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Cameron: Improving our NHS

Speech at the King’s Fund

"The world is changing. And so is the Conservative Party.

Over the next few weeks, I'm going to be setting out, in a series of speeches, the most significant social and economic challenges faced by Britain and the world…

…and how the Conservative Party is changing to meet those challenges.

I'm starting today with the issue that I think is most important. Health.

There's a very simple reason why it's first on my list.

It's because health is the most important thing in most people's lives.

If you want evidence of that, you don't need to look at sophisticated surveys of public opinion.

Just think about what every prospective parent says when you ask them if they're hoping for a girl or a boy.

"I don't care, as long as it's healthy."

They don't say "I don't care, as long as it's intelligent". Or "strong." Or "beautiful."

In the end, health is everyone's first priority, and so it should be for politics.

PERSONAL COMMITMENT

I have a child who's not too well, so I've seen a lot of the NHS from the inside.

In fact, in the last three years, I've probably spent more time in NHS hospitals than any politician apart from the few doctors in the House of Commons.

I've spent the night in A&E departments and slept at my child's bedside.

I've got to know the people who dedicate their lives to helping others.

I've met so many miracle workers who are the real jewels in the NHS crown.

Not just consultants, doctors and nurses but all the unsung heroes, too.

Porters, cleaners, and the army of voluntary workers who give their time and energy so unselfishly.

I've spent this morning with two people who work in the National Health Service.

Jack and Doreen.

They drive an ambulance, taking severely disabled children to school.

They're not just drivers, they're carers, helpers and friends to all those whose lives they make easier.

So I know, from personal experience just how important the NHS is to everyone in this country.

There isn't a single person in Britain, however rich or powerful…

…who can safely say that they won't, at some time or other, call upon the NHS.

And when they do, what they ask of the NHS is the most important thing in the world to them.

They ask to be taken care of.

The fact that we have in this country a health service that takes care of everyone…

…whatever their needs…

…whatever their background…

…whatever their circumstances…

…is one of the greatest gifts we enjoy as British citizens.

We should never forget it, and never take it for granted.

CONSERVATIVES AND THE NHS

The NHS does not belong to one political party.

Conservative governments since the war have built it up, as have Labour ones.

But there still seems to be a question mark over the Conservative Party's commitment to the NHS.

So as we embark on this process of change…

…becoming a modern, compassionate Conservative Party…

…in tune with the aspirations of the British people…

…I want us to leave no-one in any doubt whatsoever about how we feel about the NHS today.

We believe in it.

We want to improve it.

We want to improve it for everyone in this country.

PURPOSE vs POLICY

There's always a temptation in politics to dive straight into the details of policy.

After all, policy is to politicians what medical treatment is to health professionals.

In the end, it's what we offer the public.

But I don't know many doctors and nurses who went into medicine wanting to offer people "medical treatment."

They go into medicine because they have a vocation to cure the sick.

Equally, politics is more than just delivering policies.

Even as we lead the debate on health policy, we need to ask and answer some much more fundamental questions.

We need to separate two different things: our social policy objective for healthcare in this country…

…and the management decisions we need to make in order to deliver that social policy objective.

Unless we're clear about the first, we'll never get the second right.

And that means being clear about the basic purpose of the NHS.

THE PURPOSE OF THE NHS

What does the National Health Service exist for?

The core activity of the NHS is not, I would argue, the management of hospitals, the training of doctors, or the recruitment of nurses.

These are secondary activities.

The primary purpose of the NHS is different.

It is to secure for every single person in this country free access to high quality healthcare.

It is a noble vision.

But while the purpose of the NHS can be summarised as healthcare free to all who need it, at the point of use…

…as an encapsulation of the NHS's values, I think this is too narrow, and mechanical.

The National Health Service is an incarnation of the belief…

…at the heart of British society…

…that the wealthy and the healthy have an enduring duty to protect the poorer and vulnerable from life's risks.

The belief that a sick child should be treated with the best possible care, without anyone asking if her dad can afford it or whether her mum has the right insurance cover.

The only thing that should matter is the patient's need at the moment of presentation.

That is the basic entitlement at the heart of the NHS: its reason for existence.

NO IDEOLOGY

But too often in the past, politicians of both main parties have brought to their stewardship of the National Health Service a lack of understanding of these values, and an overdose of ideology.

The left have spent too much time trying to get the private sector out of the NHS.

The right have spent too much time trying to get people out of the NHS and into the private sector.

Barbara Castle's attempt to abolish pay beds was an example of the first.

Margaret Thatcher's support for giving tax relief on private medical insurance, and our Patients Passport policy at the last election, were examples of the second.

But I think both these approaches are flawed - for a practical reason and a philosophical reason.

The practical reason is that neither of them is about improving the NHS.

The philosophical reason is that they misunderstand the basic values of the NHS.

The NHS should be neither a state monopoly, as the left have sometimes believed…

… nor is it something charitable or demeaning - so we should not use taxpayers' money to encourage the better-off to opt out.

CONSERVATIVE COMMITMENT TO THE NHS

Some people think that we Conservatives want to change the NHS into something that it isn't.

Well, they're right. We do.

We want to change the NHS into a more efficient, more effective and more patient-centred service.

We want to change it into something of which we can be even more proud.

Other people - some of them in my own party - urge me to go much further.

They want me to promise that under the Conservatives, the NHS will be transformed beyond recognition into a system based on medical insurance.

I will never go down that route.

Under a Conservative Government, the NHS will remain free at the point of need and available to everyone, regardless of how much money they have in the bank.

CHALLENGES FACING THE NHS

But preserving these values cannot mean standing still.

The NHS faces great challenges.

In 1997, just under one in five adults was obese. Today, that figure is over one in four.[1]

Each average-sized general practice now has to cope with 80 new obese patients each year.[2]

This increase in our waistlines is driving the diabetes epidemic - a condition which on some estimates consumes 10 per cent of NHS resources. [3]

By the end of the decade, the Government estimates that almost three million people will suffer from diabetes - a rise of over a million from today's levels.[4]

And rates of sexually transmitted infections are soaring.

New diagnoses of syphilis are 1,265 per cent higher than in 1997.

Diagnoses of chlamydia are up by 139 per cent…

…and sufferers today will be those demanding expensive fertility treatment tomorrow.[5]

The NHS will have to cope with these cost pressures in the context of an environment which will see patients becoming more demanding.

Tomorrow's patients will be better educated, more articulate, and better informed than today's.

They will use the internet to learn more of their condition than even their GP.

Quite rightly, they will request and expect to receive the best treatments available.

And new ones are coming on stream the whole time.

Alimta, for lung cancer.

Velcade, for myeloma.

And, of course, Femara and Herceptin for breast cancer.[6]

The NHS can no longer ration these treatments as it used to.

Patients will demand them.

In October, the Government committed itself to purchase enough positron emission tomography scanners to ensure we have one for every 2.5 million people by 2009.

But this will still put us behind where Belgium, Germany, Austria, Sweden and Denmark are even today.[7]

And lung cancer sufferers in Britain have less chance of surviving than sufferers in Slovenia, Estonia and Slovakia.[8]

We must ensure the NHS harnesses the benefits of these new technologies.

In the future, gene technology will become a crucial part of healthcare.

It will lead to new treatments that target a condition rather than control its symptoms. It will bring new hope to tomorrow's patients.

For example, 1 in 800 women have a defect in their BRCA1 gene, which gives them a lifetime risk of developing breast cancer of up to 85 per cent…

…and ovarian cancer by up to 60 per cent.[9]

But a recent study showed that in some centres women must wait for up to two years to receive the results of their tests.[10]

In the future, we must harness the benefits of this new and exciting science.

Genetic testing in GP surgeries or local pharmacies should one day become a reality.

Doctors and nurses will be expected to offer new treatments, and to utilise new technologies, in an environment where their actions are placed under ever greater scrutiny.

Patients will demand more information about their performance…

…and the lessons learned from, for example, the Shipman Inquiry will mean tighter regulation of their work.

So the question is, what is the right political response to these enormous challenges for the future of the NHS?

It seems to me that there are now a number of points of consensus between the parties, as well as some critical points of difference.

POINTS OF CONSENSUS

Let's not create differences where there are none.

There are some things on which we and Labour agree.

That the NHS has been underfunded in the past; that it needs sustained investment, but that money alone is not the answer.

And that the NHS should be a truly national service, not a safety net for the poor while the rest go private.

There are some areas where Labour has ended up agreeing with our approach, but has failed to follow through with sufficient boldness.

They now agree that a National Health Service does not have to mean a nationalised health service…

…but they haven't gone far enough in giving a wide range of health providers the right to supply services to the NHS.

Labour now agree with the devolution of power and control to the local level…

…but their Foundation Hospitals are not truly autonomous, and even under Labour's new plans, GPs will still not be in the driving seat.

In fact, in every area where Labour are moving in our direction…

…whether giving patients more choice or cutting bureaucracy…

…we think they could and should go further.

The need to go further is demonstrated by the facts.

One million people still on waiting lists.[11]

One in five NHS Trusts reporting waits of longer than a year for diagnostic tests such as MRI scans.[12]

Health inequalities at their widest since Victorian times.[13]

…and the NHS is running a deficit of £1 billion.[14]

We are now at the European average of health spending.

But we are not at the European average for health outcomes.

If we achieved the European average survival rate for cancer, 10,000 more lives could be saved every year.

If we achieved the survival rates of the best country in Europe for each cancer, 25,000 more lives would be saved every year.[15]

POINTS OF DIFFERENCE

So as we argue for the changes needed to improve the NHS, we should be clear about the differences between us and the Government.

Those differences derive from our values.

Where Labour's health policy has been a values-free zone, lurching wildly from one approach to another…

…from Frank Dobson's centralisation…

…to Alan Milburn's targets and plans…

…to Patricia Hewitt's flawed half-measures in the face of Labour backbench opposition…

…our approach will be rooted in the two values that are at the heart of my kind of Conservatism: trusting people, and sharing responsibility.

Let me give you a specific illustration of each.

TRUSTING PEOPLE

I believe that the more you trust people, the stronger they and society become.

In the NHS, that means trusting in the expertise and experience of health professionals.

We intend to ask the professionals what should be done to improve the NHS.

Tomorrow we will be launching our Policy Group on Public Service Improvement.

We will be inviting everyone in the NHS to participate by giving us their prescription for the future, telling us how they would improve the NHS.

And that doesn't just mean doctors and nurses.

It's fashionable to knock those whose role in the NHS is managerial, not medical.

The so-called penpushers and paper-shufflers.

Let's be realistic about this.

The NHS, with 1.3 million people, is the biggest employer in Europe.

In world terms, its workforce is beaten for size by only the Chinese Army, the US Defense Department, Indian Railways and Wal-Mart.[16]

Of course such a large workforce needs managing - and it is good managers who most resent the bureaucracy which clogs up the system.

So we want to engage them as well.

And because we trust in the professionalism and judgment of those who work in the NHS, we will press the Government to go much further in giving them power and control.

More powers for GPs, giving them the ability to access care they know patients need.

Genuine foundation hospitals.

Real freedom for new services to be developed and offered to the NHS.

True devolution of responsibility to the professionals who simply want a system that allows them to give of their best.

And an end to the targets and bureaucracy which prevent them doing what is right.

SHARING RESPONSIBILITY

The second core value at the heart of my kind of Conservatism is sharing responsibility.

I believe profoundly that we're all in this together, and that we have a shared responsibility for our shared future.

Individuals, families, government, businesses, the voluntary sector - all have a part to play.

This is overwhelmingly the case in an area that this Government has neglected: public health.

As well as increasing the supply of healthcare, we need to reduce the demand.

That's where public health comes in: in the long term it's one of the best ways to help the NHS meet the challenges it faces.

Government should play a leadership role when it comes to public health.

The last Conservative Government's hard-hitting HIV/AIDS campaign of the late 1980s and early 1990s showed the way.

An environment was created in which everyone was made aware of the dangers of sexually transmitted infections.

This campaign helped hold infection rates constant until the mid 1990s.

But they have soared since the campaign ended: new diagnoses of HIV have increased by 168 per cent since 1997.[17]

The lack of anything like the HIV/AIDS campaign since the early 1990s is indicative of a public health apparatus which has fallen into disrepair.

Government has a responsibility to promote public health, and I want to see more hard-hitting public health campaigns.

But government can't do it on its own.

Business, too, has a vital role.

We live in a consumer society.

Modern marketing techniques can be used to great effect to tackle the root causes of preventable ill-health…

…just as irresponsible marketing techniques can have the opposite effect.

Try and buy a newspaper at the train station and, as you queue to pay, you're surrounded by cut price offers for giant chocolate bars.

The check out staff have all been trained to push this product, whatever the customer is actually trying to buy.

Why?

As Britain faces an obesity crisis, why does WHSmith's promote half-price Chocolate Oranges at its checkouts instead of real oranges?

So many consumer businesses could do more to promote healthy diets and lifestyles.

It simply requires corporate responsibility to be matched by marketing creativity.

Business should not see this as a burden, or as an altruistic or philanthropic activity.

Good health is good business.

90 per cent of employers believe sickness costs can be significantly reduced, but relatively few take steps to reduce it.

33 million working days are lost every year due to occupational ill health, and it costs employers £11 billion every year.[18]

Every business in this country has the opportunity to help improve public health and reduce burdens on the NHS…

…and with that opportunity goes a responsibility to do so: we're all in this together.

Schools too, have a vital role to play.

Adults' attitudes to physical activity and healthy living are shaped in their youth.

But today, almost one in three children aged between two and ten are overweight[19] - and the figures are growing faster than anywhere else in Western Europe.

Schools, working with their partners in the public and voluntary sectors, can do so much to help shape the habits of children and young people…

…for example by encouraging sport, play and active travel to and from school.

Ultimately of course, public health is about individual behaviour.

While Government, business, schools and other organisations in the public and voluntary sectors can do more to encourage healthy behaviour…

…reducing demands on the NHS…

…it's up to individuals and families to make their own choices.

I want us to create a culture of shared responsibility…

…in which each and every one of us understands that a publicly-funded health service, freely available to all…

…means a collective commitment to public health, sincerely made by all.

CONCLUSION

Guided by these two core values - trusting people and sharing responsibility - we will show how a distinctive Conservative approach can help improve our NHS.

We will support the Government where it does the right thing.

And we will offer constructive criticism when it doesn't.

So no-one should be in any doubt: our priorities and attitudes are changing.

We're proud of the NHS and we're optimistic about its future.

Instead of helping a few to leave the NHS and go private, we want the private sector to come and help improve the NHS for everyone.

And we'll place a renewed emphasis on public health, to help reduce demands on the NHS for the long term.

Trusting doctors and nurses by giving them greater freedom and control.

Showing that we're all in this together, and that we all have role to play in making the NHS better and making Britain healthier.

Those are the values that will guide our policy development process…

…a process which will engage the widest possible range of people and organisations, generating ideas to secure the long-term future of the health service.

We will investigate the crucial questions…

…how would the NHS use greater freedoms?

…how can we harness the vitality and innovation of the social enterprise sector to improve the NHS?

…is competition essential to deliver more efficient care?

…how can choice be made real and responsive to patient needs?

…how can we not just match European health spending, but match European health outcomes?

There is not one person in Britain, whether rich or poor, old or young, whose life could not one day be saved by the NHS.

That is how vital it is to this land.

It is our duty to make sure that the values of the NHS in the 20th Century aren't just continued in the 21st Century…

…but translated into the context of 21st Century challenges and opportunities.

The NHS must flourish…

…it must expand…

…it must succeed…

…it must continue to serve us all.

A free health service that works for everyone and is the envy of the world.

That's my aim. And I look forward to working with you and your colleagues to develop the ideas that will turn that aim into reality."

[1] Hansard, 20 December 2005, Col. 2716WA

[2] CMO, Annual Report, 3 July 2002

[3] NHS acute sector expenditure for diabetes: the present, future, and excess in-patient cost of care. Currie CJ, et al. 1997. Diabetic Medicine, 14: 686-692

[4] Hansard, 16 November 2004, Col. 1331

[5] Health Protection Agency, STI Epidemiological data, Summary tables of selected conditions by sex for England between 1995-2004, September 2005

http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/epidemiology/sti_data_1995-2004_Final.xls

[6] Named treatments taken from

CancerBACUP, NICEwatch, 20 September 2005

[7] DH, A framework for the development of Positron Emission Tomography services in England, 11 October 2005

[8] Cancer Research UK, CancerStats Monograph, 2004

[9] DH, Genetics White Paper, 24 June 2003

[10] CancerBACUP, Breast Cancer Genetic Testing - wide variety in UK services, CancerBACUP survey shows, 14 December 2005

[11] UK total: 996,100 as at: for Scotland (109,992) September 2005; for Northern Ireland (46,900) September 2005; for Wales (64,900), October 2005; and for England (774,300), November 2005.

[12] Figures are not collected centrally, so this is an estimate from:

The Times, Go private or wait 80 weeks, patients told, 18 June 2005

[13] University of Bristol and University of Sheffield, cited in

BBC News, Life expectancy gap 'widening', 29 April 2005

[14] Gross deficit is £948 million - not including NHS foundation trusts

Hansard, 1 December 2005, Col. 37WS

[15] Cancer Research UK, CancerStats Monograph, 2004

[16] (Not counting McDonalds, which has 12 million (mostly franchise-employed) workers)

Jon Hibbs, NHS Head of News, quoted in

Daily Telegraph, NHS reaches 1.4 million employees, 23 March 2005

[17] HPA, HIV and AIDS cases by year of diagnosis and deaths in HIV-infected individuals by year of death, data to end September 2005

[18] DH, Choosing Health, November 2004

[19] 28 per cent

Hansard, 20 December 2005, Col. 2716WA

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