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David Cameron: Our health priorities

This weekend the Conservatives were out fighting for our NHS.

Andrew Lansley was in Greater Manchester campaigning for maternity services.

Maggie Throup was in Solihull doing the same.

Chris Philp was campaigning in Hampstead and Kilburn to save the stroke unit at the Royal Free Hospital.

Shadow ministers, the parliamentary party, candidates, activists, volunteers

Conservatives out across the country trying to keep local services alive.


And there’s something else they were doing.

They were out there trying to gather as many signatures as possible for our petition to get Gordon Brown to commit to protecting the NHS from any spending cuts.

Yes, the state of the public finances calls for serious cuts in public spending.

And yes, tough decisions will have to be made that many may find unacceptable.

But when you are doing such difficult things it is vital that as a government, you take people with you.

And one of the ways we want to do that is to protect the institution that we all care most about.

So the Conservatives will increase spending on the NHS every year so we can protect frontline services.

We’ve made our decision on the NHS, when are Labour going to make theirs?


As the party of the NHS, we will never change the idea at the heart of our NHS

that healthcare in this country is free at the point of use and available to everyone based on need, not ability to pay.

But that doesn’t mean the NHS shouldn’t change.

It has to change because for many people, the service isn’t good enough.

And when the gap in life expectancy between the richest and poorest in our country is now greater than at any time since Queen Victoria was on the throne…

when deaths from hospital infections are more than three times higher than deaths on our roads…

when you’re more likely to die of cancer in Britain than most other countries in Europe…

the question isn’t whether the NHS should change, it’s how the NHS should change.

Today, with the publication of our priorities for a Conservative Department of Public Health, Andrew Lansley is outlining precisely what that change should be.

Nobody is better placed to bring about this change to the NHS than Andrew.

He has an exceptionally detailed knowledge of his brief…

a cast-iron determination to reform and improve the NHS…

and a deep understanding of what the health service and its values mean for this country.


Now that the Conservative Party is the party of the NHS, our health policy has been getting a lot of attention.

I welcome that scrutiny.

But with that attention has come some misunderstandings about what we want to achieve and how we’ll go about achieving it.

It’s all too easy for those misunderstandings to become well-established myths, which is why I want to take them on today.

In each case I want to explain why they are wrong – and how by using the methods of what we describe as the post-bureaucratic age…

decentralisation, accountability and transparency

we can build on the NHS and improve it for everyone.


The first misunderstanding is that by protecting NHS spending, people claim we’re happy to pour money down a black hole.

Some people say “the Conservatives may talk a big game on efficiency across government

but when it comes to the health service they’ll keep the cash taps on full flow with no questions asked.”

That is just wrong.

Yes, we have ring-fenced spending on the NHS in a way that we haven’t done for most other departments.

But that is because the NHS faces unique upward pressures on spending.

There is the massive pressure of our ageing population.

The fastest growing age group in Britain today is those aged 85 years and over.

That means more people living for longer with long-term conditions, being treated by the NHS on a regular basis.

Then there is the pressure of unhealthy lifestyle trends – obesity, drug addiction, alcohol abuse…

each taking a toll of billions of pounds on the NHS budget.

On top of this there is the pressure of big infectious diseases like TB, HIV and Hepatitis C.

The fight against these killers is far from over and NHS services are on the frontline trying to save lives – at huge expense.

And the upward pressures on our health service aren’t just about an increase in demand for care…

they stem from an increase in the range and quality of care available.

Genetics, nanotechnology and robotics are being integrated into the work of the NHS.

The cost implication of all this growth - both in the supply of healthcare and the demand for it - is clear.

Spending on the NHS cannot stand still.

But that does not mean we are simply going to pour money in as Labour have done.

If we change nothing, and if productivity keeps falling at the rate it is today, then even with real-terms increases in spending we couldn’t hope to cope with the pressures on the NHS.

That’s why as well as those increases we urgently need reform to make our whole health service more efficient.

We are determined that a Conservative pound will go much further than a Labour pound.

To bring that efficiency we need to completely change the way the NHS works.

Yes, that means zero tolerance on waste – and that’s what the Conservatives will do.

It’s astonishing to think that the NHS spends £4.5 billion – enough to pay for 50,000 doctors – on administration alone.

So we will slash the cost of health service central bureaucracy by a third during the next Parliament…

cutting that bill by £1.5 billion within four years.

But to really make the NHS more efficient, we need bold decentralisation.

Let me give you just one example of what I mean.

When Labour were deciding how to store people’s health record they commissioned a massive, bureaucratic IT project and spent billions of pounds on a centralised database.

Our approach is to say that today, in the post-bureaucratic age, you don’t need a massive central computer to do this.

With the web technology that’s already out there, one option would be for people to store their health records online.

Not only does this put people in control …

it also saves a massive amount of money.

This is how we’ll make the really big savings – not by shaving a bit off the budgets here and there…

but by replacing whole chunks of the bureaucratic machine with more modern methods - for a tiny fraction of the cost.

That’s why the Conservatives are currently consulting on how patients can take real control of their health records.

This is just one of the ways that will allow us to make a great push of resources from the bureaucrat to the professional and the patient…

from the back office to the frontline.

In the end, this is all about using decentralisation, through the latest technology, to get as much value as possible out of every pound we spend.


A second misunderstanding about our health policy is this:

People say that because we will stop further re-organisations of the NHS and implement a moratorium on the closures of District General Hospitals and their A&E and maternity units

we are committed to the status quo.

It’s true, with the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS.

Labour act as though they’re just re-arranging the furniture in the front room and not the nation’s largest employer.

The disruption is terrible, the demoralisation worse – and the waste of money inexcusable.

And yes – we will immediately stop the proposed closures of vital local services that are happening under this Government too.

Labour package up these changes as ‘progress’, but too often these reconfigurations are driven by short-term policy considerations rather than the long-term viability of the services provided.

Take the maternity services that were recently threatened with closure at the Horton General in Banbury.

This wasn’t a decision taken on what was best for mother and child.

The real story is this.

Junior doctors need to get exposure to a wide range of different cases.

And because the European Working Time Directive limits the number of hours a doctor can work, working in even larger units has become more important as it saves travel time between smaller units.

So as a result, smaller units should close to make way for larger ones.

So that’s it.

A maternity ward faced cutbacks not for the good of mums and babies, but for the convenience of new ‘training modules’.

The Conservatives fought this decision tooth and nail, we managed to get it reversed, and as the recent official independent judgement shows, we were proved right.

So yes, I’m proud to say the Conservatives will stop these pointless, retrogressive re-organisations and closures.

But that does not mean we are going to stick with the status quo.

We believe we can make a big improvement in NHS performance within the structures that already exist.

Again, we’ll achieve this through decentralisation – breaking open the state monopoly and bringing real freedom and competition to local services.

We must start with the freedom – and apply it first at the front line.

So we will give much more power to Foundation Trusts.

Under a Conservative government they will get much greater control over their own affairs and their own money, so they can become more responsive to their local community

and we also want to extend foundation status to more hospitals.

That’s the freedom, next we must bring in competition.

Labour were evangelists for market mechanisms, but in the end they rarely left what they saw as the safety of the monopoly.

The Conservatives understand that competition isn’t a dirty word – in fact it is the key to better healthcare for everyone.

With a Conservative government any service provider from the private or voluntary sectors will be able to compete on equal terms for a NHS contract.

What we will demand from them is that they provide services at least within NHS prices and at the right quality of standards.

What they will get from us is a stable, transparent and pro-competitive framework with clear payment and commissioning structures.

That way, we can increase competition, drive up standards and drive down costs.

And to make this competition really mean something, commissioning by GPs won’t be stalled – it will be propelled forward.

A good GP is more than a doctor – they are someone you trust to guide you through some of the most difficult decisions in your life.

So we will give GPs real control over their budgets, letting them negotiate contracts with service providers so they get the best deal for their patients

.and allowing them to re-invest any savings they make.

Again, through decentralisation, accountability and transparency we can improve the NHS for everyone.


The final misunderstanding I want to clear up today is about our plans for more professional responsibility.

Some people think that by promising more power to professionals we are privileging them over the patient.

One term for it is ‘producer capture’ – and in this case it doctors and nurses calling the shots to a doormat government.

Yes, we do want to give more power to professionals.

Much more power – and we think that’s a very good thing.

Go into any NHS hospital or clinic in this country, speak to the staff and you will hear stories of stifling control from faceless bureaucrats, clinical judgements undermined, nightmarish bureaucracy.

Labour’s obsession with micro-management has drained morale to an all-time low and it has wasted time and money.

It is an astonishing fact that nurses spend a million hours a week on paperwork.

Doctors admit that they have put people in the wrong wards or rushed them through the system to hit the right targets.

This has simply got to change.

The NHS should be driven not by the political imperatives of the targets hit but the clinical imperatives of the patients made better.

That’s why we will scrap all those targets, taking power away from bureaucrats and decentralising it to doctors and nurses.

With a Conservative government, our professionals will experience a level of freedom the like of which most will not have known before.

But it is very important that everyone – professionals, patients, ministers – understands something.

Freedom for professionals will not mean a free rein to do as they please, unaccountable to anyone.

No: instead of answering to the bureaucrats and the politicians, they will be answering to you, the patient.

Instead of bureaucratic accountability there will be democratic accountability.

The boss won’t be some pen-pusher at a distant PCT but the woman who needs a cataract operation, the parent of the child in A&E, the man given physiotherapy as an outpatient after a stroke.

That’s because all the information on hospitals’ performance will be published online, in detail

from the success they’ve had with heart transplants, to cancer survival rates, to how patients rate their quality of care.

Not only will all this information be online for everyone to see – but it will be backed up by real patient choice about where they go to get their treatment.

Choice and transparency – it is such a powerful combination.

When patients not only have the power to choose where they get treated but also the information to make an informed choice, then hospitals and GPs that don't provide good care will have to raise their game.

This is why our plan to scrap targets will not result in higher waiting times.

The reality is our focus on outcomes will enable doctors and nurses to deliver the best treatment for patients at every stage of their care, not just a narrowly defined part of it

while the power of patient choice will drive hospitals to keep waiting times down.

Giving more power to professionals isn’t about doing the best by them – it’s all about doing the best thing by the patient.

And through decentralisation, accountability and transparency, that’s precisely what we will do.


If you look at the changes we are making to the NHS

extending foundation trusts

opening up the supply of healthcare

GP commissioning

improving patient choice

these are all changes that are grinding to a slow and tortuous halt under Labour.

The Foundation Trusts roll-out which was supposed to be completed by December last year has been brought to a standstill

so we still have an NHS bureaucracy which controls both commissioners and providers, twenty years after we were supposed to have a purchaser-provider split.

Opening up the supply of healthcare is even worse – under Labour, it’s gone into reverse.

Indeed, the Health Secretary Andy Burnham only recently said that the NHS will always be the “preferred provider”.

That’s hardly a level playing field for new investment.

Patients should be able to choose the treatment that's right for them first off.

That may mean an independent provider, voluntary sector or the public sector.

But Labour have taken this choice away from patients.

By forcing patients to choose public sector over other providers, they are squeezing innovation and diversity.

GP commissioning is in the same boat – going backwards.

Since December 2008, the number of GP practices holding notional budgets has gone down by five percent.

And GPs know that these notional budgets are pointless anyway, as there’s no ability to reinvest savings and no ability to negotiate contracts.

And patient choice isn’t moving as fast as it should be.

The number of people offered a choice of hospital for their first outpatient appointment has gone up just four per cent in the past two years.

This is a tragic shame.

Labour wasted their first term in power by failing to reform.

And now, after they had finally assumed the mantle of change in the NHS, they have lost their nerve and failed to go far and fast enough.


With the publication of our priorities for the Department of Health today, we are ensuring we do not make the same mistakes.

We will reform the NHS.

Putting patients in control.

Empowering professionals.

Building on it.

Improving it for everyone.

And we will be ready to do this from day one.

A focus on what we want achieve – a relentless pursuit of the change we know the NHS so desperately needs.

Ready for reform.

Ready to deliver.

The Conservatives are ready for change.

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