we have made for stability not boom and bust, and investment in our public services, not cuts. Because those are the best long-term choices for Britain's hard-working families.
There is another choice. We have insisted that investment in public service is accompanied by reform. It will make our railways safer and better as we put in ??180 billion over the next ten years. It will make standards in school rise year on year. Investment in sport will produce more success stories for Britain and more opportunities for our children. Investment in childcare enables mothers to balance work and family. Investment in our communities makes our country more civilised, and brings people together. And of course investment in our NHS - buildings, equipment, salaries, more staff, will bring peace of mind to millions of patients and a better life for those who work in the NHS.
I believe investment brings not just a stronger society but strengthens our economy. If we invest we prosper.
That is what the NHS Plan which we published in July was all about.
The vision was an NHS re-designed around the needs of the patient, with a staff whose dedication would finally be matched by the conditions and modern working practices they deserved.
Despite the media concentration only on what is wrong in the NHS, I believe the glass is half full and not half empty. Yes, there are still real problems and enormous pressures. But step by step, there is also change and improvement.
Monday saw the publication of the latest waiting list figures for inpatient treatment. Down for the fifth month in a row, to 126,000 below the level we inherited. The number of people waiting over 13 weeks for their outpatient appointment is also down - by 9,000 since June.
Waiting lists will rise during winter as they always do, as the health service switches part of its capacity to focus on winter ailments and emergencies. But the downward trend will then continue. Waiting lists are 52,000 lower than at the same point last year and 182,000 than the year before.
Other improvements are also starting to come through. New hospitals in Carlisle, Dartford, Wycombe and Amersham open, with many more on the way as Alan Milburn will set out next week. 159 schemes to modernise accident and emergency departments completed and 83 under construction. 139 rapid access chest pain clinics open by the end of next March. Every health authority funding the proper drugs for breast and ovarian cancer treatment. Modern ward matrons with their own budget. Over 300 extra critical care beds for this winter. A big hospital clean-up campaign under way. The Commission for Health Improvement inspecting hospitals. And new services such as walk-in centres and NHS Direct - in which nurses have played such a leading part - up and running.
None of this could have been achieved without the effort you and your colleagues up and down the country have put in. And as Alan Milburn will set out next week, when he announces the health authority allocations for the next three years, this progress will continue.
Despite these improvements people say to me, why does it take so long? Can you not speed up the reform of the health service?
I understand people's frustration and impatience. But as those involved in recruiting nurses you know that the limits on how far and how fast we can go are firmly related to how quickly we can get in the extra staff we need.
Until we have the heart surgeons and cardiac nurses we need, we will not be able to cut waiting times for heart surgery to the level we want.
And if we cannot recruit the extra nurses and physiotherapists to staff extra beds and intermediate care facilities, then our expansion plans will remain just that - plans.
A modern patient centred health service needs a bigger workforce.
Again we have made a good start. Nearly 5,000 doctors and over 10,000 extra nurses in post compared with 1997. But we need more. A lot more.
The long term answer is to increase the supply of doctors and nurses from the training schools. That is why we have boosted the number of nursing and midwifery training places by over 5,000 with another 5,500 to come by 2004. And an extra 4,500 training places by then for other key health professionals.
By 2005 there will be up to another 1,000 medical training places on top of the first 1,000 that are already starting to come on stream.
The benefits of this investment are beginning to show. But it will take several years before we reach our target of having 25,000 nurses and midwives coming out of training every year. And it will take even longer before we get all the doctors coming through.
That is why, with your help, we have put so much effort into recruiting nurses and midwives back into the NHS. It is effort that is producing results, as the report that we are publishing today shows. Since February last year 5,800 nurses have come back to the NHS and another 2,470 are preparing to join them.
Some places are now reporting a reduction in the number of nursing vacancies. But there are still areas where there are significant staffing shortages.
Pay is one important factor in recruiting and retaining staff. Again we have been able to make progress. The basic pay of a newly qualified nurse has increased by 18% over the past three years - an increase over and above inflation of 9%. From April this year average annual earnings for fulltime qualified nurses - including allowances and overtime - are estimated to be over ??21,000.
The nurse shortages are not uniform across the country. They are most severe where there is full or near full employment and the cost of living is highest. So next week Alan Milburn will announce the details of an extra pay supplement for qualified nurses working in those areas. It will be worth a minimum of ??600, over and above London Weighting, for nurses throughout London and up to senior ??1,000 for senior nurses in the capital. In areas outside London, such as Bristol, Swindon, Oxford and Berkshire, nurses will receive on average in the region of ??500.
But pay is only part of the picture. Staff are also increasingly demanding that employers take account of other factors that affect their lives.
The NHS has to be to be seen as an attractive and good employer if it is to recruit and retain staff. Helping staff to square work and home responsibilities is not just socially responsible it is an economic necessity. In an era of near full employment public sector employers are in competition for skilled staff. They have to match the flexible approach of the banks, supermarkets, telesales companies and the best hospitals.
For example, in London and some other parts of the South East the cost of housing is a big concern. That is why the NHS has appointed a housing co-ordinator, John Yates. As a result of his work a staff accommodation bureau is up and running and plans are well advanced to open a staff hotel in central London.
In addition to this, I can tell you today that the Housing Corporation will shortly be inviting bids to implement the plans publicised earlier this year on affordable home ownership for key workers such as nurses, police officers and teachers. The Starter Home Initiative, worth ??250m over three years, will be available to fund a range of schemes to help key workers buy housing in high-cost areas. Schemes could include cash grants and new build homes.
Another concern is flexible working. A third of nurses have school age children. A recent survey by the RCN shows that for these groups the biggest single factor that determined whether they would stay in their job - bigger even than how much they were paid - was how flexible their working hours were.
A growing number of trusts are introducing flex pools that allow staff to adjust their work commitments to fit their domestic needs. They are showing that it is possible to do this and still make sure that staff who work more regular patterns get a fair deal.
But some trust managers and ward sisters have not got the message. We did it the hard way why should they have it easy, they ask. Flexible working is seen as a nuisance which those responsible for rotas would prefer to ignore.
We need a decisive and enduring change among public sector employers. The NHS Plan means that by April 2003 all employees in the health service will have the right to work for an organisation that can show it has adopted flexible working practices.
And to help this new culture take root I am announcing today a scheme to enable any nurse wanting to return to work in the NHS to take control over their working hours. Under this scheme nurse returners - and other nurses wanting to work on a casual basis - can choose to work as many or as few shifts as they like. The scheme will be operated under the banner of NHS Professionals. It will be based on the excellent initiative developed by the NHS Direct nurses in West Yorkshire.
Staff working though NHS Professionals will be entitled to holiday pay and to be members of the NHS pension scheme.
To start with the scheme will be targeted in 15 health authority areas with particular nurse staffing problems, to help them recruit part time staff during the winter months. In time NHS Professionals will link up with other trusts operating schemes of a similar standard to form a national service for staff wishing to work part time or casually.
As well as benefiting staff, NHS professionals will reduce the huge sums hospital trusts spend on agency fees - over ??350 million and rising.
NHS Professionals will have two other roles.
First, it will co-ordinate the initiatives to recruit and deploy nurses from overseas.
Second, it will pilot arrangements for co-ordinating the employment of locum medical staff and other professions - such as physiotherapists and radiographers - where sessional working is widespread. This will help to raise standards and deliver better value for money.
The third area where the NHS and other public sector employers have to up their game is childcare support. Fifteen per cent of nurses as well as tens of thousands of other NHS staff have children under school age. Their overriding concern is to know that their children are being properly cared for.
Some NHS trusts such as one in Sheffield have already appointed co-ordinators whose sole task is to help staff find the right child care arrangements. As part of the NHS plan every trust will by 2003 have to have such a co-ordinator in place.
Around half of trusts offer some childcare support for working parents. That is good but not enough. The NHS Plan commits us to having on-site nurseries at around 100 hospitals by 2004 and in September Alan Milburn announced the locations for the first 30. In addition the NHS Plan will ensure that from now on workplace cr??¨ches are an essential feature of every new hospital that is built.
Everywhere I go in the country I find nurses involved in change and pioneering new ways of working. The Chief Nursing Officer's 10 key roles for nurses roll forward that commitment to change. They provide nurses with a clear mandate to make the NHS a patient centred service. To mould services round the patient. To sweep away outdated obstacles and to adapt the nurse's role to fit what the patient needs.
Already we are consulting on extending nurses power to prescribe - one of those 10 key roles. And the Chief Nursing Officer will be bringing together all the nurse representatives of our NHS Plan taskforces, the Regional Nursing Directors and others, to form a Modernisation Group. Its remit will be to make sure that all parts of the health service put the 10 roles into practice.
The introduction of nurse consultants is also helping to drive change. They are helping to cut waiting for specialist services, introducing and spreading new procedures, improving the quality of patient care and pushing out the boundaries of clinical nurse practice.
There are already 232 nurse consultants in post or in the process of being appointed. Today I can tell you that later this month Philip Hunt will be announcing details of over a further 200 nurse consultant posts which have been approved.
The choice we have made - to invest in the NHS - is right. Of course it will take time, but each additional investment yields its dividend. The tough choices we made on entering office are now paying off.
And it is part of a wider vision: where we reach our destination of a Britain - strong modern and fair - that can offer prosperity to all. There are no short-cuts. The majority we won in 1997 was never a reason to rush it and fail; but to do the job properly. Stage by stage. Economic stability. Then putting people back to work. Then investment in our public services. Then help to those like pensioners who need it most. At each stage, a choice. A vital decision about the future. I believe we have made the right choices. And I believe that if we can explain those choices, the British people will make the right choice too.
This is the second in a series of speeches I am making about the choices facing Britain. Before I come to the main issue I want to address today - nursing in the NHS - I want to set it all in a wider context.
When we came to office we identified these key weaknesses in Britain.
1. Chronic instability in our economy, boom and bust, periods of growth then followed by recession that had given us high interest rates, a doubled national debt, high unemployment, with business and Government often unable to plan ahead financially.
2. Chronic under-investment in our public services, like schools, hospitals, police and transport.
3. Chronic social division, with one in five non-pensioner homes having no-one working within them, and four million children and 2 million pensioners living in poverty.
These weaknesses were fundamental. They required long-term solutions. They involved and still involve tough choices. One of the most frustrating aspects of modern politics is that you seldom get the chance, even as Prime Minister, to engage the public in a serious and detailed conversation about the choices you face. Yet understanding these choices and calling them the right way, is of the essence. Because each one is a fork in the road, in the journey of renewal of Britain. The right turning will take us further along the road. The wrong one leaves us stranded. So the choices of direction are vital. They are long-term and they are hard.
If we want a better NHS and more nurses in it, better paid nurses, we need to have the money to pay for it. We can only get the money if the economy is strong. And the economy can only become strong if we take the decisions necessary to strengthen it. We have to earn before we can spend, in public life just as in our household expenses as individuals.
So back in May 1997 we took two fundamental choices. We gave the Bank of England independence in setting interest rates. We set tough new spending rules which meant we could get out of serious debt, and couldn't go back in it again. Together they have revolutionised British economic management. Politics can't be played with interest rates. Governments can't spend what they can't afford. The aim was to give such confidence on economic management to markets and business that we would avoid the boom and bust of the past. Today, we are now the fourth biggest economy in the world. Inflation is the lowest in Europe. Interest rates that used to average ten per cent, average six per cent. Employment is the highest, unemployment the lowest for over 20 years. We have paid off a vast amount of national debt. But it all came from a choice.
We made another choice. Through the New Deal, the Minimum Wage and the Working Families' Tax Credit, and special help to people being made redundant, we put one million people into work and made it pay, so saving vast sums in benefit. So more people are working, paying taxes not being paid benefit, and the Treasury is in surplus.
But it all came at a price. It meant two, nearly three, tough years on public spending and some unpopular decisions like keeping the fuel duty escalator, to cut down the borrowing requirement. It meant that we didn't start really to invest in the NHS in the way we wanted until this year. So you were working flat-out and often still are in an NHS that was under-funded.
But as a result of the tough decisions, when we did start to invest, we could do it in a way that lasts. We now have a four year programme of investment which will grow NHS spending by a third more. Not feast then famine but steady, sustainable growth over a number of years. Why? Because it is built on the foundation of a strong economy.
Likewise we are investing massively and sustainably in education, transport, science and technology. All this investment is vital. I said the British economy was strengthening. But it is not as strong as it can be. We need to raise productivity. To do that we need to raise skills, to develop our most important national resource: people. This investment is the best guarantee of future prosperity for all.
However, again, it represents another turning in the road, another choice of direction. We did what we responsibly could to help motorists and hauliers on Wednesday, but we did it in a way that did not put at risk either economic stability - which helps businesses and our mortgages - or our programme of investment. That too is a choice. We have chosen the path of investment. And I say to the fuel protesters and others: we understand your concerns, we are happy to carry on in dialogue with you, but we have done as much as we responsibly can. We cannot and will not reverse the choices we have made for stability not boom and bust, and investment in our public services, not cuts. Because those are the best long-term choices for Britain's hard-working families.
There is another choice. We have insisted that investment in public service is accompanied by reform. It will make our railways safer and better as we put in ??180 billion over the next ten years. It will make standards in school rise year on year. Investment in sport will produce more success stories for Britain and more opportunities for our children. Investment in childcare enables mothers to balance work and family. Investment in our communities makes our country more civilised, and brings people together. And of course investment in our NHS - buildings, equipment, salaries, more staff, will bring peace of mind to millions of patients and a better life for those who work in the NHS.
I believe investment brings not just a stronger society but strengthens our economy. If we invest we prosper.
That is what the NHS Plan which we published in July was all about.
The vision was an NHS re-designed around the needs of the patient, with a staff whose dedication would finally be matched by the conditions and modern working practices they deserved.
Despite the media concentration only on what is wrong in the NHS, I believe the glass is half full and not half empty. Yes, there are still real problems and enormous pressures. But step by step, there is also change and improvement.
Monday saw the publication of the latest waiting list figures for inpatient treatment. Down for the fifth month in a row, to 126,000 below the level we inherited. The number of people waiting over 13 weeks for their outpatient appointment is also down - by 9,000 since June.
Waiting lists will rise during winter as they always do, as the health service switches part of its capacity to focus on winter ailments and emergencies. But the downward trend will then continue. Waiting lists are 52,000 lower than at the same point last year and 182,000 than the year before.
Other improvements are also starting to come through. New hospitals in Carlisle, Dartford, Wycombe and Amersham open, with many more on the way as Alan Milburn will set out next week. 159 schemes to modernise accident and emergency departments completed and 83 under construction. 139 rapid access chest pain clinics open by the end of next March. Every health authority funding the proper drugs for breast and ovarian cancer treatment. Modern ward matrons with their own budget. Over 300 extra critical care beds for this winter. A big hospital clean-up campaign under way. The Commission for Health Improvement inspecting hospitals. And new services such as walk-in centres and NHS Direct - in which nurses have played such a leading part - up and running.
None of this could have been achieved without the effort you and your colleagues up and down the country have put in. And as Alan Milburn will set out next week, when he announces the health authority allocations for the next three years, this progress will continue.
Despite these improvements people say to me, why does it take so long? Can you not speed up the reform of the health service?
I understand people's frustration and impatience. But as those involved in recruiting nurses you know that the limits on how far and how fast we can go are firmly related to how quickly we can get in the extra staff we need.
Until we have the heart surgeons and cardiac nurses we need, we will not be able to cut waiting times for heart surgery to the level we want.
And if we cannot recruit the extra nurses and physiotherapists to staff extra beds and intermediate care facilities, then our expansion plans will remain just that - plans.
A modern patient centred health service needs a bigger workforce.
Again we have made a good start. Nearly 5,000 doctors and over 10,000 extra nurses in post compared with 1997. But we need more. A lot more.
The long term answer is to increase the supply of doctors and nurses from the training schools. That is why we have boosted the number of nursing and midwifery training places by over 5,000 with another 5,500 to come by 2004. And an extra 4,500 training places by then for other key health professionals.
By 2005 there will be up to another 1,000 medical training places on top of the first 1,000 that are already starting to come on stream.
The benefits of this investment are beginning to show. But it will take several years before we reach our target of having 25,000 nurses and midwives coming out of training every year. And it will take even longer before we get all the doctors coming through.
That is why, with your help, we have put so much effort into recruiting nurses and midwives back into the NHS. It is effort that is producing results, as the report that we are publishing today shows. Since February last year 5,800 nurses have come back to the NHS and another 2,470 are preparing to join them.
Some places are now reporting a reduction in the number of nursing vacancies. But there are still areas where there are significant staffing shortages.
Pay is one important factor in recruiting and retaining staff. Again we have been able to make progress. The basic pay of a newly qualified nurse has increased by 18% over the past three years - an increase over and above inflation of 9%. From April this year average annual earnings for fulltime qualified nurses - including allowances and overtime - are estimated to be over ??21,000.
The nurse shortages are not uniform across the country. They are most severe where there is full or near full employment and the cost of living is highest. So next week Alan Milburn will announce the details of an extra pay supplement for qualified nurses working in those areas. It will be worth a minimum of ??600, over and above London Weighting, for nurses throughout London and up to senior ??1,000 for senior nurses in the capital. In areas outside London, such as Bristol, Swindon, Oxford and Berkshire, nurses will receive on average in the region of ??500.
But pay is only part of the picture. Staff are also increasingly demanding that employers take account of other factors that affect their lives.
The NHS has to be to be seen as an attractive and good employer if it is to recruit and retain staff. Helping staff to square work and home responsibilities is not just socially responsible it is an economic necessity. In an era of near full employment public sector employers are in competition for skilled staff. They have to match the flexible approach of the banks, supermarkets, telesales companies and the best hospitals.
For example, in London and some other parts of the South East the cost of housing is a big concern. That is why the NHS has appointed a housing co-ordinator, John Yates. As a result of his work a staff accommodation bureau is up and running and plans are well advanced to open a staff hotel in central London.
In addition to this, I can tell you today that the Housing Corporation will shortly be inviting bids to implement the plans publicised earlier this year on affordable home ownership for key workers such as nurses, police officers and teachers. The Starter Home Initiative, worth ??250m over three years, will be available to fund a range of schemes to help key workers buy housing in high-cost areas. Schemes could include cash grants and new build homes.
Another concern is flexible working. A third of nurses have school age children. A recent survey by the RCN shows that for these groups the biggest single factor that determined whether they would stay in their job - bigger even than how much they were paid - was how flexible their working hours were.
A growing number of trusts are introducing flex pools that allow staff to adjust their work commitments to fit their domestic needs. They are showing that it is possible to do this and still make sure that staff who work more regular patterns get a fair deal.
But some trust managers and ward sisters have not got the message. We did it the hard way why should they have it easy, they ask. Flexible working is seen as a nuisance which those responsible for rotas would prefer to ignore.
We need a decisive and enduring change among public sector employers. The NHS Plan means that by April 2003 all employees in the health service will have the right to work for an organisation that can show it has adopted flexible working practices.
And to help this new culture take root I am announcing today a scheme to enable any nurse wanting to return to work in the NHS to take control over their working hours. Under this scheme nurse returners - and other nurses wanting to work on a casual basis - can choose to work as many or as few shifts as they like. The scheme will be operated under the banner of NHS Professionals. It will be based on the excellent initiative developed by the NHS Direct nurses in West Yorkshire.
Staff working though NHS Professionals will be entitled to holiday pay and to be members of the NHS pension scheme.
To start with the scheme will be targeted in 15 health authority areas with particular nurse staffing problems, to help them recruit part time staff during the winter months. In time NHS Professionals will link up with other trusts operating schemes of a similar standard to form a national service for staff wishing to work part time or casually.
As well as benefiting staff, NHS professionals will reduce the huge sums hospital trusts spend on agency fees - over ??350 million and rising.
NHS Professionals will have two other roles.
First, it will co-ordinate the initiatives to recruit and deploy nurses from overseas.
Second, it will pilot arrangements for co-ordinating the employment of locum medical staff and other professions - such as physiotherapists and radiographers - where sessional working is widespread. This will help to raise standards and deliver better value for money.
The third area where the NHS and other public sector employers have to up their game is childcare support. Fifteen per cent of nurses as well as tens of thousands of other NHS staff have children under school age. Their overriding concern is to know that their children are being properly cared for.
Some NHS trusts such as one in Sheffield have already appointed co-ordinators whose sole task is to help staff find the right child care arrangements. As part of the NHS plan every trust will by 2003 have to have such a co-ordinator in place.
Around half of trusts offer some childcare support for working parents. That is good but not enough. The NHS Plan commits us to having on-site nurseries at around 100 hospitals by 2004 and in September Alan Milburn announced the locations for the first 30. In addition the NHS Plan will ensure that from now on workplace cr??¨ches are an essential feature of every new hospital that is built.
Everywhere I go in the country I find nurses involved in change and pioneering new ways of working. The Chief Nursing Officer's 10 key roles for nurses roll forward that commitment to change. They provide nurses with a clear mandate to make the NHS a patient centred service. To mould services round the patient. To sweep away outdated obstacles and to adapt the nurse's role to fit what the patient needs.
Already we are consulting on extending nurses power to prescribe - one of those 10 key roles. And the Chief Nursing Officer will be bringing together all the nurse representatives of our NHS Plan taskforces, the Regional Nursing Directors and others, to form a Modernisation Group. Its remit will be to make sure that all parts of the health service put the 10 roles into practice.
The introduction of nurse consultants is also helping to drive change. They are helping to cut waiting for specialist services, introducing and spreading new procedures, improving the quality of patient care and pushing out the boundaries of clinical nurse practice.
There are already 232 nurse consultants in post or in the process of being appointed. Today I can tell you that later this month Philip Hunt will be announcing details of over a further 200 nurse consultant posts which have been approved.
The choice we have made - to invest in the NHS - is right. Of course it will take time, but each additional investment yields its dividend. The tough choices we made on entering office are now paying off.
And it is part of a wider vision: where we reach our destination of a Britain - strong modern and fair - that can offer prosperity to all. There are no short-cuts. The majority we won in 1997 was never a reason to rush it and fail; but to do the job properly. Stage by stage. Economic stability. Then putting people back to work. Then investment in our public services. Then help to those like pensioners who need it most. At each stage, a choice. A vital decision about the future. I believe we have made the right choices. And I believe that if we can explain those choices, the British people will make the right choice too.