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Yeo: Put patients in control

Speech to the Conservative Party Spring Conference 2004

"I want to set out the how the next Conservative Government will make the nation's life more comfortable through radical reform of the way healthcare is provided.

We all know, in retirement people use the NHS more than when they are younger.

Most of them have paid for it all their lives and when the time comes to use it, they expect and deserve a world class service.

A service Labour has failed to deliver.

Nowhere in all our public services are reforms more urgently needed than in health.

Despite the best efforts of hundreds of thousands of dedicated professional doctors, nurses and other staff, there's little to show for all the extra cash that's being spent.

Patients are denied control over how, where or when they're treated.

Constant meddling by Ministers prevents doctors and nurses from responding to the needs of patients.

Bureaucracy has gone mad, with administrators hired at three times the rate of doctors.

There are fewer qualified nurses in the NHS than there are managers and support staff.

In Labour's NHS, the State is too large and the patient is too small.

Health outcomes in England are now cause for concern.

Derek Wanless, the man Gordon Brown asked to report on the state of the nation's health, confirmed that death rates in England from respiratory diseases in both men and women are worse than France, Sweden, Denmark, Canada, Australia, Finland, Germany and the Netherlands.

All countries with similar population structures, health care systems and per capita wealth as England.

In 2001, life expectancy at birth in England is lower for women than in all these countries save Denmark.

The United Kingdom has one of the worst rates of hospital acquired infections in the Western World.

Deaths from MRSA, the hospital superbug, have more than doubled since 1997.

The consequences of Labour's health targets are equally damaging.

For example, as Liam Fox mentioned this morning, a Government waiting time target for new outpatient appointments at the Bristol Eye Hospital led to other follow-up appointments being delayed or cancelled. The result - 25 people went blind.

And despite Ministers' claims about progress on waiting times, average waits have actually got longer. And since 1998 more than 600,000 people have got so fed up with the prospect of waiting, they've decided to pay for their own treatment.

People without medical insurance.

Many of them older people dipping into their savings.

These problems are the result of a system that is over-centralised, unable to cope with rising demand, increasingly wasteful of resources and staffed by dedicated professionals driven to distraction by a constant stream of Ministerial directives.

That's the problem. What's the solution?

First of all let me stress that under the Conservatives the founding principle of the National Health Service, that healthcare should be available to patients on the basis of need, not on the basis of ability to pay, will be maintained.

With that principle as our starting point we will make far-reaching and radical changes to the way healthcare is delivered.

First - By giving patients more control and freedom within the system.

Second - by giving genuine independence to providers of health care.

These two themes will involve a complete culture change and I'll say more about both in a moment.

They will be backed up by two more themes - firstly, a much clearer focus on public health - the one aspect of health policy which should be delivered from the centre.

And secondly a vigorous attack on waste at every level. David James and his team are helping us identify where savings can be made.

Let me return to how we will empower both patients and providers simultaneously.

First and foremost our Patients Passport will give every patient a proper say in how, where and when they are treated.

Say your elderly uncle suffers abdominal pain.

His doctor confirms that he needs a hernia operation.

Under the Patients Passport, your uncle, with the help of his doctor and carer if necessary, will have control over the next stage of his treatment.

He may wish to be treated at his local hospital.

Or he may prefer to be treated at a different hospital, perhaps one closer to where his family live.

Alternatively he may simply choose where he can be treated quickest or where he will be under a particular doctor.

With the Passport all these preferences can be taken into account.

Because the Passport means a patient can receive treatment anywhere, it will make the NHS, for the first time, a truly National Service. By allowing money to follow the patient automatically constraints on where the patients can choose to be treated will be removed. Doctors will be able to advise patients where waiting times are shortest and outcomes best.

Following Oliver Letwin's speech on the spending plans of the next Conservative Government, I can announce the roll-out of the Patients Passport beyond simply elective care.

It won't be confined to the 1 million people who require inpatient treatment. I believe it should extend to some of the 17 million people who suffer from long-term illnesses, such as bronchitis, asthma, diabetes or kidney disease.

These people have been neglected under Labour, as their needs have fallen outside the focus of the Government's Whitehall based targets.

Work to extend the Passport is already under way. The Shadow Health team met this week with the Long Term Medical Conditions Alliance, the umbrella body for voluntary organisations working for people with long-term illness.

The Alliance has just published a document containing the views of service users, carers and voluntary organisations which confirmed their profound concern over the process, scope and content of the Government's framework for long-term conditions.

The report said that the view of service users are not being taken seriously in the development of standards and showed that individuals are often marginalised, with decisions about their care taking place without their involvement.

The mechanics for the Patients Passport in relation to chronic conditions will naturally be more complex. Its structure will need to reflect the character of the case and the choices relevant to each specific disease.

In some cases, the treatment may be carried out within the community, through specialist GPs or nurses. There may be a diversity of therapists and therapies to choose from.

That is why we are engaging now with the relevant bodies and organisations, so we can roll out the Passport at the earliest possible opportunity to those who so desperately need it.

But it won't be enough merely to give patients more say in how and where they are treated.

We must give more freedom to the providers, too.

We want to give professionals, doctors, nurses and others working in health, including managers, freedom to do the jobs they have been trained to do.

We will abolish the star ratings and Whitehall-set targets through which Ministers have constantly meddled with the National Health Service, often to the detriment of patients' interests.

Hospitals will of course continue to publish data on the standards achieved, not least because patients and their doctors will need this data to make well-informed choices.

Real independence will be given to hospitals, not the hopelessly watered-down version offered by Labour's Foundation Trusts.

Decisions by hospitals, primary care trusts and other health bodies must be taken without interference or direction from Whitehall.

The full benefits of the Patients Passport will only be achieved when hospitals are free to respond to patient need by expanding facilities in areas where demand for their services is greatest.

Even where NHS hospitals do expand, we recognise there may be some patients who wish to seek treatment in the independent sector.

The Patients Passport will allow them to take a proportion of the cost of NHS treatment to offset the cost of independent treatment, which can then be topped-up at the patient's own expense.

Patients who do this will help others on NHS waiting lists obtain NHS treatment more quickly because they will have freed up an NHS bed or a hospital appointment.

There will therefore be a direct benefit for NHS patients whenever a patient uses the Passport to access the independent sector.

The Passport will give every patient power now only enjoyed by a few.

And the power of choice is the power to force improvement.

As with education, at the next General Election the country will have clear choice when it comes to health.

Either continue with Labour's wasteful ways.

Where standards in Britain lag behind other countries.

Where an over-centralised system demoralises staff.

Where patients are denied control because Ministers think Whitehall knows best.

A system where the State is too large and patients are too small.

Or follow the new Conservative path.

Which will transform the way health care is delivered.

Which puts patients in control.

Which lets doctors and nurses do their job.

Which leads to higher standards.

That's the choice which will help the people of Britain enjoy a comfortable life.

Together we can help them make that choice."

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