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Fox: The healthcare we deserve

Speech to Conservative Party Conference 2002

I must start tonight with an apology. What you are about to hear will contain no political trivia or tittle-tattle. No opinion on colleagues past or present, and no diary extracts.

I don't know about you, but frankly, I'm not interested in the Conservative Party's past. I'm interested in the Conservative Party's future.

So let me tell you what I won't apologise for. I won't apologise for telling the truth about the NHS. Or doing what we think is right. Or leading the debate rather than following it.

As a Party we are fully committed to the values of the NHS - of high quality health care available to all irrespective of their ability to pay.

They are the values I learned as a doctor who trained and practiced in the NHS - and they are values I appreciated recently as a patient in the NHS.

But sadly, our NHS is not living up to those ideals. What do we find in reality? Filthy hospitals, mixed-sex wards and long waiting times. And what is worse, the poorest who have the greatest need for healthcare often get the worst deal.

With New Labour's obsession with celebrity, glamour and the good life, many feel that vulnerable people in our society now have no champions left. Speaking up for them is an essential part of any programme for a truly national party such as ours.

That is why we cannot allow our political opponents to misrepresent our concerns. Our criticisms of the failures of the NHS are not criticisms of the staff in the NHS. They are dedicated beyond all reasonable expectations. Yet many cannot speak out for fear of politically-motivated retaliation.

LEARNING FROM ABROAD

You know, as a young doctor, I was always led to believe that the NHS was the best healthcare system in the world. No-one believes that any more. As John Wilson pointed out, our cure rates and survival rates lag too far behind.

Gordon Brown says we have nothing to learn from Europe.

His approach is blinkered. It is misplaced. It is arrogant.

We have looked abroad. It has been an illuminating experience.

In Germany, I spoke to a Consultant about the long waiting times in the NHS. I asked if he had similar problems. He said "Yes, we have".

I asked for an example. He said "Sometimes if we have a patient diagnosed with cancer we cannot admit them for treatment immediately. They might have to go home and not be admitted until the next day".

What a difference from the long waits in this country. Waits so long that tumours sometimes become inoperable as a result.

In Paris, I asked a Consultant whether they had any mixed-sex wards in the hospital. He asked me what I meant. I said were there any wards with patients of the opposite sex at the same time. He laughed. He said "It would be unlikely that a husband and wife would be sick at the same time".

It was the only circumstance in which he could imagine such a thing happening. Yet it is an indignity and a degradation that still routinely afflicts patients in this country.

In Berlin, I commented on the cleanliness of the wards. I could have eaten my breakfast off the floors. Our hosts were surprised that we found this unusual - which says a lot.

A journalist who was with us asked if the cleaning was done in-house or if it was contracted out. The Consultant said that of course it was contracted out. When he heard that we in the UK also contracted cleaning out, yet our wards were filthy, his reply was quite simple. 'Well then,' said the Consultant, "if they are filthy, why do you pay the contractors?"

Why do we put up with the filthy state of many of our hospitals. And let's be honest, some of them are completely disgraceful.

I wonder how many people in this hall realise that, in every year, over 100,000 patients contract an infection while they are in hospital. Every year, 5,000 patients die from hospital-acquired infections. This is an outrage. No-one should accept it. And it doesn't take billions of pounds to solve. It takes good clinical practice. It takes good, and basic, hygiene. Washing your hands does not require a cash injection from the Treasury. Does it?

Overseas, we learned other things too. Its not just about money, its about the way you do things.

We are all aware of the problems associated with caring for the mentally ill in Britain.

I'm sure I'm not the only one who believes that the pendulum was allowed to swing too far and too fast in mental health policy.

Too much of the care in the community programme has failed both patients and the public.

Too many mentally ill people sleep in the doorways of our cities.

Too high a price has been paid by those least able to stand up for themselves. For example, can you believe that each year 1,000 patients with schizophrenia commit suicide in the UK? That surely is a cause for shame in a civilised country.

What we saw in Denmark was starkly different.

There was none of the stigma encountered there. None of the shame.

Instead, there was a decent and humane system that saw patients as individuals with unique needs. That's what I want to see more of in this country. One in four of us will be touched by mental illness in our lives. It might be ourselves, our partners or our children. We can't afford to walk by on the other side of the road. And I thank Julia Neuberger for her much-valued support today. And I promise you, Julia, we will lead the fight in Parliament to defeat the Government's regressive Mental Health Bill. It not only stigmatises the mentally ill but it fundamentally threatens our civil liberties.

DIRECTIONS FOR REFORM

So how do we get from our current position to the NHS we want to see.

There are three areas for reform.

First, TAKE THE POLITICIANS OUT OF THE NHS

Second, GIVE MORE FREEDOM TO THE PROFESSIONALS

And third, give REAL CHOICE TO PATIENTS

TAKING POLITICIANS OUT OF THE NHS

The NHS has been a political football for far too long. I don't want politicians deciding which patients should be treated and when.

Frankly, I wouldn't let a politician run my bath, never mind my health service.

But the NHS was designed to be a centralised, political model. The preferences of politicians are deliberately put before the needs of individual patients in today's NHS.

Priorities are frequently distorted, with more seriously-ill patients having to wait longer than those with less serious illness, just to meet Government targets.

And we now have so many administrators in the NHS that we have more than one administrator for each NHS bed. This has to stop.

We intend to dramatically cut the size of the central bureaucracy. I have asked my team to undertake a systematic review of civil service posts, departments and quangos. The test will be a simple one. If you are not adding value to the care of patients, you should not be there. The NHS is about services to the patients, not a job creation scheme for bureaucrats.

Another dragon to slay is the Government's obsessive target culture. Only last week I spoke to a plastic surgeon who wanted to pilot a new scheme to improve the early detection of skin cancer. But he was told he couldn't do it. This would increase the number of those waiting for minor procedures.

What a shameful, unethical and immoral way to run a health service. It is time to set our professionals free so that they can determine which of their patients need to be seen and in what order.

And managers need to be free from Ministerial meddling designed to fiddle the figures. I sometimes think while we've been learning about health in Europe, Alan Milburn has been learning the accounting methods of Enron.

Let me tell you about what can happen to make your casualty figures look better.

If you don't want the patients to have long waiting-times - keep them waiting in an ambulance as the waiting time only starts officially if you are inside the building. Then, if you don't want your figures to show that patients have been waiting on trolleys - take the wheels off a trolley as a trolley without wheels is officially a bed. Then you can be really creative and put a partition at the end of a corridor and redesignate it as a ward. So, there you have it, your figures will show that patients aren't waiting and they are in beds in wards. Except that the truth is that real patients are waiting on trolleys in corridors. What a perverted charade. What a way of running a health service.

On return to office, we will dismantle the central target culture, take the politicians out of the driving seat and restore freedom to the professionals.

MORE FREEDOM FOR PROFESSIONALS

Labour like to talk about devolving power. In fact they have learned the lingo very well. Alan Milburn went on a visit to Spain and came back to tell us that he wanted to follow the Spanish model of what they called Foundation Hospitals.

So being intrepid sorts we decided to go ourselves to see what had caused this road to Damascus conversion. And what did we find? They said there were three things that made Foundation Hospitals work. Setting their own pay and conditions. Being free to develop their own technology. And being free to borrow from outside Government.

But what will we get in Labour's version? No raising funds outside the NHS. Paralysed by the Government's IT strategy. Unable to break free from the straitjacket of national collective pay bargaining.

In other words, the very things that made the Foundation Hospitals work in Spain would be denied to the NHS - and for entirely ideological reasons.

Let me be frank. The concept of Foundation Hospitals goes clearly in a direction with which a future Conservative Government would be comfortable. It is a concept we would want to dramatically expand. Indeed, Alan Milburn is breaking ground for us in a way that will make further reforms easier - which is why it is so important that Gordon Brown's objections are overridden.

Unless the Chancellor's opposition is dismissed, then any new proposals for greater autonomy will be a complete sham. Once again, New Labour will have borrowed the language without delivering the substance.

Even worse, Labour will be guilty of knowing what reform is required but failing to have the nerve or the ability to see it through.

Reform of the NHS will be sacrificed on the altar of Labour's political dogma and bitter internal division.

What a waste.

What a tragedy.

What a betrayal.

REAL CHOICE FOR PATIENTS

So what are we going to do? Well, for a start, it wouldn't be a bad idea to give some choice to us - the patients.

At the moment, patients have no choice of GP, consultant, hospital, time or treatment in today's NHS.

Choice can, of course, be exercised by those who go private - either because they have private medical insurance or, like an increasing number, because they decide to pay directly for treatment themselves.

It is extraordinary that those who make this decision are so often criticised. They should in fact be congratulated.

Not only do they pay their taxes to keep up the NHS and support the social solidarity that it represents: but by paying for their own treatment elsewhere they also relieve the NHS of the burden of their treatment, making way for someone else. In any sensible system, people would be encouraged to do this. Instead, one of the first acts of Gordon Brown was to abolish the tax incentives for the over 60s. It's all part of socialism's age-old belief that public spending is somehow more moral than private spending. And that's plain wrong.

I listened with great excitement to what Mike Wooldridge had to say about how Australian Conservatives took away health from Labour's political territory and I listened with particular interest about the experience of introducing tax incentives in Australia.

When we return to office, we will recognise the contributions of those who take out insurance on top of their NHS contributions. And not before time either.

But we will go much further. At present, an increasing number of people do not opt for additional health insurance but use their money to buy extra care - everything from physiotherapy to a cardiac by-pass. And its not just the well off. These patients are often elderly, using their hard earned saving to get the treatment they need in order to maintain their quality of life. They too should be helped as their sacrifice also reduces the burden on the NHS.

Labour believe that it is morally unacceptable to allow people to buy better care for themselves or their families using private income. But what is really morally unacceptable is that people should be forced to use their own savings to escape from a system they have contributed to all their working lives. Yet that is what is increasingly happening in this country.

Why should it be that a 71 year old war veteran should be forced to pay for heart surgery rather than taking the risk of waiting in the NHS. And you all know as well as I do that it is not an isolated example.

So not only do we intend to reinvigorate and re-energise the NHS itself.

We will ensure on return to office that those who have used their own savings to provide for themselves or their families are helped to do so. Because helping them helps everyone in the NHS.

Labour will say that this will produce a two tier service. I have news for them. We already have a two tier service where only those who are lucky enough to afford it, including millions of trade union members, or who have families willing to help can have the option of being treated elsewhere in a fraction of the time. I want to see that choice extended to as many people as possible. And, even more importantly, I want to extend choice within the NHS too.

Labour will do everything to block that choice. It is just the same as when we Conservatives wanted to give people the right to buy their own council houses and have a chance to participate in a home owning democracy.

We didn't force them, we offered them a new opportunity. And you all remember what happened, don't you? Labour blocked it every step of the way because they cannot bear the fact that people should set themselves free by being less dependent on the State. We were right then and we are right now.

For us, choice cannot be limited just to those who opt to pay for extra care on top of what they contribute to the NHS. Choice must be available for the huge majority who will remain within current NHS provision. And, unlike Labour, we do not believe that this choice should only become available after the system has already failed you.

The time has come for us to redefine the NHS. To us, the NHS is not about buildings or machines or property. If the NHS is anything, it is about patients and the services delivered to those patients, wherever they are treated. It's time to let go of the 1940s and welcome in the 21st century.

Over the next few months we will be looking at the experience in other countries, and seeing what lessons we can learn to increase choice for patients within the NHS. For example, in Finland, which I'll be visiting this weekend, the state will contribute 60% of the standard public sector price of an operation, if patients choose to go outside state hospitals. I find that an appealing concept. Why should state-funded services have to be state-run services?

Patients must have a greater say about the care they have already paid for through their taxes.

And another thing. Who does the NHS belong to? Not Labour, certainly. It does not belong to any politician. It belongs to all those who have worked and contributed to it throughout their lives and they should be given more choice and treated with greater respect when they use the service they have already paid for. Labour will continue to control, command and constrict choice. They are the party of the monopoly, the bureaucracy, the system.

Tony Blair says, "it's about schools and hospitals". It's not. It's about pupils and patients.

The Conservatives will set free, enable and expand choice.

Choice is a Conservative word.

CHARGING FOR SERVICES

One area we have looked at in other countries is the experience of introducing charges for medical care. We have thought long and hard and have decided that it would not be acceptable to introduce new barriers to access to care, especially as it would be likely to affect those on lowest incomes who often have the greatest need for care in the first place. That is with one exception. It is a cause of great concern that many of our services are treated in an unacceptable way.

Patient rights also mean patient responsibilities. Those who use emergency services in an inappropriate way and without thought to others may deny vital treatment where it is needed. Likewise those who treat the ambulance service as a taxi service need to understand the possible clinical consequences. Even more widespread is the failure to turn up to appointments with all the inconvenience it brings for staff and other patients. We intend to introduce charges for those who abuse the system we all depend upon and we are studying practical ways to do this.

Let us be quite clear.

Health care should be free at the point of use, not free at the point of abuse.

PERORATION

This week, we will put clear blue water between ourselves and Labour. Of course other parties will have their own responses to the problems the country faces. And no doubt the responses of the Liberal Democrats will be different in every constituency according to what their audience wants to hear.

But where we will have clear blue water, the LibDems will have clear yellow water. We have a name for that in the medical profession.

This week we will demonstrate to the people of this country, first, our resilience and then our imagination. We must be brave enough to admit where we have made mistakes but proud enough to retain ownership of our achievements.

During our last period in opposition, we employed our energy and our Conservative beliefs to tackle the problems of the time - taming the trade unions, turning round our nationalised industries, giving people the right to buy their own homes.

Now, we must demonstrate that we can bring the same energy and the same principles to deal with the problems in our society today. Not least a health service that fails to give us the healthcare we deserve.

We do it not because it is good for us, not because it is good for our party, but because it is right for our country and above all, it is the right thing to do.

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