 Well, thank you, Joe, for an incredibly generous introduction that would have to come from someone who wasn't British. But he was very warm and very appreciated. Let me actually salute you because you also made a very, very big choice. Joe set up in a fabulously successful business and he could have stayed in his villa in Malibu or wherever it is looking at the waves lapping on the beautiful beaches of California and enjoyed himself. And he's devoted himself to public service and to this cause and to spreading the message on patient safety around the world. And I think everyone here, Joe, is here because of you and everyone salutes you for the incredible work you've done. And it is also an incredible honour to have the Director-General of the World Health Organization, Dr Tedros Adnahom, here as well, who has championed universal coverage, which of course is absolutely critical in terms of safe patient care for every member of a population. It's a huge honour and we're really looking forward to what you have to say later, but we're very honoured by your presence. And I want to welcome everyone to London. I said quite flippantly last year's summits that why don't you do it in London next year. And not realising quite what a man of action, Joe, is, here you are. And I just want to reassure you that the warmth of your welcome here to London is not reflected by the warmth of the weather. We really are very, very pleased to see you and we'd love to see you again in the future. My own journey on patient safety really started with patients and I became Health Secretary five and a half years ago. I really had no background at all in healthcare, a lot of doctor, nurse, hadn't been a manager in the NHS. And suddenly I was given the daunting responsibility of being responsible for the largest healthcare organisation in the world. And I was trying to figure out where I should focus my efforts. And then I met some remarkable people and they were some of the patient campaigners who'd suffered terrible bereavements or losses in their own lives. And I just want to tell you about some of the early people I met. If I just show you this picture on the left hand side here. The first people I met, a few months after I became Secretary on this picture on the left, a couple called Scott and Sue Morris who come from Devon. And they lost their three-year-old son Sam who's pictured there to Sepsis. And they were told by the local hospital that it was just one of those things that couldn't be avoided. And they went home and they grieved for six months. And then they noticed some discrepancies in the account they had been told of Sam's death. And when they tried to raise it with the hospital they said the shutters came down. No one wanted to talk to them, no one wanted to meet them. In fact the only person who apologised to them was their local GP who was presumably the first person who didn't spot the potential Sepsis. And Sue Morris actually said to me very movingly that we still use that GP. It's not easy for us but he at least was completely straight with us about what happened. And they have become big Sepsis campaigners here in Britain. And then top right, a gentleman called Martin Bromley who's actually a pilot for British Airways. And Martin lost his wife Elaine who's in that picture there back in 2006 when she went into hospital in Milton Keynes for a routine sinus operation. And during the course of the operation her airways got blocked and the surgeons understandably were focusing on trying to unblock her airways. And they didn't think to give her a tracheotomy and it had tragic consequences. But what was even sadder was that in that theatre there was a nurse who thought I wonder if they're going to want to do a tracheotomy. And she got all the equipment brought down from the intensive care unit. She had it there but she didn't have the courage to challenge the mighty surgeons. And Martin actually spends nearly half his time going around lecturing at NHS hospitals about human factors work. He does it completely free of charge. And one of the most important things that he talks about is the importance of breaking down hierarchies. And I don't know what medicine is like in the United States in this respect but in the UK we are still very hierarchical in medicine. It's one of the only professions where we're talking about Mr this, Doctor that rather than the first name terms that are normally used. And every flight that Martin flies for BA he starts by saying to his crew, my name's Martin I want you to call me by my first name. And the reason for that is that in an operating theatre if you have a hierarchy it means you've only got one pair of eyes spotting a mistake. Whereas if you remove the hierarchy you can have eight or nine pairs of eyes spotting those potentially lethal mistakes. And what people like Martin and Scott and Sue did was they made a choice that's different to the choice that nearly all of us would make. When most of us have a bereavement or a loss we want to draw a line under it, close the chapter, move on. They actually chose to relive their own tragedies time after time because they wanted us to get safer. And I thought well if that's what they're prepared to do then I want to try and support them. The question is what? And we realised we had one or two terrible scandals, failings in care in hospitals. We realised that we had no overall picture of the quality and safety of care in our trusts. So we set up an independent organisation. We appointed someone to a job which we call chief inspector of hospitals. And this person's job was to go around every NHS hospital and inspect it and rate it for quality. And every hospital is given one of just four words to describe the overall quality of their care. They're either outstanding, good, requires improvement or inadequate. And when we did this process we had some really big surprises. So if I just show you the latest overall rating for hospitals is the left hand column then GP practices and then we also do it for care homes. We thought at the start of the process we knew who the outstanding hospitals were going to be. We were going to upset a few people here but we thought it was going to be the famous London teaching hospitals, the UCHs, the St Mary's, St Thomas's and so on. In fact not a single London teaching hospital got an outstanding. And very often they were hospitals in parts of the country that no one had really heard of. Like a small district hospital on the south coast in Sussex where the chief executive of that trust had been inspired by the work of Virginia Mason in Seattle, had flown over of her own accord, had completely taken on board their approach to rapid process improvement. And I think that trust is probably the best example of a learning culture in the whole NHS. Now we have lots of challenges with money as do all healthcare systems but we asked ourselves the very simple question is quality of care, is safety of care something that just has to be bought? Is it about getting the checkbook out? And we found the relationship to be a lot more complex. If you have a look at this graph this is the relationship between the quality rating of the hospital and their financial situation. Remember in this country all hospitals basically get paid the same tariff for elective care and emergency care. But on average the good and outstanding hospitals were in surplus with their finances that required improvement and inadequate ones were in deficit. We're still trying to understand because of course money matters if you haven't got enough nurses in a ward you need to put more nurses on that ward that costs money. So money is clearly important but we think the reason is because poor care is about the most expensive care you can give. If someone has a fall that could have been avoided they're going to stay in that hospital for two, three weeks longer that's horrible for them. It's also expensive for the system it also means that beds are not available for another patient who might need it. But we nearly didn't do this because we were particularly worried about what the impact would be on hospitals at the very bottom of the scale that got the lowest scores. And what we were worried about was that they might end up getting into a vicious circle of decline where staff didn't want to go there, patients didn't want to use the trust. In the end we did take the plunge and again the results were a big surprise. If I tell you the story of one hospital this is Wexham Park Hospital in Slough just west of London they were rated four years ago as unsafe in the care they gave. We had a change of leadership but we found when they were rated unsafe we survey all our hospitals and we ask staff in the hospitals whether they would recommend the quality of care they give to a friend or a member of their family. And this particular trust less than half the staff in that trust would recommend the care that they were actually giving. That's a pretty shocking thing for a hospital in a developed country. Anyway two years later transformation in the care they gave all eight of their clinical areas moved to good or outstanding. More than two thirds of staff recommending their care. I learnt from this process perhaps the most important thing that I've learnt as health secretary. Which is that the staff in that trust were the same when they went into special measures when they got their inadequate rating as when it came out of special measures two years later. In other words it was nothing to do with the staff it was all about leadership. Everyone goes into healthcare because they want to help people at the most vulnerable moments in their life when they're sick or when they're dying. The question is whether you have the leadership in place that can unlock that basic human instinct. And at the heart of this is what Joe was just talking about which is transparency. Because if you really want your hospital or your healthcare system to be a safe one you've got to be really brave and be prepared to be honest when it's not. And that means a completely different approach to what has been traditional in healthcare systems all over the world where we are often very guarded and worried about being open when things are going wrong. So in England this approach to transparency has applied not just to hospitals but to areas of care like mental health, dementia, diabetes. We've applied it to areas of clinical care. So if I just show you this is something called the getting it right first time program. This is looking at orthopedic infection rates. We've now extended it to all surgery and most of medicine as well. And we went around every hospital that was led by a really inspiring orthopedic surgeon called Professor Tim Briggs. We went around every hospital in the country and we coaxed the orthopedic departments to share their infection rates. Now as everyone here knows if you have an infection when you're changing someone's knee or someone's hip that is one of the most dangerous things possible. You're literally sewing up an infection inside someone potentially fatal. And what shocked us when we started collecting this data from all over the country was the variation. So our best hospitals in Britain infect about 1 in 500 patients. That's care at its best. Still too many but nonetheless that is care at its best. Our worst hospitals one in 25 patients. In fact there's one part of the north west of England where there are two hospitals next door to each other. Both with the same blue NHS sign outside both with patients expecting the same high quality care. One of them one in 500 patients. One of them one in 25 patients. And what we learned from this exercise was that transparency and openness providing the data is reliable and the data is trusted is actually the simplest and easiest way to get behaviour change. You don't need to instruct people. You don't need to give people new targets. You don't need to have financial incentives. You just need to share the data in an open supportive way and you can start to get really big changes. And so we've had this big focus for the last four or five years on safety and quality and the NHS has been under enormous pressure. Huge increase in demand enormous financial pressure in the system and yet despite that we have seen some significant improvements in quality. And if you ask NHS staff which is the top graph if they're happy with the quality of care that they're being asked to deliver in their organisation that's gone up by 7%. If you ask members the public if they're happy with the care that they're getting from the NHS that's actually gone up by 13%. And if you ask the Americans Joe the Commonwealth Fund which is a New York think tank regularly rates healthcare systems across the world and we were very proud last year when they said that we were the safest healthcare system in the world. But that gave us a lot of cause for reflection. We may or may not be the health safest healthcare system in the world of course I hope we are. But we still have in the NHS in England 3.6% of all hospital deaths with the 50% or more chance of being avoidable that is 150 preventable deaths every single week. We still have what we call never events in our system once a week we put a wrong prosthesis onto someone twice a week. We leave a foreign object in someone's body three times a week we operate on the wrong part of someone's body. Last year we removed two people's ovaries by accident. So if those terrible things happen in somewhere that a New York think tank says is the safest healthcare system in the world what does that tell us about the need for healthcare everywhere urgently to change. And I need to add that although I've made a big priority of this I wasn't the first and I was building on the foundations of people like Aridasi Liam Donaldson who you're going to hear from later on this journey. But what I have concluded is that if we are really going to change this it's not going to happen just because a minister says so. Or even just because a hospital boss decides it's the right thing to happen it's going to happen because there is a culture change that comes from the ground up. And I want you just to reflect for a moment about the worst things that have happened in your medical careers the things that you've come across that have most traumatised you. And I want to tell you a story that was actually told to me by someone who's in the audience today about the worst thing that happened to him. He was a surgeon and he was operating on a 30 year old postman here in Britain with acute appendicitis and at the end of the procedure he asked for the muscle relaxation to be reversed. And the anesthetist instead of giving him the right medicine actually gave him adrenaline and the result was that the person went into ventricle fibrillation and eventually died on the table. And the anesthetist immediately took responsibility for what happened. The family were understandably incredibly angry. The anesthetist was a trainee doctor and it was incredibly traumatic for her. But it turned out that the medicine that she should have administered the neostygmine had actually been swapped and adrenaline had been put in the neostygmine box. An assistant had picked out from that box the adrenaline. She of course should have checked it but she didn't. And it also turned out that that was the fourth patient she'd operated on that night and she was absolutely knackered. And she subsequently attempted suicide, thankfully didn't succeed and thankfully continued to practice as a doctor. And luckily the coroner in that situation recorded a verdict of accidental death which was the right thing to do. But what that story tells you is that when you have medical error there is a second set of victims. Not just the families and patients involved but also the doctors, nurses, midwives involved for whom it is incredibly traumatic. In that situation any clinician wants nothing more than to be completely open and transparent about what happened. To learn whatever lessons need to be learned to make sure that tragedy doesn't ever happen again. But in modern healthcare systems we make that practically impossible. People are terrified that if they're open about what happens they will be removed from the register. They might get fired by their hospital. It will be bad for the reputation of their unit, for the reputation of their trust. A thousand worries prevent the one thing that really should be happening which is proper learning from that mistake and then a proper attempt to make sure it can never be repeated. Now there are industries that have been on this journey before us and one of them which I mentioned last year which I just want to mention again is the airline industry. Totally different industry, complicated though a 747 is it isn't anything like as complicated as the human body. But they also have been on this journey from a blame culture to a learning culture. After a series of terrible accidents in the 1970s they realised they had to make this big, big change. The result is that if you're a pilot today and you have a near miss there are five different ways that you can report. It doesn't matter which airline you work for you can report it to your union, you can report it to your airline, to your regulator, you can report it anonymously. They make it really easy for people to report and they really focus on the learning. And the results have been dramatic. If you look at this graph here the red line is the number of fatalities in airline accidents since the 1970s. That's gone down by about three quarters. The blue line is the number of people flying, gone up by nine times. It has become massively safer to fly over that period. Because the airline industry recognised that there is a central difference between gross negligence. If you turn up to fly a plane drunk you will lose your licence. It doesn't matter how open or transparent you are that is never acceptable. But a world of difference between that and the ordinary human error. Which means you might forget to do check number 21 of 48 checks. When I did this presentation at a hospital in Plymouth the medical director afterwards took me aside and said did I know that every year in Britain 30,000 people put petrol into a diesel engine or diesel into a petrol engine. So in the hour that we've been together 15 people have screwed up their car engines. And this is an example of the ordinary human error that is part of our existence as human beings. But the difference between you and me is that you all chose a career where the price of that ordinary human error is sometimes a tragedy. And that takes incredible courage. But if we're going to improve patient safety if we're going to get to Joe's zero ambition we've got to be much better at supporting you to make sure that our systems learn from those mistakes. And one of the biggest areas where mistakes are made is medication errors. And this is what we are today launching a big campaign on in England to try and reduce. Like that anesthetist who gave the neostigmine instead of the adrenaline. I commissioned the University of York, Manchester and Sheffield to do a study to try and estimate the amount of medication error. Now they said that it was no worse in England than in the US or in European countries. So we're probably fairly typical. But they looked at the 36 studies that have been done in individual areas. They pulled them all together and they said that there are 1700 deaths every year in England. That means between four and five deaths every single day because of wrong prescription, wrong dispensing or wrong monitoring of medicines. A lot of the victims typically will be people older people with dementia on cocktails of drugs that may not agree with each other that we're not properly reviewing. A lot of GI bleeds as well. So we are taking a number of measures e-prescribing, which I think is well ahead of us in the US compared to the UK. We still have hospitals using paper-based systems. But it's also the cultural thing. We are going to decriminalise dispensing errors by pharmacists because the one way you can guarantee a pharmacist won't want to be open about a dispensing error is if they think they could be prosecuted for it. And we're going to put 2000 pharmacists into GP surgeries to particularly look at polypharmacy and the patients on multiple medications. So this is going to be a very big thank you. And I've asked Joe as a man of action if he will lead a campaign in the US on medication error. Because I think this is something that needs to happen in different ways in different countries. I can't think of anyone better. But the person who is far more important than me or Joe in this is actually Sir Liam Donaldson because he is leading the World Health Organisation's campaign on medication error. And the reason that we are so honoured to have the director general here today is the World Health Organisation has an ambition to halve medication error across the world over five years, which is a huge ambition. Joe will be disappointed that the word zero isn't in that ambition. But you have to start somewhere and so this is a fantastically important point. So my final point really is this. I mean I think what you're doing in the world patient safety movement, the campaign for zero preventable deaths, the work that we're doing in Britain, the work that's happening all over the world. It's all part of a big journey that we're going on in healthcare. But I think our ambition is very simple. We just want to point to a graph like that about healthcare in a few years time and to be able to save thousands and thousands of lives. Thank you very much indeed.