Conservatives value equality as well as quality in the NHS

Hospitals will have to match cost of cheapest operations

By Andrew Lansley

In the 62nd year of the NHS, this country has a proud tradition of equity in access to healthcare.  The next Conservative Government will preserve and build upon that tradition.  But we will not be content with equity alone.  We will also set ourselves the task of reversing declining productivity and improving the health of the nation so that it is amongst the best in Europe.

The challenge is great: delivering equity, efficiency and excellence in our NHS at a time of crisis in our public finances.  But the opportunity cost of failing to deliver these goals at a time when demographics are changing, the population is ageing and expectations are rising is greater still.

Firstly, equity: one of the most remarkable things about the NHS is the loyalty it inspires in the population it serves.  The British sense of fair play tells us that we are all equal; healthcare in time of need should be a right for all, rather than a privilege for the few.  A Conservative Government will continue to provide healthcare that is free at the point of use, and based on need rather than ability to pay.

But equality in healthcare is about much more than access to services.  At present, the difference between the life expectancy of the richest and poorest in our country is greater than at any time since Queen Victoria’s reign.  Your chances of being alive five years after being diagnosed with cancer are significantly lower if you live in one of the most deprived areas of England. 

Too often in the past, public health budgets and the infrastructure to tackle these entrenched health inequalities have been raided to offset short term financial problems in the NHS.  So we will set aside separate budgets to enable the NHS locally to develop long-term strategies to reduce health inequalities.  We are also determined to work across Government, society, communities and families to tackle the standards of living, behavioural patterns and social norms that underpin these inequalities.

Secondly, efficiency: we can not go on seeing productivity fall in our public services, just as it rises in the private sector.  In fact, the responsibility to use resources well is more weighty in the NHS because the NHS has had the greatest funding increases of all our public services over the last decade.

We will drive efficiency by opening up the NHS to allow charities and private organisations to compete to provide NHS services if they meet the necessary high quality standards.  By increasing the number of organisations providing care for patients, we will drive down costs and ensure NHS care is provided by only the most efficient and effective organisations.  We will also move to a system where no hospital can expect to be paid more to treat patients than it costs efficient hospitals, providing powerful incentives for all organisations to save money.

Instead of unaccountable health authorities, we will give GPs the responsibility to manage the costs of their patient’s care.  With part of GPs' pay dependent upon the results of their patient's treatment, they will have a direct incentive to buy the most efficient services on behalf of their patients, because they will be able to keep any savings and use them to reinvest in their patient's care. 

Thirdly, excellence: we know that there are two-thirds more deaths from lung disease in this country than the European average.  We have the worst record on infant deaths in Western Europe.  And we have some of the worst five year cancer survival rates in the whole of Europe.

Turning this round is a big task.  We have committed a Conservative government to be judged against how it improves our health on some key outcomes for preventing premature death from disease, and making quality improvements in patient care.  We believe that the people to trust with this task are those with the clinical expertise to deliver it.  But we will only succeed by giving them the autonomy to make outcomes for patients the absolute priority of the NHS from top to bottom.  

So we will scrap the political targets that demoralise our doctors and nurses and divert time from the task of improving front-line care.  No longer will our NHS be governed by spreadsheets and tick boxes.  It will be lead by clinicians exercising their professional judgement.  They will be accountable to patients for outcome measures which measure the whole of their treatment, rather than one tick in a box marked ‘four hours’ or eighteen weeks’. 

Together, the proposals that I have set out will create the reform that the NHS has needed for so long, but that has remained out of reach. Reform which enables the NHS to meet and exceed European average health outcomes. Reform which offers patients quality care from empowered professionals, who have wrested control back from an unaccountable bureaucracy.  Reform which sets the NHS free to deliver the combination of equity, efficiency and excellence that will make it the finest health service in the world.

24 February 2010

Andrew Lansley. Shadow Health Secretary,