Sunday, 23 September 2007

David Cameron on the NHS

This time last year I had a simple message for our Party Conference. I said I could explain my personal priority not in three words, as Tony Blair once did, but in three letters: NHS.

Since then, we have been translating that commitment into action.

Over the Spring and Summer, we campaigned with junior doctors who have been let down disgracefully by the shambles of their new medical training programme.

We have published the report from the Public Services Policy Group, and Andrew Lansley’s NHS White Paper – both of which contained specific proposals to improve the NHS.

And in August we stepped up our campaign over the future of district general hospitals.

No one should be under any illusion on the scale of closures and cut-backs the NHS faces. At least 29 hospitals face the closure or downgrading of either maternity units or A&E units - or, in some cases, both. Gordon Brown’s new health minister, Lord Darzi, has said that “the days of the district general hospital are over.”

Yet where is the evidence to support such an approach?

In the case of A&E, only 2 per cent of attendances need the highest level of specialist care. These cases should either be taken straight to a specialist centre or stabilised at a local A&E and then transferred.

Downgrading the local A&E unit won’t help these people. And it will mean that the other 98 per cent of attendances will have to travel further.

Yet recent research demonstrated that every extra six miles a patient has to travel to an A&E unit adds one per cent to the chance that they will die before reaching hospital.

In the case of maternity units, the Government can point to no clear published evidence to suggest that small consultant-led units have worse outcomes than larger units. Indeed, many parents opt for smaller units, because they appreciate what can often be a calmer atmosphere and more personal service.

This is presumably why some ministers appeared on picket lines claiming they were trying to help “save” their own local services – from themselves.

It is little wonder that even Gordon Brown’s own health adviser, Derek Wanless, recently questioned the Government’s approach on hospital reconfiguration – saying “question marks remain” over the “robustness” of the evidence it is using.

I think two factors are really behind these cutbacks.

The first is the dire financial situation in which many hospitals now find themselves – not through their own mismanagement, but as a result of the poorly negotiated GP and consultant contracts, the botched NHS computer, the Government’s endless costly reorganisations, and the red tape which results from Gordon Brown’s target regime.

Quite simply, local health services are paying the price for central government incompetence.

The second driver of these reconfigurations arises from the way doctors are trained, and the requirements of the EU Working Time Directive. In my view these are not legitimate reasons to cut local services.

We have set out five steps to stop the cuts.

First, there should be an immediate moratorium on closures to allow breathing space for the right changes to be put in place.

Next, we should scrap the top-down targets that have added so much cost to local NHS services.

Third, it is time for the Government to take action and delay implementation of the Working Time Directive, as it is permitted to do, and seek to amend the Directive so that it affects the NHS no more adversely than the majority of other European health care systems - as it has tried, but failed, to do.

We need to put GPs in the driving seat of the NHS, commissioning care on behalf of their patients - and thereby ensuring that services are driven by their needs rather than by the diktats of central government.

Finally, we need to give real freedom to hospitals and their clinicians to determine how to deliver services, including allowing them to work with colleagues in neighbouring hospitals to provide the relevant specialisms.

These steps illustrate the simple divide between the parties.

On the one hand, there is Labour’s top-down central control, seen in the blueprints for hospital reorganisation which they continue to impose from on high.

On the other, there is our tangible commitment to real devolution – seen in our commitment to empower GPs.

The NHS will be a vital issue at the next election. And, as in so many areas, there is a battle between Labour’s belief in state control, and the social responsibility and devolution of power which lies at the heart of the modern Conservative approach.

This is a battle we can and must win

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