In a speech to the Conservative Party Conference in Blackpool this afternoon, Dr Liam Fox, the Shadow Health Secretary, said:
"There are three things I want to get clear right at the outset.
"Firstly, it is high time that we started to be honest with the British people when we talk about health. I would love to stand here, as so many have done, and say proudly that the NHS is the envy of the world. But you know, and I know, and those watching us know that sadly it is not. We must have the courage to say so.
"The second thing is that this whole debate is not about systems, or private versus public, or political models or ideology. It is about people. It is about our fellow citizens, our families, our neighbours, our friends and ensuring that we get the quality of health care that we all deserve. And as long as better health care is available to all, and free at the point of use, people in Britain are not concerned how it is provided.
"The third thing is that we mustn't be downhearted. It is possible to make a difference. We can and we will.
The failing NHS
"But the NHS, frankly, is failing and it is not a capital crime to admit that it needs far-reaching reform. On the contrary, until that reform is undertaken, the health of the British people will continue to suffer. You know, after World War II, people actually came to Britain to see the NHS, believing it to be a signpost to the future of healthcare. Now we are forced to ship our patients across the breadth of the Continent to get the care they need. What a national humiliation. But don't get me wrong, there is much to value in the NHS.
"Yes, we have excellent doctors.
"Yes, we do have dedicated nurses.
"Yes, we have do laboratory staff, ambulance staff and a whole army of health professionals doing their very best.
"So it hurts me to say that no matter how much harder these people work, it won't make any difference because the system they work in is fundamentally flawed.
"The clinical decisions of our hospital doctors are distorted by bureaucrats. Our GPs are swamped by red tape. Our nurses are frustrated by endless form filling. They are stuck at the computer at the nurses' station in the ward instead of looking after patients. Managers are bombarded by Whitehall circulars and simply not allowed to manage.
"No one in the health service is free to do the jobs they were trained to do. And all because Labour believes that Whitehall knows best.
"Only a Conservative Government will set them free.
Labour's broken promises
"Isn't it all a far cry from Labour's promises at the last two elections. Things can only get better. Twenty-four hours to save the NHS. So ask yourself: Are you waiting longer to see your GP? Are you waiting longer to be seen in your local casualty? Are you waiting longer for your operation?
"Labour got the benefit of the doubt last time. They won't get it next time. And what's more, they're hopelessly split.
"The Prime Minister has correctly stated that there should be no ideological barriers to delivery and there needs to be more private sector involvement in healthcare. His Health Secretary has exactly the opposite view. He told the House of Commons that, "we thankfully have one monopoly provider and that is the NHS. As long as a Labour government are in power that will remain the position". Both views cannot be held simultaneously. While Labour fight it out, patients continue to suffer.
The demoralised professions
"It is not only patients who are suffering. Doctors and nurses are completely demoralised. Let me give you just one statistic. When I was applying to become a doctor, there could be as many as 30 applicants for each place. This year some medical schools have seen the numbers fall to as little as four per place. Why? Because medicine has become an unattractive career. No wonder consultants and GPs are threatening to quit the NHS altogether.
"Doctors have to face endless form filling and target setting, with too little time to see their patients. They are scapegoated by Ministers and subjected to political interference, with lost clinical freedom and of course the ever-increasing threat of being sued and dragged in front of the courts.
"The nursing profession fares little better. Overworked, understaffed, subjected to inflexible shift patterns and moved around hospitals with no regard to their professional expertise or self-esteem. Yet when Labour underspent the NHS budget by £700 million last year, what did they tell the nurses' pay review body? That there is "no case for the a special pay response from us this year on the grounds of recruitment and retention.
"But let me say this to you: There is a moral dimension to our recruitment crisis and it should not be filled by plundering the most vulnerable Third World countries of their precious nursing and medical resources.
"We need to ask ourselves how do we set our doctors free to look after their patients in the way they think is best?
"How do we set our nurses free to expand their role and return to real patient care? And how do we set our patients free to have greater choice about where they are treated or which doctor they see? Why should any of us accept the enslavement of Whitehall telling us what we can have, where we can have it and when? And why shouldn't local hospitals be free to operate in a way which best suits the needs of their patients?
World-class health care
"At the election Tony Blair promised us, in this Parliament, not good, not better, but world-class public services. That can only mean that our clinical outcomes must match the best in the world. A patient with leukaemia in Britain has only a 28% chance of being alive in 5 years compared with 44% in France. Similarly, a British man with prostate cancer has only a 44% chance of being alive in 5 years, but it is 68% in Germany.
"So what went wrong?
"Let us remember that the original idea of the all-party wartime government was to set up a comprehensive health service which would be funded by the state, not run by the state. In the end, the Labour government nationalised the doctors and the hospitals at a stroke. They set about trying to run the whole health service from Whitehall through a myriad of boards and committees. And so it has continued under governments of both parties, through reform after well-intended reform. Every detail of health has been run by directive and diktat, with the medical teams merely there to execute what the unqualified officials and politicians tell them. You know, even at the foundation of the NHS wise people inside the Department of Health warned that it was not the job of Whitehall to run the doctors and hospitals and that they would not do it well. And sadly, they were right.
"Central planned structures have another problem: they run out of money. For decades, governments have curbed or cut or frozen expenditure for capital or held down doctors and nurses' wages. From crisis to crisis we have gone with targeting, directing, freezing. But one thing has continued to grow - the bureaucracy on which Ministers rely to run a service out of control and where patients are all too often the last to be considered. Under New Labour, the bureaucracy has grown like never before and the Secretary of State says that he is decentralising. What a cheek?
"We will take a new direction. The powers of the Secretary of State will be dramatically reduced to limit political interference. The bureaucracy and red tape will be slashed and removed, and we will free the health professionals at the front line.
"But we will also redefine the role of the NHS. We need a flourishing health service, free at the point of use for everyone, regardless of their age or health or background. But it must better reflect the needs of patients.
"Let me tell you that many of our hospitals are less in need of a shiny new entrance hall than a good whiff of Detol.
"And all too often the system puts the hospital before the patient. The sick are at the mercy of a rigid state monopoly.
"I want the NHS to identify all those healthcare providers who can offer the appropriate quality of care, and I don't care whether they are in the NHS, the private sector, the voluntary sector or the non-profit sector. I want the care they can offer to be available to all of us.
"This is the only way to set patients and doctors free from the shackles imposed by Labour and give them real freedom of referral and choice. The real horror of Alan Milburn's hospital star ratings is that you may find out that your hospital is failing but you have no means of escape. You have been locked in a health ghetto, where you must accept whatever service they deign to give you.
"Even the Socialist French Health Minister last week characterised care in the NHS as 'medieval'.
"Well, it is time to end the serfdom of the NHS monopoly. Our cry must be 'it doesn't matter where a patient is treated, only when a patient is treated, and the quality of that treatment'.
"We need to look carefully at the health systems of our neighbours to see why their performance is so much better and see what we can learn from them. If I may say so as a Scotsman, we must not be little Englanders believing we know all the answers. That is why, along with Iain Duncan Smith and members of my health team, I will be visiting our European neighbours over the coming months to see first hand, how we can learn from their experience. That is how seriously we take this task.
A better way
"But I'm sure that we will find that it is not simply about money.
"You may remember the Prime Minister on the Frost programme committing the Government to spend the European average on health. What would that mean? Well, the Lib Dems have talked about a penny in the pound. Remember them? The most amateur and unprincipled political group in Britain - lying about our health plans at the election, frightening the sick and vulnerable to win votes. And never have they looked so marginal and irrelevant as during the current crisis. But a penny in the pound? Forget it.
"Let me tell you how far off the mark Labour and the Liberal Democrats are. The King's Fund tells us that European health spending will be around 9.1% of GDP this year. Now that means nothing to most of us but it would mean the UK spending about £30 billion extra this year. What would that mean in practice? To get to the European average we would have to raise tax by 10 pence in the pound or, in other words, increase tax for the average taxpayer by over £100 per month. Is that what they really plan? Or have they never really thought out the detail? Or is it just that they really believe that the only thing that matters is how much you spend not how you spend it?
"The public have a right to expect two things of the Conservative Party. The first is honesty and the courage to tell the truth. We must accept that medical science is expanding faster than our ability to fund it so it is inevitable that choices will have to be made and priorities set.
"The second is that any changes will benefit us all and not just a privileged few. People in this country will not accept change unless it protects the weakest and most vulnerable among us. Neither will we. No doubt the scaremongers will try again to frighten the frail and sick to win votes. That says more about their moral fibre than ours and we will not flinch from our task.
"Many of our fellow citizens are living in pain and fear because of our unwillingness in the past to deal with the fundamental flaws in our health system. It is time to rise to that challenge.
"When we reach the next election and Labour's cupboard of ideas is empty, ours must be full. There will be a choice between Labour who talk the talk and the Conservatives who can do the job.
"We will show that we have real solutions to the real problems of the real world.
"We will break free from the shackles of the focus groups and start to lead the agenda not just follow it.
"We will escape from the soundbites, the photo-opportunities, the endless relaunches and the sermonising and tell things the way they are with honesty and courage.
"We will trust our instincts and trust the British people.
"The crisis in the public services is the public's top issue, therefore it is our top issue.
"And if we can show that we exist not for the sake of the Conservative Party but for the British people - all the British people - then, and only then we will deserve and be given their trust once again to govern."