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Dr Fox: A Fair Deal for Patients

Speech to Conservative Party Conference 2003

"I want to begin today with a little general knowledge test. I'm sure we all remember Labour's 1997 election campaign.

Remember "24 hours to save the NHS"?

Remember how they were going to get rid of hospital waiting lists?

I wonder how many of you have been following the detail. Let me ask you. At the current rate of reduction, after six years of Labour government - how long would it take to deal with the backlog for NHS surgery?

5 years, 15 years or 20 years? Well, actually, none of these .

According to the Government's own figures published last Friday, it will take no less than 62 years and 3 months to deal with the backlog of patients waiting.

Some 24 hours to save the NHS.

There is something going very badly wrong in Labour's NHS. Record amounts of taxpayers money have been thrown at it. Yet despite huge spending increases, the number of hospital admissions actually fell last year. And the average waiting time for an operation actually went up not down. And the number of hospital beds fell .... again.

It's all because Labour have never learned the basic lesson that it's not how much money you spend, it's how you spend the money. It's easy to spend money - especially, as a taxi driver in Birmingham pointed out to me last week, if it's other people's money. It's easy to create waste and regulation and bureaucracy. It is much harder to carry out the real and difficult reforms which create greater choice, improved outcomes and more efficient use of taxpayers' money.

Yet to listen to Labour Ministers you would think everything was improving no end. Not that we can believe a word they tell us.

What will they tell us next? That there are no pregnant mothers waiting more than six months for delivery?

When they announced last year that only 2 patients were waiting more than eighteen months for treatment my office was inundated with calls from patients all over the country wanting to know who the other one was!

There seem to be 2 NHSs. The one we all use and the virtual NHS that exists in the minds of the Government.

So we need to ask them:

If the NHS is doing so well, why are more nurses leaving Britain to work abroad than ever before?

If the NHS is doing so well, why are we asset stripping some of the world's poorest countries to staff our wards?

If the NHS is doing so well, why is it harder to get to see your GP?

If the NHS is doing so well, why are 3,500 elderly patients unable to leave hospital each day?

If the NHS is doing so well, why are our hospitals so filthy, and why do so many patients pick up infections while they are in hospital?

It is an appalling fact that 1% of all deaths in this country, the 4th richest in the world, are caused by hospital acquired infections.

How many of us here today will be victims of what we catch while in hospital?

How things have changed. Even when I was a hospital doctor, cleanliness was not a bolt on extra for patient care, it was taken for granted. Now, to add insult to injury, of the 20 hospitals with the highest infection rates, 15 got the Government's top rating for cleanliness.

The gap between the spin and the reality gets ever bigger, but it's the public who are suffering while Ministers look the other way.


Over the past year, we have produced three Consultation Papers on our health policies.

A central theme of all our reforms has been to take the politicians out of the day-to-day running of our public services.

We know that politicians couldn't run the airlines, couldn't run telecoms and can't run the post office.

But if politicians couldn't properly run any of these things, why does anyone think they can run the NHS? A complex and highly varied body employing over a million people and with a budget the size of the Egyptian economy!

Too many Conservative governments wrongly believed that they could manage the NHS better than Labour.

But let me tell you - it cannot be managed from Whitehall, from behind the Secretary of State's desk. The NHS is too big, too diverse and too complex.

And, of course, it's all especially true for a Secretary of State who represents a seat in Scotland, where health is a devolved subject. What an insult to voters in England to have a Secretary of State who will have no electorate to answer to when he gets it all wrong. And what an insult for Labour to use their Scottish MPs to force through health legislation in England when they have no say in health matters in their own constituencies. That is the real unfinished business in the devolution settlement.

No, when it comes to the running of the NHS, we intend to slash the central bureaucracy. We intend to abolish whole departments where possible. Whole quangos. And we will be able to do it because if we don't have the targets we will not need those who implement the targets. And if we give more power to those on the front line we won't need Whitehall babysitters to watch their every move.

But there are some things we can learn from New Labour.

Perhaps most importantly, we have seen the benefits Labour has derived from the discipline of an independent Bank of England. It is a lesson we must learn in the NHS. For too long, and especially under this Labour Government the allocation of health funding has been shrouded in mystery and used as a tool of political patronage.

The NHS must not be used as a political football.

That is why we will establish an independent NHS Board to allocate in a fair and transparent way the funding within the NHS. This step change will give the clearest possible signal that we are deadly serious about taking the politicians out of the day to day running of the NHS and it will be part of a rolling plan to reduce the powers of the Secretary of State and the Department of Health. It follows on to our plans to give hospitals greater financial independence and our frontline professions more freedoms.


But there is one other area of freedom they need.

If there is one aspect of this interfering, controlling, know-it-all Government that has corroded the ethical basis of the NHS, it is their pathological obsession with targets. Let me give you just two examples.

In the Thames Valley we have had the ridiculous sight of ambulances loaded with sick patients queueing around hospitals. Why? Because if Accident and Emergency Departments don't admit the patients then it doesn't count for their four hour waiting target. So not only do sick patients have to wait in ambulances instead of the hospital but the ambulances are not available when other patients may require them in an emergency.

Can you think of anything more heartless, stupid or wasteful?

And if you think that is bad, it is nothing to the experience of patients in Bristol. 25 patients have been documented as losing their sight permanently and, what's worse, unnecessarily. Why? Because the Consultants who they should have seen for their follow up appointments for their glaucoma were instructed to see new patients instead. Because there is a target for new patients, but not for follow up appointments.

Going blind to save the targets. Is this the ethical basis of Labour's NHS? Am I the only one who finds this utterly disgusting?

What's worse, it is a policy instruction which comes directly from Ministers.

It is entirely a product of Tony Blair and Gordon Brown's whole approach to health care. It tells us all we need to know about the real moral basis of new Labour- run for them and not for us.


So we need to alter the balance in the NHS. Labour believe that the patients are there to service the system. We believe the system should be there to service the patients.

People must be given a real say in what happens to them, or their children, or their elderly relatives.

Labour's pathetic so-called choice programme is little more than a watered down version of the system they abolished when they came to office in 1997. But it is the choices that they think you should be allowed to have and you are only allowed to get it once you have reached a maximum waiting time. In other words Labour only believe that patients deserve a choice once the NHS has already failed them.

Let me remind them. We have already paid for this service through our ever mounting taxes. We don't want a say about what happens to us- we demand a say in what happens to us. The NHS is not a gift from Government. It is a right we have already paid for.

Gordon Brown loves to say that the NHS is the best insurance policy in the world. But who would buy car insurance or house insurance where your insurer could keep raising the premium whether you wanted it or not, where they wouldn't tell you what was covered and didn't have to deliver when you needed it.

No, it simply won't do in the world's 4th richest country at the beginning of the 21st century for British patients to be denied the freedoms that are taken for granted in Germany, and France, and The Netherlands, and Sweden and Switzerland and any number of other European countries. Gordon Brown says "consumers cannot be sovereign in a health market" which is New Labour gobbledygook for saying that British patients would not be able to understand or operate the sort of choices, freedoms and control that is taken for granted by the French, the Germans, the Dutch, the Swedes or the Swiss. What breathtaking arrogance. What offensive patronising drivel - especially from a Chancellor who thinks that never smiling makes you an intellectual!


That is why we will introduce the Patients Passport. It will work quite simply. There will be a standard price set for each treatment or investigation inside the NHS. Patients will be able to be treated wherever they choose and the bill will be paid by the NHS.

It means that if you see your GP and they decide you need further treatment you will be able to decide where and when you would rather be treated and by whom. Still free of charge. But for the first time you will have access to a genuinely national health service rather than being sent to the hospital that is more convenient for those running the system.

Why do we tolerate the elderly widow waiting in pain for her hip replacement when she could be treated more quickly elsewhere?

Why should women be told that they cannot give birth at a midwife led unit because it is outside their district?

How can we stand by while a war veteran goes blind when the cataract surgery that would transform his quality of life is denied because his local NHS won't pay for his treatment anywhere else?

Under the next Conservative Government each of these patients will get a patient's passport that will empower them to take control over the treatment they get. After all, they have already paid for it through their taxes. What could be fairer than that?

But never underestimate how much Labour fear and hate choice. It is at the core of their being that central planning is a good thing. That we need to be told what to do. That the man in Whitehall knows best. If Labour don't have the NHS to run they don't know what they're for. Redundant. Pointless. Obsolete. They have no concept that patients might want to exercise choice to improve the care of themselves or their families. They have never understood that not everyone wants to wait at the mercy of the state - and they never will.

We, on the other hand, will take patient choice and freedom much further. Each year more and more people use their savings to buy an operation or an investigation. Last year 300,000 patients did this- 3 times the number when Labour came to power. Often they are not wealthy but forced to use their hard earned savings to spare themselves or their loved ones a wait in pain or fear. Yet despite the fact that they have already paid for their healthcare often through a lifetime of contributions, the state will give them no help whatsoever. I believe that those who have already paid for their NHS care but who reduce the queues for others by going to the voluntary or not for profit or private sectors should be given a helping hand. That is why we will give patients 60% of the standard NHS price to take with them.

What would that mean for a patient waiting for, say, a hip replacement? The standard price might be set at around £5,000. Our Patients Passport would mean that this money would automatically fund the patient's care anywhere inside the NHS - entirely free to them at the point of use. If they chose to go outside the NHS they could take £3,000 with them to give them a helping hand. They would leave £2,000 behind to help the NHS and the queue would have got shorter. Everyone would benefit.

Everyone should get a helping hand - choice should not only be available for the rich.

In the 1980s Margaret Thatcher, our greatest peace-time Prime Minister set out to extend home ownership to those who had previously been unable to afford it. We didn't force people to buy their homes. Nor did we give them away for nothing. But through our sale of council homes we brought a new choice within the reach of millions of people. Labour fought us every step of the way. But what we achieved in home ownership we are now challenged to do in health care.

Our principle is clear. We believe that when you pay taxes you do so to cross subsidise your fellow citizens, but you have a right to expect the state, like any other insurer to deliver when you need it.

And the difference, the essential political, philosophical, ideological difference between ourselves and Labour is this. Labour believe that when you pay your taxes it is their money. We believe that when you pay your taxes it is still your money.

What we propose is nothing less than the fundamental recasting of the relationship between the state and the citizen - and no wonder the self-serving, centralising control freaks of New Labour are scared.

No wonder there is no lie they won't tell to distort our plans. Because they know that when the British people are given a freedom they will never give it back.


People say to me - it must be wonderful to be a doctor in your political position. I want to let you in on a little secret. It can be the most frustrating experience to sit in the House of Commons and listen to debates which have little resemblance to the real NHS that I worked in. Sometimes, to listen to Ministers, you would think that the only things the NHS did were hips, knees and cataracts.

The PM says "it's all about hospitals". Well, actually, it's not. Most of our health care is in primary care from our GPs, practice nurses, midwives and others.

And what about those patients with chronic illness? Not the ones who can be easily counted on a waiting list, but those with conditions that cause constant misery. What about the stroke patients, the MS patients, the Crohn's disease patients? What about those with rheumatoid disease or depression or in need of terminal care. They must be part of the picture too.

That is why we intend to extend our Patient's Passport to chronic illness as well. To help stroke patients determine where they are looked after and how support services are provided to them. To help those in need of palliative care to decide if they want to be in a hospital setting or at home or in a hospice. We must never assume that we always know best for the patient and we must never fail to recognise the wonderful contribution the voluntary sector makes to the care of patients and their families. We at this conference thank them and salute them.


Over the summer I outlined a new set of proposals on public health to deal with the horrendous rise in diabetes, sexually transmitted infections and TB afflicting our country. We need to act now to prevent not only enormous suffering but enormous financial liabilities arising for the NHS and our taxpayers.

Today's young people with chlamydia or gonorrhoea will be joining tomorrow's infertility patients demanding expensive NHS care.

Today's overweight, underactive children will be tomorrow's diabetics with eye problems, kidney problems or vascular problems. It's a case of too many gameboys and not enough games.

But politicians nowadays are too scared to criticise peoples' lifestyles.

That is why we are going to introduce a Public Health Commissioner who will be able to force governments to take action when it is needed instead of hiding behind some pathetic and cowardly concept of political correctness.

One of my colleagues said to me: "Are you mad? Do you know what they would do to us in office". Yes, I do. They might force us to do the things that are right for our people rather than what is comfortable for the politicians. And isn't it about time.

But the most controversial aspect of our proposals dealt with compulsory health screening for those coming to stay in Britain and health entitlement cards to prevent those so called health tourists who have contributed nothing from using the NHS free of charge.

Let me put it bluntly. We are now seeing the resurgence of TB, especially in London. There are higher TB rates in Brent than Azerbaijan. Higher rates in Newham than Uzbekistan. It cannot be allowed to continue.

That is why we intend to base our new public health law on the model adopted in Australia. Those seeking to come to reside in the country must satisfy three tests.

First that they do not have an infectious disease that might put the public health at risk.

Second that they are not coming to target relatively scarce resources such as renal dialysis or cancer care.

And third that they will not be an undue burden on the public purse by requiring long term care.

We are perfectly willing to give care to those who need it and are genuinely entitled to come to this country. That is our moral duty. But we also have a duty to ensure that our own citizens who have paid for these services get the priority they deserve.

The NHS mustn't be allowed to become the international health honeypot and a future Conservative government will ensure that it is not.

There are those who try to claim these ideas are extremist. Let me give them this warning. If we, in the political mainstream are not willing to deal with these issues in a reasonable and responsible way then there will be those on the darker edges of our politics who will exploit them in a totally irresponsible and dangerous way.


Today we find ourselves confronted by a Government that has tried to hijack our language of fairness. So let's ask Tony Blair what's fair.

What's fair about patients with brain cancer, prostate cancer or ovarian cancer having to wait longer for treatment now than they did back in 1999?

What's fair about a system where those with mental illness are the last to get help and first to be forgotten?

What's fair about a system that leaves people blind to satisfy government targets?

And what's fair about a system that forces elderly people to sell their homes for care while those who have never paid a penny tax can come from overseas and use the nhs for free?

No it's not fair because fairness like truth is a casualty of New Labour's mindset- that New Labour always come first and the British people come second.

We now have a Government which has taxed and failed and taxed again and failed again.

It is the most dishonest and untrustworthy Government we have ever seen.

It is led by the most self-serving, self-righteous and un-British Prime Minister we have ever had. He doesn't trust our people, despises our history and would sell out our national interests in a minute. We are constantly given distorted truths and fiddled figures especially in health care.

But they are not just figures- they represent real people. They could be our families, our friends or ourselves.

How do we counteract this corrosion of truth?

We do it by treating our people with respect and telling them the truth even if it is not what they want to hear.

We do it by remembering that politics is about leading the debate not following it.

And we do it by remembering what made us such a formidable force. By being a truly meritocratic party which sees Britain as a single nation.

We should have no talk about the grey vote or the gay vote or the black vote or any other vote that tries to define our fellow citizens. Our party's and our country's strength lies in offering opportunity to all those who are willing to contribute to their country. We offer not patronising slogans but opportunity to all those who want it.

We judge people on the talents and endeavours they will give to Britain not what they look like or who their parents were.

We have an urgent task. To prepare to be the Government our country needs.

To govern not for north or south, for rich or poor nor any other divide. But for all our people. And when the call comes let us take our place with pride."

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