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Duncan Smith: Government failing to get to grips with health

Welcome to this Health Policy Seminar. I am very grateful to you for giving up your time to come to talk to us today. This is the first in a series of seminars that we will be holding over the coming months as part of our policy renewal process.

I hope that you will excuse me, as Leader of the Opposition, if some of my remarks are of a political nature. However, I would like to stress that after these opening remarks, today's seminar is not a political exercise. Chatham House rules apply. Liam, his frontbench team and members of the policy unit are here to listen, and to engage with, the ideas that you put forward. I hope that all of you will feel comfortable in speaking openly and honestly.

I want to begin by describing how we are renewing our policies. There are four stages.

First, we need to have a really thorough understanding of the problems that people encounter with these services day to day and of the government's policies, and their weaknesses. Our job in opposition is to understand these problems and the government's failure to deal with them and to bring them to the public's attention.

And, to this end, we are publishing today, the first in a series of Conservative Policy Unit pamphlets called "The Wrong Prescription". This sets out our analysis of the shortcomings of the NHS and the weaknesses of the government's approach.

As this paper demonstrates in detail, the NHS is not providing the level of healthcare that the people of Britain want.

On almost any measure it is falling short of expectations. Waiting lists have been stuck at over a million people for more than 8 years. The number of people waiting more than 12 months for operations has increased ten-fold in many Health Authority areas since Labour came to power. In-patient activity in hospitals actually fell last year. Cancelled operations and bed-blocking are on the increase. But worst of all, health outcomes are demonstrably worse than in comparable countries.

So it is not surprising that the profession is demoralized. 64% of doctors believe that, over the past year, they are delivering slightly or markedly worse care. And public confidence in the NHS has also been falling. 65% of people now think that the NHS is in quite or very poor condition.

The problem does not lie with the professionals. I have nothing but respect for the heroic work of doctors and nurses every day. The problem is in the system, which is failing patients and failing doctors and nurses. In many senses, those being treated and those carrying out the treatment have all become victims of the system.

As our paper sets out, the government is failing to get to grips with the problems the health service faces.

Labour are pursuing three policies on the NHS - spend more money, tinker with the system internally and talk about how they will use the private sector in provision.

They have also set themselves a target of getting health spending up to the European average by 2005, which the Prime Minister says will be 8% of national income. In fact, economists say that by 2005 the European average will be nearer 10% of national income. Getting to this level of expenditure would clearly cost tens of billions of pounds.

However, the problems of the NHS are not just a matter of money. The present European average is at least 8.9% of national income. But the Prime Minister - in a muddle over this - insists on using 8%, which is wrong. Nevertheless, even if we use his figure, health spending in Scotland, Wales and Northern Ireland is already well over his target and patients are not faring any better, and in many cases are faring worse, than in England. We learned today, for example, that waiting lists in Northern Ireland have hit an all-time high and are now the worst in Europe. Yet health spending in Northern Ireland is 9.2% of national income, it is 9.1% in Wales and 8.6% in Scotland. The problem is in the system. The Head of Controls Assurance at the NHS, Stuart Emslie, has estimated that there is a staggering £9 billion of waste each year, almost 20% of the total budget.

Labour's plans for reforming the system are couched in appealing rhetoric, all about decentralizing the system, delegating power from the centre. But the reality is exactly the opposite. Look at the Government's NHS Reform Bill, currently passing through Parliament to see the reality of what they are doing. This Bill will turn the bureaucratic structures of the NHS inside-out, at a time when everyone should be focusing on delivering top quality healthcare. In the process the government has taken 58 new powers, rights and duties for the Secretary of State. But there is not one clause that gives power to doctors and patients. This is a wholly centralizing piece of legislation. Labour's policy of 'command and control' will continue.

They have also talked recently about using the private sector in the provision of NHS services. However, just as with their decentralizing talk, they have failed to deliver. Their approach is incoherent and piecemeal. They have failed because they insist on keeping centralized state control in place. The private sector, as they see it, is welcome, but only with certain conditions. Only if the public sector does not have capacity. Only if it accepts the level of control exercised over the public sector. Only on the Secretary of State's terms. They have not given them true freedom of operation and true financial freedom. That is not surprising. In the past, Alan Milburn has threatened to "come down like a ton of bricks on anyone who has anything to do with the private sector" and only six months ago he said there should be "one monopoly provider" of health care.

The second part of our policy renewal process builds on our analysis of the current system, and asks whether the system will continue to fail in its current structure. It is clear that it is not just a matter of money but of reform. The reform must put patients in charge and bring the policy of command and control to an end.

Next week, Liam will make a speech that builds on the facts in the pamphlet that we have launched today, showing not only that the government has failed in its management of the NHS, but also that, without fundamental reform of the structure, the government will not, and cannot succeed.

Reform is word that is much used by the Government, but the last four years have seen not reform but regression.

The third part of the Conservative Party's policy renewal process is to study alternative approaches. We are researching the systems in other countries, in Europe and beyond, to see what we can learn from how other governments organise services. We are listening to as many people as we can, people in policy think tanks, practitioners and industry experts. And we are gathering ideas about better approaches in future from all quarters.

That is where this seminar fits in. I know that the members of my Policy Unit and the Shadow Health Team here have been talking to you individually. Today is an opportunity for us to get you all together and to debate the ideas collectively. We are here to listen to your ideas and to discuss them with you. We do not have any policy pronouncements to make. We have not reached that stage in our policy development process yet. But the input we are getting from you and that we will get today will be a substantial input into our thinking.

The last part of our policy renewal process is to build our own policies, in the context of today's problems and today's government policies, from what we have learned from other countries and what we have learned from you. Individually and taken together, our policies will offer a clear, Conservative alternative.

Now Liam will take you briefly through the way we have been thinking about the health service in the policy development process. We have been thinking of it in terms of a three-part structure: the funding system, resource allocation and the system of provision.

Liam will also tell you about how we would like to run this seminar. It is an open discussion on Chatham House rules. It is important to us that everyone feels comfortable so that they can discuss the issue openly without fear of anything being reported.

So, to close, I would just like to thank you again for coming today. It is a substantial contribution you are making to our thinking. And we are grateful for your help.

Reform of our public services, particularly our health service, is the priority of people in this country and it is my priority. British people have been short changed by spin and fancy words. As we renew our policy, I want my party to show the way to achieve high quality services available to all when people need them and as they need them. Deeds not words.

ENDS

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