Charles Kennedy

Liberal Democrats | Ross Skye & Lochaber

A Healthy Future for the NHS

Rt. Hon Charles Kennedy MP
Leader of the Liberal Democrats
Thursday 20th January 2005
Jubilee Room, Palace of Westminster

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INTRODUCTION

I want to talk today about the key issues which will underpin our manifesto on health for the coming General Election.

Health is a number one campaigning topic.  It always is.  Ask the British people to list their priorities for government and health is usually top. 

The people of this country have a great affection for, and attachment to, our National Health Service.  And they have great respect for its hardworking staff.  In surveys, 75% of people think that the NHS is critical to British society and that we must do everything to maintain it.

It was a Liberal – Beveridge – who laid the groundwork and brought the NHS into being in the middle of the last century.  It was a masterstroke. 

The principles of the NHS are as relevant today as they were then.

A universal service;
A common good funded through general taxation;
Delivering health care to all citizens;
Based on need not on what a person can afford;
Free at the point of delivery. 

And I am proud that my party is determined to defend those principles on which the NHS was founded.
 
This speech is about how we will put those principles into practice – but before I go into greater detail, I want to make this point.

Our campaign will be about providing a quality health service closer to home. 

It will not be about the false ‘choice’ being promoted by the other main parties. 

A well managed national health service should not be about resorting to shipping people around the country in search of a free hospital bed.  It should be about making sure that your local hospital is top class, never mind the one fifty miles away.

This is an important difference – and as the campaign develops, I expect to find the Liberal Democrats occupying the position of the ‘real’ opposition, while Labour and the Conservatives squabble among themselves about ‘choice’.

FUNDING

Any national health service comes with a price tag; no political party should make un-costed promises that they can’t keep. 

Neither Labour nor the Conservatives score highly on the issue of trust at the moment.  After so many broken promises from them, let me make it clear that we will spell out the costs of our policies.

And my promise to you today is that our manifesto will contain no commitment to raise taxes across the board to fund the public services. 

In 2001, our party was arguing for tax rises.  We were straight about that to make up for 18 years of Conservative neglect and Labour’s slow start.

We won that argument.

Huge sums are now being spent on health – An extra £23bn more by 2007/8 than in this year.  The money is going in now.  So we don’t need to return to tax pledges we made in 2001.

Instead, I have already announced that we will have just one income tax rise in our next manifesto. 

It will apply only to the top 1% of the wealthiest taxpayers who would pay no more than a 50p rate on any money they earn over £100,000.

We need this to tackle three specific injustices under Labour that hit ordinary families hard. 

We would spend it on free personal care for the elderly, abolishing student top up and tuition fees and cutting the cost of local taxes as we move from the unfair council tax to a local income tax based on ability to pay.

This means that the Liberal Democrats will be spending around £2bn a year extra on health, over and above the Government’s proposals, mainly as a result of our commitment to long-term care for the elderly.

But that doesn’t mean that we won’t have other money to spend on improving the health service.  All the new money from Labour’s tax rises has not been well spent.

Our ‘spending review’ has identified some £5bn a year of Government money which we would re-direct from low to high priority areas in the public services.

That’s how, for example, we would fund our pledge to bring back free dental and eye tests and for swifter diagnosis of illness: existing resources spent differently.

It’s important that there are no misunderstandings from the outset about funding – since the NHS budget is set to be over £70bn next year:  and it is important that the other parties are left no room to misrepresent what we are saying.

We will sustain the investment in the NHS and make sure that every penny the taxpayer invests is spent wisely.

A LOCAL NHS, FREE OF WHITEHALL TARGETS

But the priority for rebuilding the health of the NHS, and rebuilding the health of the nation, is not a matter of resources alone.  It means doing things differently.

A national programme for health demands two kinds of thinking: running a service to treat ‘sickness’ and running a ‘health’ service.

To most of us, the priority is whether we can be treated and cured quickly and efficiently if we fall ill. 

But health professionals will also tell you that prevention is as important as cure - not only for personal well-being, but for prudent financial management – the financial burden on the NHS that arises from smoking related diseases and from bad diets has been well publicised – we are storing up problems for the future if we don’t act on such issues today. 

Liberal Democrat policy addresses both these issues, both treatment and prevention.  But in order to deliver both, you need a NHS which is well run and well organised.

While there is a tendency to criticise the overall performance of the NHS, individuals will often speak warmly about their local service. Given the huge sums being spent, it would be amazing if there weren’t some improvements. 

Yet the Health Service Journal reports that the NHS is on course to be £500m in the red by the end of the financial year.  Indeed many Trusts, it claims, are freezing recruitment and shutting down services to make ends meet.

Our own research shows that over £10 million is being misspent everyday because of Labour’s failure.

For instance:

Fees to agencies for the use of self-employed private temporary doctors and nurses are costing over £4m a day.

Hospital infections are costing nearly £3m a day, leading to people having to stay in hospital for longer.

Lack of basic care is leading to patients suffering bed-sores. It costs £2m a day to treat.

Not every penny of this can be saved.   But savings can be made.

It is fashionable these days to label anyone in public service in a suit as a bureaucrat ripe for the chop.  I do not buy that cheap rhetoric.  The NHS needs good managers to put a stop to the waste.

But it is staggering to think that the equivalent of 7 and a half district general size hospitals are filled each year with people who pick up infections and have to remain in hospital as a result.

No wonder the number of operations being cancelled is rising.  Hospital beds are being blocked by the people struck down by superbugs.

Again this target obsessed Government’s answer is yet another target:  A target for halving MRSA rates.

But the target misses the point.  MRSA is not the only superbug.  Concentrating on MRSA alone is the wrong strategy. 

Going for a headline grabbing target for each hospital is not the answer.  What managers and clinical staff need to know is where the problem areas are within the hospital and put robust anti-infection measures in place.  The Government’s approach won’t deliver that.  Firm local management would. 

This is emblematic of what’s going wrong.

The problem is fundamental to Labour: New or Old.

Despite all the spin and the ‘New Labour’ branding, this administration is ‘Old Labour’ in its instinctive statism. 

It cannot resist micro-managing how local hospitals and GP surgeries are run. 

Labour claims to want to shift the balance of power within the NHS, but while minister’s still set the targets and hold the purse strings, what they are doing is more a case of shifting the blame.

Labour won’t relinquish central control to local administrators – or individual doctors and nurses – who can work out priorities with their communities. 

The result?  Money wasted, local needs left unmet.  Targets get hit but the point is missed.

This addiction to political target-setting sends a powerful signal.
It says Ministers distrust frontline NHS staff. 

Every minute of every day, NHS has great success with lives saved and lives changed.  The dedication and knowledge of the staff is a great asset.

But the culture of targets and tick boxes, which has become the hallmark of Labour, stifles innovation and undermines their ability to use their own judgement. 

And it is retarding the ability of NHS Trusts to deliver services tailored to meet local needs.

As one Primary Care Trust Chief Executive, quoted in the Health Service Journal, said bluntly “Our money goes on things we have targets for.” 

Of course, Government must retain overall responsibility for setting the broad framework for the NHS - for performance measures, collecting data, auditing and minimum standards of care.  But it should relinquish its current role in defining national targets that create such distortions. 

It should also relax its grip, trust the professionals to use their judgement and allow the maximum scope for design and delivery of services locally.

To aid this we would slim down the central government functions. 

We will abolish Strategic Health Authorities and reduce the number of arms' length bodies which inspect and monitor NHS organisations. 

We will plough the resultant savings back into frontline care. 

Giving local health services the freedom to manage their own affairs will ensure that money in the NHS is spent where it is needed rather than at the whim of Ministers.

Reformed, reinvigorated local government would have the mandate to determine local health priorities.

That does not mean committees of councillors deliberating on who the surgeon should operate on next.

But it does mean councillors identifying the health needs of local people and commissioning services that meet those needs.

How our health service is run, the future of the local hospital, or the threat of closure of the A&E department, or the downgrading of a maternity unit is something that people feel strongly about.

I want to harness that passion to engage people in planning and running their local heath service.

It is this commitment to accountability in healthcare that marks Liberal Democrats out from our opponents.

HIDDEN WAITING LISTS

The structural and political failures by the Government have led directly to another problem.  The ‘hidden waiting lists’.  A problem that is in urgent need of attention.

The Prime Minister loves to read out statistics that reflect well on his administration – particularly the fall in headline waiting lists.

But such statistics tell us only part of the story, they don’t tell us about people’s real experience of the NHS.

The big problem with centrally imposed political targets is that what gets measured gets done.

But as hospitals are forced to meet a target to reduce maximum waiting times, the result is other patients wait longer.

This is what I mean by the hidden waiting lists.
They don’t show up in the Prime Minister’s statistics but the worry and frustration of those stuck on them is real.

This is what has happened in diagnostics, which directly affect thousands of people each day.

It’s quite a simple scenario to sketch out. 
You’ve not been feeling quite right for a while. 
You wake up one morning and you feel worse.
So finally you go to the doctor to find out what’s wrong with you –
And he or she thinks it may be serious.

Imagine. 
The thoughts that go through you head.  
The fear you feel – and not just you but your family as well.

You need to know exactly what is wrong with you – as quickly as possible.
You’ve paid your taxes, and now you reckon its payback time. 
So you hope the NHS will swing into action to cure you.

But it doesn’t quite happen like that.

What you do is join the hidden list of people who are suffering long agonising waits after being referred from their GP with potential illnesses, before they actually find out what is wrong with them.

I call it a ‘hidden list’ because the Government have no idea how long these people wait: they have not bothered to collect the figures. 

But a recent investigation by our Shadow Health Secretary Paul Burstow revealed the extent of the problem.

He found that in two out of five NHS Trusts, people are waiting six months or more for routine MRI scans that are used to detect brain tumours, cancers and serious heart conditions.  And around 8% of NHS trusts have waiting times of over a year.

This situation is replicated for patients waiting for all kinds of scans and test across the NHS.

25% of all NHS MRI scanners are so old that they are past their ‘best- before’ date.
Vacancies for diagnostic radiographers have doubled in the last five years.  A quarter of NHS Trusts cite a lack of skilled or experienced radiographers as the reason why these ‘hidden’ diagnostic waiting lists are so long. 

Put yourself in the place of one of those patients.  Your GP has decided you may have a serious, perhaps life-threatening, condition.  But if you can’t afford to go private - six months - a year later - you are still waiting to find out what is wrong – which means no treatment has started.

If you do choose to pay and jump the NHS queue – you may well end up being diagnosed using NHS equipment and consultants who happen to be working privately ‘out of hours’.

It should be the policy of any party dedicated to our ‘national health’ to ensure that illnesses are diagnosed by the quickest route possible so that treatment can start soonest. 

It really is a scandal that after eight years in office this Government doesn’t know the extent of these hidden waiting lists. 

It is not acceptable that the Government hasn’t published the waiting times for these scans and tests, while focussing the efforts of the NHS on only one part of the process – which is only the waiting time after a patient has been diagnosed until they receive treatment. 

While that remains the only bit that is measured, it is surely premature for Labour to boast about great leaps forward.

What would we do about this? 

As a first step, the Liberal Democrats would ask the Healthcare Commission to collect and publish waiting times for tests and scans so that people can’t be trapped on these hidden lists.

The next steps would be to ensure that new systems and processes are put in place to make the best use of available equipment, invest in diagnostic infrastructure and boost recruitment of diagnostic staff. 

It may be that using private hospitals or mobile units to provide NHS care in such areas is both feasible and cost effective.  Our party has no ideological objections to using a choice of providers – and we should not turn our backs on any spare diagnostic capacity if it makes sense and it represents good value for the taxpayer.

A Liberal Democrat Government would make this a very high priority indeed.  We would make sure the NHS starts treating you as soon as possible by pledging the swiftest diagnosis that can be sensibly, efficiently and affordably introduced.

In the absence of reliable data, there are inevitably question-marks over the scale of what is required to turn this around.  But we will be earmarking money from our savings review to begin the effort of reducing diagnostic waiting lists.

A HEALTHY FUTURE FOR THE NHS

Having dealt with these key structural problems – central control, political targets and the ‘hidden waiting lists’ of undiagnosed patients – in some detail, I will mention the other elements which make up our policy platform in broader terms as I have addressed many of these on other occasions.

As I mentioned earlier we would end the indignity that many older people are suffering because of their long-term care needs. 

We would not make vulnerable older people wait three years before they qualify for free personal care and have paid out tens of thousands of pounds, which is what the Conservatives have proposed.

No-one should be forced to sell their home to pay for their care if they develop a long-term illness such as Alzheimer’s disease. 

We will introduce free personal care.  Liberal Democrats in government in Scotland have delivered free personal care and we would make it happen in the rest of the United Kingdom.

For Tony Blair and Michael Howard people are reduced to the role of consumers in a market place of false choices.

False choice because for millions of our fellow citizens the NHS is not something you turn to in a crisis; it is part of your life.

It is about enabling people to take control of their own health not just working off a menu of predetermined choices.

There are over 17 million people today with long term medical conditions -   Anything from asthma to arthritis or cystic fibrosis to MS.  They should have individual ‘Personal Care Plans’ tailored to their own needs.

What these people want is an NHS that fits around their lives rather than always having to fit their lives around the NHS.  Patients deserve a seamless service. 

Social care and the NHS are two sides of the same coin.  That is why we have long advocated bringing these two services together at a local level. 

It makes sense to integrate the way they are planned, commissioned and delivered.  Allowing agencies to work together to fit the services to the needs of the individual.

Clearly we need to boost recruitment and improve retention of nurses, doctors, dentists and other clinical staff.  We will maintain the funding and efforts to ensure there are thousands more doctors, nurses, dentists and other clinical staff in the NHS.  And we will focus particularly on recruiting GPs, community nurses and physio and occupational therapists to provide health care in the local community.

These policies would dramatically improve the NHS, but what about the other side of the coin – the preventive agenda for health?

As part of that agenda, the Liberal Democrats are already committed to getting rid of unfair charges and reinstituting free eye and dental checks.

In a liberal society, everyone, not just the educated, should have the opportunity to improve their own health. The Government could and should encourage people to track their health and adjust their lifestyles, especially as they grow older.

So we are also proposing to introduce a targeted ‘health MOT’ for individuals, delivered through our public services. 

By expanding screening to catch diseases early, it is sometimes possible to prevent them from becoming acute and costing dearly.  The National Institute for Clinical Excellence should develop targeted health MOTs, with appropriate screening tests based on age, family history and other risk factors. 

Nationally a slim-line Health Department no longer micro-managing the NHS should take the lead across Government to ensure that no opportunity is missed to tackle the causes of ill-health. 

THE MYTH OF PUBLIC VS PRIVATE

Briefly before I close, there is one final area I would like to touch on:  The question of private provision in the health service.

So why is it that we would devote so much attention to improving the National Health Service?  What about the private health sector? 

The answer is that private health provides only a tiny fraction of the health care in Britain. 

Revenues of private hospitals totalled around £2bn in 2003 and the private medical insurance market is worth about £3bn a year – dwarfed by an NHS budget of over £70bn. 

It’s the NHS that shoulders the burden of Britain’s health care and it is the health of the NHS that people in Britain want addressed.

We could use the private sector to augment NHS services and make use of the small amount of spare capacity that exists there but because the quality and capacity of our local NHS services touch all of us most directly, the health of the NHS is of the most critical importance. 

That is one of the reasons why I reject the notion of false choice being promoted by the Conservatives.  Subsidising private operations for those who can already afford them is a policy for the few.  And before delivering a single extra operation it would drain billions of pounds out of the NHS.

My fear is that, despite protestations, the Conservatives do not really believe in the founding principles of the NHS. 

For years under different guises, whether it be the ‘right to choose’ or ‘patient passports’  they have looked for ways of privatising health care rather than promoting quality local health care services free at the point of delivery.

CONCLUSION

What I have been proposing here is a clear set of policy and management changes for improving our national health service. 

The Liberal Democrat purpose is clear. 

To create a modern, efficient and effective health service which is properly staff and securely funded.
A health service where prevention is as important as cure.
A health service where all waits matter and swift diagnosis and treatment count.
A health service where quality services are delivered closer to home.
A health service true to Beveridge’s ideals, in tune with today’s needs.

I believe that is what many people in this country also want.

Thank you.